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Lambrecq V, Hanin A, Munoz-Musat E, Chougar L, Gassama S, Delorme C, Cousyn L, Borden A, Damiano M, Frazzini V, Huberfeld G, Landgraf F, Nguyen-Michel VH, Pichit P, Sangare A, Chavez M, Morélot-Panzini C, Morawiec E, Raux M, Luyt CE, Rufat P, Galanaud D, Corvol JC, Lubetzki C, Rohaut B, Demeret S, Pyatigorskaya N, Naccache L, Navarro V. Association of Clinical, Biological, and Brain Magnetic Resonance Imaging Findings With Electroencephalographic Findings for Patients With COVID-19. JAMA Netw Open 2021; 4:e211489. [PMID: 33720371 PMCID: PMC7961310 DOI: 10.1001/jamanetworkopen.2021.1489] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
Importance There is evidence of central nervous system impairments associated with coronavirus disease 2019 (COVID-19) infection, including encephalopathy. Multimodal monitoring of patients with COVID-19 may delineate the specific features of COVID-19-related encephalopathy and guide clinical management. Objectives To investigate clinical, biological, and brain magnetic resonance imaging (MRI) findings in association with electroencephalographic (EEG) features for patients with COVID-19, and to better refine the features of COVID-19-related encephalopathy. Design, Setting, and Participants This retrospective cohort study conducted in Pitié-Salpêtrière Hospital, Paris, France, enrolled 78 hospitalized adults who received a diagnosis of severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) and underwent EEG between March 30 and June 11, 2020. Exposures Detection of SARS-CoV-2 from a nasopharyngeal specimen using a reverse transcription-polymerase chain reaction assay or, in the case of associated pneumonia, on a computed tomography scan of the chest. Main Outcomes and Measures Data on the clinical and paraclinical features of the 78 patients with COVID-19 were retrieved from electronic patient records. Results Of 644 patients who were hospitalized for COVID-19, 78 (57 men [73%]; mean [SD] age, 61 [12] years) underwent EEG. The main indications for EEG were delirium, seizure-like events, and delayed awakening in the intensive care unit after stopping treatment with sedatives. Sixty-nine patients showed pathologic EEG findings, including metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities. Of 57 patients who underwent brain MRI, 41 showed abnormalities, including perfusion abnormalities, acute ischemic lesions, multiple microhemorrhages, and white matter-enhancing lesions. Fifty-five patients showed biological abnormalities, including dysnatremia, kidney failure, and liver dysfunction, the same day as the EEG. The results of cerebrospinal fluid analysis were negative for SARS-Cov-2 for all tested patients. Nine patients who had no identifiable cause of brain injury outside COVID-19 were further isolated; their brain injury was defined as COVID-19-related encephalopathy. They represented 1% (9 of 644) of patients with COVID-19 requiring hospitalization. Six of these 9 patients had movement disorders, 7 had frontal syndrome, 4 had brainstem impairment, 4 had periodic EEG discharges, and 3 had MRI white matter-enhancing lesions. Conclusions and Relevance The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy.
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Affiliation(s)
- Virginie Lambrecq
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Aurélie Hanin
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
| | - Esteban Munoz-Musat
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Lydia Chougar
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Neuroradiology Department, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Salimata Gassama
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Cécile Delorme
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Louis Cousyn
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
| | - Alaina Borden
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Maria Damiano
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Valerio Frazzini
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Gilles Huberfeld
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Frank Landgraf
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Vi-Huong Nguyen-Michel
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Phintip Pichit
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Aude Sangare
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Mario Chavez
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
| | - Capucine Morélot-Panzini
- Service de Pneumologie, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Service de Pneumologie, Médecine Intensive et Réanimation, Pitié-Salpêtrière Hospital, Paris, France
| | - Elise Morawiec
- Service de Pneumologie, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Service de Pneumologie, Médecine Intensive et Réanimation, Pitié-Salpêtrière Hospital, Paris, France
| | - Mathieu Raux
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Department of Anesthesia, Critical Care and Peri-Operative Medicine, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Department of Anesthesia, Critical Care and Peri-Operative Medicine, Pitié-Salpêtrière Hospital, Paris, France
| | - Charles-Edouard Luyt
- Institut de Cardiologie, Sorbonne Université, Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche, 1166–Institute of Cardiometabolism and Nutrition, Paris, France
- Assistance Publique des Hôpitaux de Paris, Service de Médecine Intensive Réanimation, Institut de Cardiologie, Pitié-Salpêtrière Hospital, Paris, France
| | - Pierre Rufat
- Assistance Publique des Hôpitaux de Paris, Biostatistic Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Damien Galanaud
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Neuroradiology Department, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Jean-Christophe Corvol
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Catherine Lubetzki
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
| | - Benjamin Rohaut
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
| | - Sophie Demeret
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Nadya Pyatigorskaya
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Neuroradiology Department, Sorbonne Université, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neuroradiology Department, Pitié-Salpêtrière Hospital, Paris, France
| | - Lionel Naccache
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurophysiology Department, Sorbonne Université, Paris, France
| | - Vincent Navarro
- Sorbonne Université, Paris Brain Institute, Institut du Cerveau, Institut National de la Santé et de la Recherche Médicale U 1127, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 7225, Paris, France
- Assistance Publique des Hôpitaux de Paris, Clinical Neurophysiology Department, Pitié-Salpêtrière Hospital, Paris, France
- Assistance Publique des Hôpitaux de Paris, Neurology Department, Pitié-Salpêtrière Hospital, Paris, France
- Neurology Department, Sorbonne Université, Paris, France
- Center of Reference for Rare Epilepsies, Pitié-Salpêtrière Hospital, Paris, France
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Vellieux G, Sonneville R, Vledouts S, Jaquet P, Rouvel-Tallec A, d’Ortho MP. COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature. Front Physiol 2021; 11:622466. [PMID: 33679425 PMCID: PMC7933549 DOI: 10.3389/fphys.2020.622466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the end of year 2019 and is currently responsive for coronavirus infectious disease 2019 (COVID-19). The first reports considered COVID-19 as a respiratory tract disease responsible for pneumonia, but numerous studies rapidly emerged to warn the medical community of COVID-19-associated neurological manifestations, including encephalopathy at the acute phase and other postinfectious manifestations. Using standard visual analysis or spectral analysis, recent studies reported electroencephalographic (EEG) findings of COVID-19 patients with various neurological symptoms. Most EEG recordings were normal or revealed non-specific abnormalities, such as focal or generalized slowing, interictal epileptic figures, seizures, or status epilepticus. Interestingly, novel EEG abnormalities over frontal areas were also described at the acute phase. Underlying mechanisms leading to brain injury in COVID-19 are still unknown and matters of debate. These frontal EEG abnormalities could emphasize the hypothesis whereby SARS-CoV-2 enters the central nervous system (CNS) through olfactory structures and then spreads in CNS via frontal lobes. This hypothesis is reinforced by the presence of anosmia in a significant proportion of COVID-19 patients and by neuroimaging studies confirming orbitofrontal abnormalities. COVID-19 represents a new viral disease characterized by not only respiratory symptoms but also a systemic invasion associated with extra-respiratory signs. Neurological symptoms must be the focus of our attention, and functional brain evaluation with EEG is crucial, in combination with anatomical and functional brain imaging, to better understand its pathophysiology. Evolution of symptoms together with EEG patterns at the distance of the acute episode should also be scrutinized.
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Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Sérafima Vledouts
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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