Increasingly, concerns regarding potential neurological complications of COVID-19 are being reported, mostly in small series. Larger studies have been limited by both geography and specialty. Consequently, the breadth of complications is not represented. Comprehensive characterisation of clinical syndromes is critical to rationally select and evaluate potential therapies.
During the exponential pandemic phase, we developed coordinated online portals for rapid notification across the spectrum of major UK neuroscience bodies, representing neurology, stroke, psychiatry, and intensive care. Evidence of infection and clinical case definitions were applied prospectively. Cases were compared to overall Government Public Health COVID-19 reporting.
The notification portals were live from 2nd April for ABN, 3rd April for BASP and 21st April for RCPsych, and data lock for this report was the 26th April 2020. During this period, 153 cases were notified, from across the UK and with an exponential growth in reported cases which correlated with the same period of exponential growth as overall COVID-19 Public Health report data. Median (range) age was 71 (23-94) years. Complete clinical data for Clinical Case Definitions were available for 125 patients. Of whom 77/125 (62%) had a cerebrovascular event, of whom 57/77 (74%) had ischemic strokes, nine (12%) intracerebral haemorrhages, and one clinical diagnosis of CNS vasculitis. The second most common group were 39/125 (31%) who had altered mental status, including nine/39 (23%) with encephalopathy and seven (18%) with encephalitis. The remaining 23/39 (59%) had a psychiatric diagnosis of whom 21/23 (92%) were new diagnoses. Of these psychiatric diagnoses, ten/23 (43%) were psychosis, six (26%) neurocognitive (dementialike) syndrome, and four (17%) an affective disorder. Of cases with altered mental status, 18 (49%) were under 60 and 19 (51%) were over 60; whereas 13 (18%) cases of cerebrovascular events were under 60 relative to 61 (82%) cases in those over 60 years old (p=0.001).
This is the first nationwide, cross-specialty surveillance study of acute complications of COVID-19 in the nervous system. Alteration in mental status was common, reflecting encephalopathy/encephalitis and primary psychiatric diagnoses, often in young patients. These data provide valuable and timely information urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy throughout the areas of neurology and neuropsychiatry