Utilization of diagnostic testing for COVID-19 patients suffering from encephalopathy

Objective: To assess frequency of utilization of advanced diagnostic testing in COVID-19 patients with encephalopathy, incidence of serious complication, and outcomes. Background: Extensive literature and clinical experience suggest a high rate of neurologic complications for COVID-19, especially encephalopathy, but also complications associated with significant morbidity such as ischemic stroke and encephalitis. However, not much literature has yet examined the utility of advanced diagnostic testing resources in COVID-19 associated encephalopathy in identifying such complications. We present a retrospective case series of patients with encephalopathy during COVID-19 infection, diagnostic test results and associated outcomes. Design/Methods: Cases were reviewed from inpatient neurologic consultations at two associated hospital sites from 2019-2020. In total, 47 COVID-19 cases of encephalopathy from March through May of 2020 were retrospectively reviewed. A control group of 20 cases was retrospectively randomly selected from QI records from 2019-2020. All cases were reviewed for utilization of diagnostic testing including CT, MRI, EEG, lumbar puncture (LP), as well as outcome at discharge. Results: The incidence of serious neurologic complication was found in a much higher frequency on MRI and EEG diagnostic testing in patients with encephalopathy and COVID-19, compared with controls (24% and 11% respectively, vs 9% and 0%). CSF results were obtained in 6 COVID- 19 cases and 0 had diagnostic results or markers of illness. We conclude that MRI and EEG are of significant utility in the evaluation of COVID-19 encephalopathy in spite of logistical challenges in obtaining the studies. More research is needed for COVID-19 associated encephalopathy, including advancing reliability of COVID-19 detection in CSF. Conclusions: In conclusion, MRI and EEG are of significant utility in the evaluation of COVID-19 encephalopathy in spite of logistical challenges in obtaining the studies during the height of pandemic. More research is needed for COVID-19 associated encephalopathy, including advancing reliability of COVID-19 detection in CSF.