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

18 Pages Posted: 22 May 2020

See all articles by Aravinthan Varatharaj

Aravinthan Varatharaj

University of Southampton

Naomi Thomas

Newcastle University

Mark Ellul

University of Liverpool - Institute of Infection and Global Health

Nicholas WS Davies

Chelsea and Westminster NHS Foundation Trust

Tom Pollak

University of London - Institute of Psychiatry, Psychology and Neuroscience

E.L. Tenorio

University of Utah - Department of Medicinal Chemistry

Mustafa Sultan

Newcastle University

Ava Easton

Encephalitis Society

Gerome Breen

King's College London

Michael Zandi

University College London

Jonathan P Coles

University of Cambridge

Hadi Manji

University College London

Rustam Al-Shahi Salman

University of Edinburgh

David Menon

University of Cambridge - University Division of Anaesthesia

Timothy Nicholson

King's College London

Laura Benjamin

University College London

Alan Carson

University of Edinburgh

Craig Smith

University of Manchester

Martin R Turner

University of Oxford

Tom Solomon

University of Liverpool - Institute of Infection and Global Health

Rachel Kneen

University of Liverpool

Sarah Pett

University College London

Ian Galea

University of Southampton

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

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

Aravinthan Varatharaj

University of Southampton ( email )

University Rd.
Southampton SO17 1BJ, Hampshire SO17 1LP
United Kingdom

Naomi Thomas

Newcastle University ( email )

Newcastle upon Tyne
NE1 7RU
United Kingdom

Mark Ellul

University of Liverpool - Institute of Infection and Global Health ( email )

8 West Derby Street
Liverpool, L69 7BE
United Kingdom

Nicholas WS Davies

Chelsea and Westminster NHS Foundation Trust ( email )

Tom Pollak

University of London - Institute of Psychiatry, Psychology and Neuroscience ( email )

London
United Kingdom

E.L. Tenorio

University of Utah - Department of Medicinal Chemistry

30 S. 2000 E.
Salt Lake City, UT 84112
United States

Mustafa Sultan

Newcastle University ( email )

Newcastle upon Tyne
NE1 7RU
United Kingdom

Ava Easton

Encephalitis Society ( email )

Gerome Breen

King's College London ( email )

Strand
London, England WC2R 2LS
United Kingdom

Michael Zandi

University College London ( email )

Gower Street
London, WC1E 6BT
United Kingdom

Jonathan P Coles

University of Cambridge ( email )

Trinity Ln
Cambridge, CB2 1TN
United Kingdom

Hadi Manji

University College London ( email )

Gower Street
London, WC1E 6BT
United Kingdom

Rustam Al-Shahi Salman

University of Edinburgh ( email )

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

David Menon

University of Cambridge - University Division of Anaesthesia ( email )

United Kingdom

Timothy Nicholson

King's College London ( email )

Strand
London, England WC2R 2LS
United Kingdom

Laura Benjamin

University College London ( email )

Gower Street
London, WC1E 6BT
United Kingdom

Alan Carson

University of Edinburgh ( email )

Old College
South Bridge
Edinburgh, Scotland EH8 9JY
United Kingdom

Craig Smith

University of Manchester ( email )

Oxford Road
Manchester, M13 9PL
United Kingdom

Martin R Turner

University of Oxford ( email )

Mansfield Road
Oxford, Oxfordshire OX1 4AU
United Kingdom

Tom Solomon

University of Liverpool - Institute of Infection and Global Health ( email )

8 West Derby Street
Liverpool, L69 7BE
United Kingdom

Rachel Kneen

University of Liverpool ( email )

Chatham Street
Liverpool, L69 7ZA
United Kingdom

Sarah Pett

University College London ( email )

Gower Street
London, WC1E 6BT
United Kingdom

Ian Galea

University of Southampton ( email )

University Rd.
Southampton SO17 1BJ, Hampshire SO17 1LP
United Kingdom

Rhys H Thomas

Newcastle University ( email )

Newcastle upon Tyne
NE1 7RU
United Kingdom

Benedict Michael (Contact Author)

University of Liverpool - Institute of Infection and Global Health ( email )

8 West Derby Street
Liverpool, L69 7BE
United Kingdom

The Walton Centre NHS Foundation Trust ( email )

NIHR Health Protection Research Unit for Emerging and Zoonotic Infection ( email )

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