In this study, recently published in the New England Journal of Medicine, the authors report the neurologic features in an observational series of 58 of 64 consecutive patients admitted to two intensive care units (ICUs) in Strasbourg, France, because of acute respiratory distress syndrome due to Covid-19 infection. Neurologic findings were recorded in 8 of the 58 patients (14%) on admission to the ICU (before treatment) and in 39 patients (67%) when sedation and a neuromuscular blocker were withheld. In particular, agitation was present in 40 patients (69%) when neuromuscular blockade was discontinued. A total of 26 of 40 patients were noted to have confusion according to the Confusion Assessment Method for the ICU. Diffuse corticospinal tract signs were present in 39 patients (67%). The 33% (15 of 45) of the patients who had been discharged had a dysexecutive syndrome consisting of inattention, disorientation, or poorly organized movements in response to command. Brain MRI was performed in 13 patients due to the presence of unexplained encephalopathic features. Interestingly, enhancement in leptomeningeal spaces was noted in 8 patients while bilateral frontotemporal hypoperfusion was noted in all 11 patients who underwent perfusion imaging. Two asymptomatic patients each had a small acute ischemic stroke and one patient had a subacute ischemic stroke. Electroencephalograph showed only nonspecific changes while RT-PCR assays of the cerebrospinal fluid samples obtained from 7 patients was negative for SARS-CoV-2. The authors concluded that data are lacking to determine which of the neurological features emerged in this consecutive series of patients were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.
https://www.nejm.org/doi/full/10.1056/NEJMc2008597
by Marialuisa Zedde and Francesco Cavallieri
