Background: The clinical description of the neurological manifestations in
COVID-19 MESHD patients is still underway. This study aims to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with
SARS-CoV-2 infection MESHD. Methods: We conducted a nationwide, multicentric, retrospective study during the French
COVID-19 MESHD epidemic in March-April 2020. All
COVID-19 MESHD patients with de novo neurological manifestations were eligible. Results: We included 222
COVID-19 MESHD patients with neurological manifestations from 46 centers throughout the country. Median age was 65 years (IQR 53-72), and 136 patients (61.3%) were male.
COVID-19 MESHD was severe or critical in almost half of the patients (102, 45.2%). The most common
neurological diseases MESHD were
COVID-19 MESHD associated
encephalopathy MESHD (67/222, 30.2%),
acute ischemic cerebrovascular syndrome MESHD (57/222, 25.7%),
encephalitis MESHD (21/222, 9.5%), and
Guillain-Barre Syndrome MESHD (15/222, 6.8%). Neurological manifestations appeared after first
COVID-19 MESHD symptoms with a median (IQR) delay of 6 (3-8) days in
COVID-19 MESHD associated
encephalopathy MESHD, 7 (5-10) days in
encephalitis MESHD, 12 (7-18) days in
acute ischemic cerebrovascular syndrome MESHD and 18 (15-28) days in
Guillain-Barre Syndrome MESHD. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Brain MRI of
encephalitis MESHD patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small
ischemic lesion or microhemorrhages MESHD in 4 patients. Among patients with
acute ischemic cerebrovascular syndrome MESHD, 13/57 (22.8%) had multi territory
ischemic strokes MESHD, with large vessel
thrombosis MESHD in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with
pleocytosis MESHD in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2
encephalitis MESHD patients. Among patients with
encephalitis MESHD, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated
seizure MESHD (8/222, 3.6%),
critical illness neuropathy MESHD (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%),
intracranial hemorrhage MESHD (5/222, 2.3%),
acute benign lymphocytic meningitis MESHD (3/222, 1.4%),
cranial neuropathy MESHD (3/222, 1.4%), single acute
demyelinating lesion MESHD (2/222, 0.9%),
Tapia syndrome MESHD (2/222, 0.9%),
cerebral venous thrombosis MESHD (1/222, 0.5%),
sudden paraparesis MESHD (1/222, 0.5%), generalized
myoclonus MESHD and
cerebellar ataxia MESHD (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms (
headache MESHD,
anosmia MESHD,
dizziness MESHD, sensitive or
auditive symptoms MESHD,
hiccups MESHD, 15/222, 6.8%). The median (IQR) follow-up of the 222 patients was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%). Conclusion: Neurological manifestations associated with
COVID-19 MESHD mainly included CAE, AICS,
encephalitis MESHD and
GBS MESHD. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.