Brain MRI and EEG Clues to COVID-19-Related Encephalopathy

Brain electroencephalograph (EEG) and magnetic resonance imaging (MRI) may help guide treatments for patients with COVID-19, according to findings of a retrospective cohort study published in JAMA Network Open.

Patients (N=78) hospitalized at the Pitié-Salpêtrière Hospital in France with confirmed COVID-19 infection between March 30 and June 11, 2020, underwent EEG and MRI assessments. Study researchers retrospectively analyzed medical records for clinical outcomes.

Patients were mostly 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 symptom onset. A total of 7 patients died during hospitalization.

Among surviving patients, 61% underwent a neurologic evaluation follow-up, at which time 35% of these patients exhibited total neurologic recovery.

The initial symptoms that triggered orders for EEGs and MRIs included delirium (n=44), movement disorders (n=15), anosmia (n=12), seizures (n=10), and oculomotor disorders (n=6).

At EEG, study researchers observed delirium (n=24), seizure-like events (n=22), and delayed awakening after sedative discontinuation (n=17). The electroencephalographic abnormalities identified were frontal slow waves (n=47), abnormal EEG background (n=12), periodic discharges (n=6), and epileptic activities (n=4).

At MRI, acute ischemic lesions (n=13), white matter-enhancing lesions (n=5), basal ganglia abnormalities (n=4), and metabolic abnormalities (n=3) were observed.

Findings indicated more abnormalities during EEG (28%) than MRI (12%; P =.02). Patients who exhibited focal frontal abnormalities were less likely to recover at discharge (10% vs 57%; P =.05).

Patients who had acute neurologic injuries without any identified cause (n=9) were more likely to present with frontal syndrome (78% vs 12%; P <.001), brainstem impairment (44% vs 4%; P <.001), periodic EEG discharges (44% vs 3%; P <.001), movement disorders (67% vs 14%; P =.002), and white matter-enhancing MRI lesions (33% vs 4%; P =.03).

The patients with unidentified neurologic injury could be identified from clinical, EEG, and MRI data with an area under the receiver operating characteristic curve of 0.94 (95% CI, 0.88-1.00; P <.001), sensitivity of 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 its low sample size and observational, single-center design. Confirmation in other settings is needed for validation of these findings.

These data indicated EEGs and MRIs were valuable diagnostic tools for patients with COVID-19 presenting with neurologic symptoms. It remains unclear whether earlier diagnoses and interventions may improve the rate of neurologic recovery.

Disclosure: Multiple authors declared affiliations with pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

Lambrecq V, Hanin A, Munoz-Musat E, et al; Cohort COVID-19 Neurosciences (CoCo Neurosciences) Study Group. Association of clinical, biological, and brain magnetic resonance imaging findings with electroencephalographic findings for patients with COVID-19. JAMA Netw Open. 2021;4(3):e211489. doi:10.1001/jamanetworkopen.2021.1489