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Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study
Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study

Background:

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

Methods:

During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

Findings:

The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.

Interpretation:

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy. Funding: None.

2215-0366
875-882
Varatharaj, Aravinthan
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Thomas, Naomi
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Ellul, Mark A.
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Davies, Nicholas W.S.
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Pollack, Thomas A.
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Tenorio, Elizabeth L
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Sultan, Mustafa
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Easton, Ava
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Breen, Gerome
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Zandi, Michael
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Coles, Jonathan P.
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Manji, Hadi
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Al-Shahi Salman, Rustam
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Menon, David K.
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Nicholson, Timothy R.
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Benjamin, Laura A.
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Carson, Alan
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Smith, Craig
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Turner, Martin R.
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Solomon, Tom
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Kneen, Rachel
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Pett, Sarah L.
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Galea, Ian
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Thomas, Rhys H.
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Michael, Benedict D.
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CoroNerve Study Group
Varatharaj, Aravinthan
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Thomas, Naomi
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Ellul, Mark A.
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Davies, Nicholas W.S.
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Pollack, Thomas A.
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Tenorio, Elizabeth L
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Sultan, Mustafa
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Easton, Ava
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Breen, Gerome
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Zandi, Michael
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Coles, Jonathan P.
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Manji, Hadi
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Al-Shahi Salman, Rustam
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Menon, David K.
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Nicholson, Timothy R.
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Benjamin, Laura A.
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Carson, Alan
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Smith, Craig
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Turner, Martin R.
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Solomon, Tom
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Kneen, Rachel
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Pett, Sarah L.
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Galea, Ian
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Thomas, Rhys H.
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Michael, Benedict D.
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Varatharaj, Aravinthan, Thomas, Naomi, Ellul, Mark A., Davies, Nicholas W.S., Pollack, Thomas A., Tenorio, Elizabeth L, Sultan, Mustafa, Easton, Ava, Breen, Gerome, Zandi, Michael, Coles, Jonathan P., Manji, Hadi, Al-Shahi Salman, Rustam, Menon, David K., Nicholson, Timothy R., Benjamin, Laura A., Carson, Alan, Smith, Craig, Turner, Martin R., Solomon, Tom, Kneen, Rachel, Pett, Sarah L., Galea, Ian, Thomas, Rhys H. and Michael, Benedict D. , CoroNerve Study Group (2020) Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry, 7 (10), 875-882. (doi:10.1016/S2215-0366(20)30287-X).

Record type: Article

Abstract

Background:

Concerns regarding potential neurological complications of COVID-19 are being increasingly reported, primarily in small series. Larger studies have been limited by both geography and specialty. Comprehensive characterisation of clinical syndromes is crucial to allow rational selection and evaluation of potential therapies. The aim of this study was to investigate the breadth of complications of COVID-19 across the UK that affected the brain.

Methods:

During the exponential phase of the pandemic, we developed an online network of secure rapid-response case report notification portals across the spectrum of major UK neuroscience bodies, comprising the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), and the Royal College of Psychiatrists (RCPsych), and representing neurology, stroke, psychiatry, and intensive care. Broad clinical syndromes associated with COVID-19 were classified as a cerebrovascular event (defined as an acute ischaemic, haemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (defined as an acute alteration in personality, behaviour, cognition, or consciousness), peripheral neurology (defined as involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other (with free text boxes for those not meeting these syndromic presentations). Physicians were encouraged to report cases prospectively and we permitted recent cases to be notified retrospectively when assigned a confirmed date of admission or initial clinical assessment, allowing identification of cases that occurred before notification portals were available. Data collected were compared with the geographical, demographic, and temporal presentation of overall cases of COVID-19 as reported by UK Government public health bodies.

Findings:

The ABN portal was launched on April 2, 2020, the BASP portal on April 3, 2020, and the RCPsych portal on April 21, 2020. Data lock for this report was on April 26, 2020. During this period, the platforms received notification of 153 unique cases that met the clinical case definitions by clinicians in the UK, with an exponential growth in reported cases that was similar to overall COVID-19 data from UK Government public health bodies. Median patient age was 71 years (range 23–94; IQR 58–79). Complete clinical datasets were available for 125 (82%) of 153 patients. 77 (62%) of 125 patients presented with a cerebrovascular event, of whom 57 (74%) had an ischaemic stroke, nine (12%) an intracerebral haemorrhage, and one (1%) CNS vasculitis. 39 (31%) of 125 patients presented with altered mental status, comprising nine (23%) patients with unspecified encephalopathy and seven (18%) patients with encephalitis. The remaining 23 (59%) patients with altered mental status fulfilled the clinical case definitions for psychiatric diagnoses as classified by the notifying psychiatrist or neuropsychiatrist, and 21 (92%) of these were new diagnoses. Ten (43%) of 23 patients with neuropsychiatric disorders had new-onset psychosis, six (26%) had a neurocognitive (dementia-like) syndrome, and four (17%) had an affective disorder. 18 (49%) of 37 patients with altered mental status were younger than 60 years and 19 (51%) were older than 60 years, whereas 13 (18%) of 74 patients with cerebrovascular events were younger than 60 years versus 61 (82%) patients older than 60 years.

Interpretation:

To our knowledge, this is the first nationwide, cross-specialty surveillance study of acute neurological and psychiatric complications of COVID-19. Altered mental status was the second most common presentation, comprising encephalopathy or encephalitis and primary psychiatric diagnoses, often occurring in younger patients. This study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy. Funding: None.

Text
Varatharaj et al 2020 postprint - Accepted Manuscript
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More information

Accepted/In Press date: 4 June 2020
e-pub ahead of print date: 25 June 2020
Published date: October 2020

Identifiers

Local EPrints ID: 441468
URI: http://eprints.soton.ac.uk/id/eprint/441468
ISSN: 2215-0366
PURE UUID: 331559dd-6b1e-401d-b7b4-b5936860450b
ORCID for Aravinthan Varatharaj: ORCID iD orcid.org/0000-0003-1629-5774
ORCID for Ian Galea: ORCID iD orcid.org/0000-0002-1268-5102

Catalogue record

Date deposited: 15 Jun 2020 16:30
Last modified: 13 Nov 2021 05:29

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Contributors

Author: Naomi Thomas
Author: Mark A. Ellul
Author: Nicholas W.S. Davies
Author: Thomas A. Pollack
Author: Elizabeth L Tenorio
Author: Mustafa Sultan
Author: Ava Easton
Author: Gerome Breen
Author: Michael Zandi
Author: Jonathan P. Coles
Author: Hadi Manji
Author: Rustam Al-Shahi Salman
Author: David K. Menon
Author: Timothy R. Nicholson
Author: Laura A. Benjamin
Author: Alan Carson
Author: Craig Smith
Author: Martin R. Turner
Author: Tom Solomon
Author: Rachel Kneen
Author: Sarah L. Pett
Author: Ian Galea ORCID iD
Author: Rhys H. Thomas
Author: Benedict D. Michael
Corporate Author: CoroNerve Study Group

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