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Brain complications of hospitalized COVID-19 patients included both neurologic and psychiatric conditions, an early analysis of the study showed.

Among 125 hospitalized coronavirus patients selected by specialist physicians in the U.K., complications ranged from stroke (77 people) to altered mental states including brain inflammation, psychosis, and dementia-like symptoms (39 people), reported Benedict Michael, MD, PhD, of University of Liverpool, and co-authors, in .

While COVID-19 patients with cerebrovascular events tended to be older -- 82% were over age 60 -- only half of patients with altered mental states were in that age group.

"What was interesting about this altered mental status group -- and which is a relatively new discovery in our cohort -- was there was a slight skew towards younger patients," Michael noted.

"About 26% of patients with new-onset neuropsychiatric causes of altered mental status were in their 20s, 30s, and 40s," Michael said in an interview with 番茄社区app.

To track neurologic and psychiatric manifestations associated with the coronavirus, the CoroNerve research group developed an online network of case report notification portals, working with the Association of British Neurologists (ABN), the British Association of Stroke Physicians (BASP), the Royal College of Psychiatrists (RCPsych), and other professional groups. The ABN portal was launched on April 2, the BASP portal on April 3, and the RCPsych portal on April 21, 2020.

"About 90% of cases were reported prospectively," Michael said. The system also allowed physicians to enter retrospective data with a confirmed date of admission or clinical assessment to include cases that occurred before the portals were available.

Researchers classified broad clinical syndromes as cerebrovascular events (acute ischemic, hemorrhagic, or thrombotic vascular event involving the brain parenchyma or subarachnoid space), altered mental status (an acute alteration in personality, behavior, cognition, or consciousness), peripheral neurology (involving nerve roots, peripheral nerves, neuromuscular junction, or muscle), or other.

Median patient age was 71, and complete clinical datasets were available for 125 of 153 patients. The cohort included 114 patients with confirmed COVID-19 infection by polymerase chain reaction test, six people with probable infection diagnosed from chest x-rays or CT scans, and five people with possible infection whose symptoms were consistent with disease, but diagnostic tests were either negative or not done.

The data lock for this report was on April 26. Reporting physicians included stroke physicians (41%), neurologists (26%), psychiatrists or neuropsychiatrists (17%), and others.

Among 125 patients, 77 presented with a cerebrovascular event, including 57 with ischemic stroke and nine with intracerebral hemorrhage.

Of 39 patients who presented with altered mental status, nine had unspecified encephalopathy and seven had encephalitis. All patients with encephalitis were confirmed COVID-19 cases.

The remaining 23 patients with altered mental status fulfilled clinical case definitions for psychiatric diagnoses by the notifying psychiatrist or neuropsychiatrist, and nearly all -- 21 of 23 patients -- were new diagnoses.

Ten of 23 patients with neuropsychiatric disorders had new-onset psychosis; six had a neurocognitive, dementia-like syndrome, and seven had another psychiatric disorder, including one case of catatonia and one case of mania.

"The next question, of course, is to what extent is this direct viral neurotrophic infection to the central nervous system? To what extent is this para-infectious cytokine storm or antibody-mediated disease?" Michael said. "One also has to think about what the mental health consequences of being hospitalized with potentially fatal illness in a pandemic situation might be."

The group also plans to look at biomarker data and follow patients to see whether long-term effects of neurologic and psychiatric complications emerge. "We're in the acute stage of a pandemic," Michael noted. "I don't think we can prognosticate really about what things will be like for these patients in 6 months time."

"Now that we have some sense of the scale, the next step is to look at cerebrospinal fluid and serum biomarkers of neuronal injury and see what might allow us to identify early on who's at risk for longer-term sequelae," he added.

All patients were selected for inclusion in the study by expert doctors, thus skewing the sample. Conclusions about the total proportion of COVID-19 patients likely to have neurologic or psychiatric manifestations can't be drawn, the researchers pointed out. It's also possible that some conditions were undiagnosed before patients developed COVID-19.

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