Background and Aims:

The number of cases of encephalitis in COVID-19 pandemic is increasing. We describe characteristics and outcome of encephalitis in COVID-19 (COV-ENC) patients in one of the most affected regions by COVID-19 of the world, Lombardia, during the first pandemic wave.

Methods:

A multi-center observational study on neurological complications in COVID-19 patients was conducted by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to 20 Neurological Departments in Lombardia between February-April 2020 with COV-ENC have been included.

Results:

30 COV-ENC patients had a mean age of 66.5 years and male frequency of 56.6%. Altered consciousness was characterized by confusion in 86%, coma in 30%, delirium in 37.9% and alteration of personality traits in 27.6%. Epileptic seizures occurred in 74% of cases. One third of cases had hyperproteinorrachia, one third pleocytosis/hyperproteinorrachia, and remaining third had a normal CSF. PCR for SARS-CoV-2 was negative in all tested patients. EEG was altered in 82.7% of patients. Brain CT and MRI were normal in 9 patients, and among abnormal findings 9 patients had mesial temporal lesions, one of which confirmed with PET imaging. The course was favorable in 39.2% of patients, sequelae were few in 26.6% and moderate in 19.2%, while 20% of patients died.

Conclusions:

The outcome tends to be worse in male patients. PCR negativity seems to confirm an autoimmune etiology more than a direct invasion of the virus. However, a temporal lobe involvement, detected in 30% of patients with COV-ENC, suggests usual sites of encephalitis due to herpes virus.

Background and Aims:

Several studies reported increased incidence of Guillain-Barre’ Syndrome (GBS) after Zika
epidemic, SARS-CoV and MERS, and more recently SARS-CoV-2 infection. We estimate
incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients in
one of the most affected regions by COVID-19 of the world, Lombardia.

Methods:

A multi-center observational study on neurological complications in COVID-19 patients was conducted in 20 Neurology Departments by the Italian society of Hospital Neuroscience (SNO). Adult patients admitted to Neurological units between February-April 2020 with COVID19-GBS were included.

Results:

38 COVID19-GBS patients had mean age of 60.7 years and male frequency of 86.8%. Mean interval between COVID-19 onset and GBS onset was 15.1 days. CSF albuminocytologic dissociation was detected in 71.4% of cases, PCR for SARS-CoV-2 negative in all 15 tested patients, and anti-ganglioside antibodies positive in 43.7%. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP diagnosis, 12.1% AMSAN and 6% AMAN. 29 patients have been treated with intravenous Immunoglobulin (IVIg), 2 with plasma exchange (PE), 2 with PE followed by IVIg and 5 untreated. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.1% worsened, of which 3 died. The estimated occurrence rate in Lombardia is 0.5 GBS cases per 1000 COVID-19 infections.

Conclusions:

We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients or be secondary to a higher seroprevalence of COVID-19 in this geographic area during the first pandemic wave.

Background and Aims:

Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis.

Methods:

Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1^st 2020 and March 30^th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded.

Results:

Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis.

Conclusions:

Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.

Background and Aims:

Single cases and series of Guillain-Barré syndrome (GBS) were reported during the SARS-CoV-2 outbreak worldwide. We aimed to evaluate the incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of COVID-19 patients.

Methods:

GBS cases diagnosed in 12 referral hospitals in March and April 2020 were retrospectively collected. As a control population, GBS patients diagnosed in March and April 2019 in the same hospitals were considered.

Results:

Incidence of GBS in March and April 2020 was 0.202/100,000 per month (estimated rate 2.43/100.000 per year; C.I. 0.140-0.282) versus 0.077/100.000 per month (estimated rate 0.93/100.000 per year; C.I.: 0.041-0.132) in March and April 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19 positive patients was 47.9/100,000 and in the COVID-19 positive hospitalized patients was 236/100,000.

COVID-positive GBS were compared with COVID-negative patients and a higher frequency of demyelinating subtype (AIDP) (76.6% vs 35.3%; p. 0.005), a lower MRC sum score (26.33 +/- 18.31 vs 41.41 +/- 14.85; p 0.006) and more frequent admission to ICU (66.6% vs 17.6%; p 0.002) were observed.

Conclusions:

This study shows an increased incidence of GBS during the first COVID-19 wave in northern Italy. This might not be unexpected considering that GBS is unanimously considered a post-infectious disease with several new infectious agents even recently added as possible trigger for GBS, including Zika and Hepatitis E viruses. We suggested that a correlation might exist between the COVID-19 and the increase in GBS incidence.