The brain electroencephalograph (EEG) and magnetic resonance imaging (MRI) can serve as a guide for treating patients with COVID-19, according to the results of a retrospective cohort study published in JAMA Network Open.
Patients (N = 78) who were hospitalized between March 30 and June 11, 2020 at the Pitié-Salpêtrière hospital in France with a confirmed COVID-19 infection were subjected to an EEG and MRI examination. Study researchers retrospectively analyzed medical records for clinical outcomes.
The patients were predominantly men (n = 57) with a mean (standard deviation) [SD]) Age of 61 (SD, 12) years who were hospitalized an average of 29 (SD, 21) days after the onset of symptoms. A total of 7 patients died during the hospital stay.
61% of the surviving patients underwent a neurological examination. At this point, 35% of these patients showed complete neurological recovery.
The first symptoms that triggered commands for EEGs and MRIs were delirium (n = 44), movement disorders (n = 15), anosmia (n = 12), seizures (n = 10), and oculomotor disorders (n = 6).
On the EEG, the researchers observed delirium (n = 24), seizure-like events (n = 22) and delayed awakening after discontinuation of the sedative (n = 17). The electroencephalographic abnormalities identified were frontal slow waves (n = 47), abnormal EEG background (n = 12), periodic discharges (n = 6), and epileptic activity (n = 4).
Acute ischemic lesions (n = 13), lesions that enhance white matter (n = 5), basal ganglia abnormalities (n = 4), and metabolic abnormalities (n = 3) were observed on MRI.
The results showed more abnormalities during the EEG (28%) than the MRI (12%; P = 0.02). Patients with focal frontal abnormalities were less likely to recover on discharge (10% versus 57%; P = 0.05).
Patients with acute neurological injuries without an identified cause (n = 9) were more likely to have a frontal syndrome (78% versus 12%; P <0.001) and a brain stem disorder (44% versus 4%; P <0.001). , periodic EEG discharges (44% versus 3%; P <0.001), movement disorders (67% versus 14%; P = 0.002), and MRI lesions that enhance white matter (33% versus 4%; P = 0, 03)).
The patients with unidentified neurological injury were able to use clinical, EEG and MRI data with a range below the recipient’s operating curve of 0.94 (95% CI, 0.88-1.00; P <0.001) and a sensitivity 76% (95%) CI, 33% to 100%), specificity of 93% (95% CI, 86% to 100%) and accuracy of 91% (95% CI, 76% to 100%).
This study was limited by the small sample size and observational design with only one center. Confirmation in other settings is required to validate these results.
These data showed that EEGs and MRIs were valuable diagnostic tools for patients with COVID-19 who showed neurological symptoms. It remains unclear whether previous diagnoses and interventions can improve the rate of neurological recovery.
Disclosure: Several authors have stated that they are part of the pharmaceutical industry. For a full list of details, see the original article.
reference
Lambrecq V., Hanin A., Munoz-Musat E. et al .; Cohort COVID-19 Study Group Neurosciences (CoCo Neurosciences). Association of clinical, biological and brain resonance tomography findings with electroencephalographic findings in patients with COVID-19. JAMA Netw Open. 2021; 4 (3): e211489. doi: 10.1001 / jamanetworkopen.2021.1489
