Table 2.
Demographics, clinical features, investigations, management, and outcomes in the COVID-19 neurology group by condition subgroup
|
Recognised neuroimmune condition subgroup (n=13) |
Other neurological disorder subgroup (n=14) |
|||||||
|---|---|---|---|---|---|---|---|---|
| Acute demyelinating syndromes (n=7) | GBS (n=5) | Limbic encephalitis (n=1) | Severe encephalopathy (n=9) | Psychiatric disorder (n=2) | Movement disorder (n=2) | Cerebrovascular disorder (n=1) | ||
| Age, years | 5 (1–10) | 6 (1–14) | 4 | 11 (2–16) | 12 (10–14) | 12 (9–14) | 10 | |
| Sex | ||||||||
| Female | 3 (43%) | 2 (40%) | 0 | 3 (33%) | 1 (50%) | 1 (50%) | 0 | |
| Male | 4 (57%) | 3 (60%) | 1 (100%) | 6 (67%) | 1 (50%) | 1 (50%) | 1 (100%) | |
| Ethnicity | ||||||||
| White | 2 (29%) | 2 (40%) | 1 (100%) | 5 (56%) | 0 | 2 (100%) | 1 (100%) | |
| Black | 1 (14%) | 1 (20%) | 0 | 2 (22%) | 2 (100%) | 0 | 0 | |
| Asian | 4 (57%) | 2 (40%) | 0 | 2 (22%) | 0 | 0 | 0 | |
| Underlying comorbidity | ||||||||
| Neurological comorbidities | 1 (14%) | 2 (40%) | 0 | 4 (44%) | 0 | 0 | 1 (100%) | |
| Other comorbidities | 1 (14%) | 0 | 0 | 0 | 0 | 0 | 0 | |
| Clinical features | ||||||||
| Systemic features* | 6 (86%) | 3 (60%) | 0 | 6 (67%) | 0 | 0 | 0 | |
| Respiratory involvement at presentation | 2 (29%) | 2 (40%) | 0 | 1 (11%) | 1 (50%) | 0 | 0 | |
| Encephalopathy | 4 (57%) | 0 | 1 (100%) | 9 (100%) | 0 | 0 | 0 | |
| Seizures | 0 | 0 | 1 (100%) | 7 (78%) | 0 | 0 | 0 | |
| Headache or meningism | 2 (29%) | 1 (20%) | 0 | 1 (11%) | 0 | 0 | 0 | |
| Peripheral nervous system involvement | 0 | 5 (100%) | 0 | 0 | 0 | 2 (100%) | 0 | |
| Focal CNS involvement | 3 (43%) | 0 | 0 | 0 | 0 | 0 | 1 (100%) | |
| Behavioural change | 0 | 0 | 1 (100%) | 0 | 2 (100%) | 0 | 0 | |
| Hallucinations | 0 | 0 | 0 | 0 | 1 (50%) | 0 | 0 | |
| Recognised para-infectious or post-infectious neurological disease | 7 (100%) | 5 (100%) | 1 (100%) | 0 | 0 | 0 | 0 | |
| Investigations | ||||||||
| SARS-CoV-2 PCR positive | 5 (71%) | 4 (80%) | 1 (100%) | 9 (100%) | 1 (50%) | 0 | 1 (50%) | |
| SARS-CoV2- IgG positive | 3 (43%) | 1 (20%) | 1 (100%) | 4 (44%) | 2 (100%) | 2 (100%) | NP | |
| C-reactive protein, mg/L | 12 (0–42) | 1 (1–2) | 1 | 1 (0–158) | 9 (5–12) | 0 | NP | |
| Elevated acute-phase reactants† | 2 (29%) | 0 | 0 | 1 (11%) | 0 | 0 | NP | |
| Plasma white cell count, cells per μL | 10·0 (4·0–27·3) | 11·0 (7·0–18·0) | 7·5 | 9·4 (4·0–11·6) | 7·5 (4·0–10·5) | 6·3 (5·3–7·3) | NP | |
| CSF white cell count >5 cells per μL | 5 (71%) | 1 (20%) | 1 (100%) | 1 (11%) | 1 (50%) | NP | NP | |
| Abnormal neuroimaging | 7 (100%) | 2 (40%) | 1 (100%) | 2/8 (25%) | 0 | 0 | 0 | |
| Treatment | ||||||||
| PICU admission | 2 (29%) | 1 (20%) | 0 | 5 (56%) | 0 | 0 | 0 | |
| Inotropic support | 0 | 0 | 0 | 0 | 0 | 0 | ||
| Immunomodulation | 6 (86%)‡ | 4 (80%) | 1 (100%) | 2 (22%) | 0 | 0 | 0 | |
| Outcome | ||||||||
| Disability§ | 4 (57%) | 2 (40%) | 0 | 1 (11%) | 1 (50%) | 1 (50%) | 0 | |
| Death | 0 | 0 | 0 | 0 | 0 | 0 | 0 | |
Data are n (%) or median (range). GBS=Guillain-Barré syndrome. NP=not performed. CSF=cerebrospinal fluid. PICU=paediatric intensive care unit.
*
Systemic features were fever, shock, hypotension, or rash.
†
Combined acute-phase reactants were defined as lactate dehydrogenase, ferritin, and D-dimers.
‡
One patient did not receive immunomodulation because of underlying malignancy.
§
Disability was defined as a modified Rankin scale score of 2–5.