What are the Neurological and Neuropsychiatric Complications of COVID-19?

These were evaluated in 153 patients within a UK-wide surveillance study by Varatharaj and others published in The Lancet Psychiatry June 25, 2020. 

There is increased concern regarding potential neurological complications of COVID-19. 

This group developed an online network of secure rapid-response case reporting across a spectrum of major UK neuroscience bodies, including the Association of British Neurologists and the Royal College of Psychiatrists and others.  They presented neurology, stroke, psychiatry and intensive care. 

They classified broad clinical syndromes associated with COVID-19 as:

  • Cerebrovascular event

Defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space.

  • Altered mental state

Defined as an acute alteration in personality, behaviour, cognition, or consciousness.

  • Peripheral neurology

Defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle

  • Other

The physicians from these groups were encouraged to report cases prospectively.  Recent cases were to be notified retrospectively.

153 unique cases met the clinical case definitions with an exponential growth in reported cases that was similar to overall COVID-19 data.

The median patient age was 71.

Complete clinical datasets were available for 125, that is 82% of the 153 patients. 

77, 62% of 125 patients presented with a cerebrovascular event of whom 57, 74%, had an ischaemic stroke, 9, 12% an intracerebral haemorrhage, and 1, 1% CNS vasculitis. 

39, 31% of 125 patients presented with altered mental status comprising 9, 23% patients with unspecified encephalopathy and 7, 18% patients with encephalitis.

The remaining 23, 59% patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnosis as classified by the notifying psychiatrist or neuropsychiatrist, and 21, 92% of these were new diagnoses. 

10, 43% of 23 patients with neuropsychiatric disorders had new-onset psychosis.  6, 26% had a neurocognitive dementia-like syndrome, and 4, 17% had an affective disorder. 

18, 49% of 37 patients with altered mental status were younger than 60 and 19, 51% were older than 60, whereas 13, 18% of 74 patients with a cerebrovascular event were younger than 60 versus 61, 82% patients older than 60 years.

They concluded cerebrovascular events were the most common presentation particularly in an older age group. 

Altered mental status was the second most common presentation comprising encephalopathy or encephalitis and primary psychiatric diagnoses, and this often occurred in younger patients.

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