Antonio Cagnana (Italy)
Ospedale Maggiore U.O. NeurologiaAuthor Of 2 Presentations
CLINICAL, NEUROPHYSIOLOGICAL AND NEURORADIOLOGICAL CHARACTERISTICS OF SARS-COV-2-ASSOCIATED ENCEPHALITIS IN LOMBARDIA
- Filippo G. Martinelli Boneschi (Italy)
Abstract
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.
COVID-19-ASSOCIATED GUILLAIN-BARRÉ SYNDROME IN THE FIRST WAVE OF COVID-19 PANDEMIC IN LOMBARDIA: INCREASED INCIDENCE OR INCREASED SEROPREVALENCE?
- Filippo G. Martinelli Boneschi (Italy)
Abstract
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.