Stéphane Kremer, François Lersy, Mathieu Anheim, Hamid Merdji, Maleka Schenck, Hélène Oesterlé, Federico Bolognini, Julien Messie, Antoine Khalil, Augustin Gaudemer, Sophie Carré, Manel Alleg, Claire Lecocq, Emmanuelle Schmitt, René Anxionnat,  View ORCID ProfileFrançois Zhu, Lavinia Jager, Patrick Nesser, Yannick Talla Mba, Ghazi Hmeydia,  View ORCID ProfileJoseph Benzakoun, Catherine Oppenheim, Jean-Christophe Ferré, Adel Maamar, Béatrice Carsin-Nicol,  View ORCID ProfilePierre-Olivier Comby, Frédéric Ricolfi, Pierre Thouant,  View ORCID ProfileClaire Boutet, Xavier Fabre,  View ORCID ProfileGéraud Forestier, Isaure de Beaurepaire, Grégoire Bornet, Hubert Desal,  View ORCID ProfileGrégoire Boulouis, Jérome Berge, Apolline Kazémi, Nadya Pyatigorskaya, Augustin Lecler, Suzana Saleme, Myriam Edjlali-Goujon, Basile Kerleroux, Jean-Marc Constans, Pierre-Emmanuel Zorn, Muriel Mathieu,  View ORCID ProfileSeyyid Baloglu,  View ORCID ProfileFrançois-Daniel Ardellier, Thibault Willaume,  View ORCID ProfileJean-Christophe Brisset, Sophie Caillard, Olivier Collange, Paul Michel Mertes, Francis Schneider, Samira Fafi-Kremer,  View ORCID ProfileMickael Ohana, Ferhat Meziani, Nicolas Meyer, Julie Helms,  View ORCID ProfileFrançois CottonFirst published July 17, 2020, DOI: https://doi.org/10.1212/WNL.0000000000010112

Objective To describe neuroimaging findings and to report the epidemiologic and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with neurologic manifestations.

Methods In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI.

Results The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20–92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome (p = 0.006) and more frequently had corticospinal tract signs (p = 0.02). Patients with encephalitis were younger (p = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement (p = 0.009).

Conclusions Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF.

Methods In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI.

Results The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20–92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome (p = 0.006) and more frequently had corticospinal tract signs (p = 0.02). Patients with encephalitis were younger (p = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement (p = 0.009).

Conclusions Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF.