UK-Wide Surveillance of Neurological and Neuropsychiatric Complications of COVID-19: The First 153 Patients

Clinical Neurosciences, Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, UK; Department of Neurology, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, UK

Rhys H. Thomas

Newcastle University

Benedict Michael

University of Liverpool - Institute of Infection and Global Health; The Walton Centre NHS Foundation Trust; NIHR Health Protection Research Unit for Emerging and Zoonotic Infection

Date Written: May 14, 2020

Abstract

Background: Increasingly neurological complications of COVID-19 are identified, mostly in small series. Larger studies have been limited by both geography and specialty.

Consequently, the breadth of complications is not represented. Comprehensive characterization of clinical syndromes is critical to rationally select and evaluate potential therapies.

Methods: 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.

Findings: Within three weeks, 153 cases were notified, both geographically and temporally representative of overall COVID-19 Public Health reports. Median (range) age was 71 (23-94) years. 77 (62%) had a cerebrovascular event: 57 (74%) ischemic strokes, nine (12%) intracerebral hemorrhages, and one CNS vasculitis.

The second most common group were 39 (31%) who had altered mental status, including 16 (41%) with encephalopathy of whom seven (44%) had encephalitis. The remaining 23 (59%) had a psychiatric diagnosis of whom 21 (92%) were new diagnoses; including ten (43%) with psychosis, six (26%) neurocognitive (dementia-like) syndrome, and 4 (17%) an affective disorder. Cerebrovascular events predominated in older patients. Conversely, altered mental status, whilst present in all ages, had disproportionate representation in the young.

Interpretation: 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.

Note: Funding: The CoroNerve Study Management Group are supported by research grants from the MRC, Wellcome, NIHR, and Academy of Medical Sciences. No specific grant funding was obtained for this study.

Conflict of Interest: None.

Keywords: COVID-19, SARS-CoV2, Coronavirus, Pandemic, Neurology, Psychiatry, Stroke, Encephalitis, Psychosis

JEL Classification: I1

Suggested Citation: Suggested Citation

Varatharaj, Aravinthan and Thomas, Naomi and Ellul, Mark and Davies, Nicholas WS and Pollak, Tom and Tenorio, E.L. and Sultan, Mustafa and Easton, Ava and Breen, Gerome and Zandi, Michael and Coles, Jonathan P and Manji, Hadi and Al-Shahi Salman, Rustam and Menon, David and Nicholson, Timothy and Benjamin, Laura and Carson, Alan and Smith, Craig and Turner, Martin R and Solomon, Tom and Kneen, Rachel and Pett, Sarah and Galea, Ian and Thomas, Rhys H. and Michael, Benedict, UK-Wide Surveillance of Neurological and Neuropsychiatric Complications of COVID-19: The First 153 Patients (May 14, 2020). Available at SSRN: https://ssrn.com/abstract=3601761 or http://dx.doi.org/10.2139/ssrn.3601761