Acute Encephalopathy in COVID-19 patients Early Experience from an Inner-City Hospital

Objective: We aim to investigate the prevalence, characteristics and outcomes of COVID-19 patients with encephalopathy. Other neurological manifestations of COVID-19 were described. Background: SARS-CoV-2 has rapidly spread worldwide and has now affected more than 30 million people. Although respiratory symptoms are the primary clinical manifestations of COVID-19, neurological manifestations of COVID-19 are increasingly recognized. Encephalopathy is reported as a common neurological presentation of COVID-19. The characteristics of patients with COVID-19 associated encephalopathy, including potential confounding toxic/metabolic/hypoxic factors has not been explored. Design/Methods: We retrospectively reviewed all patients consulted to the neurology service at the Detroit Medical Centre, from March 3 , 2020 to May 1 2020 who were tested positive for SARS-COV2. Clinical and laboratory data were recorded. Characteristics of encephalopathic COVID-19 patients with or without confounders were compared. Statistical analysis was performed using SPSS. Results: 49 patients were included, 40 patients (81.6%) had encephalopathy, of whom 21 patients (52.5%) had no confounders. Most common confounders were hypoxia and uremia. Patients with confounders were more likely to have dementia at baseline (p=0.049), significantly elevated inflammatory markers-C-reactive protein (P=0.02), white blood cell count(p=0.019), Ddimer(p=0.015). They were also less likely to be discharged home (p=0.009). Overall mortality is high in patient with encephalopathy (65%). 5 patients had embolic strokes, 5 had new onset seizures and 2 patients had pleocytosis on cerebrospinal fluid examination. Conclusions: We found a high prevalence of COVID-19 associated encephalopathy, independent of confounders. COVID-19 associated encephalopathy can be attributed to stroke, seizure, meningoencephalitis or idiopathic. This early report is part of an ongoing study with a larger cohort of all COVID-19 patients that continue to be admitted to our center to investigate underlying etiological mechanisms of encephalopathy, including long-term follow up of these patients.