COVID-19 often complicated with stroke risk and altered mental state

A recent UK nationwide, cross-specialty surveillance study on coronavirus disease 2019 (COVID-19) suggests that stroke, followed by altered mental state comprising encephalopathy or encephalitis and primary psychiatric diagnoses, are the most common complications, with altered mental state occurring as frequently in younger vs older patients.

“The study provides valuable and timely data that are urgently needed by clinicians, researchers, and funders to inform immediate steps in COVID-19 neuroscience research and health policy planning, to distinguish the role of the virus and the host inflammatory response versus the broader socioeconomic effects of the pandemic,” said the authors.

In the study, data were collected from an online network of secure rapid-response case report notification portals (CoroNerve platforms) across the spectrum of major UK neuroscience bodies, including the Association of British Neurologists (ABN), Rare Diseases Ascertainment and Recruitment (RaDAR), the British Association of Stroke Physicians (BASP), and The Royal College of Psychiatrists (RCPsych), in collaboration with the British Paediatric Neurology Association (BPNA), the NeuroAnaesthesia and Critical Care Society, the Intensive Care Society and key stakeholders. [Lancet Psychiatry 2020, doi: 10.1016/S2215-0366(20)30287-X]

Cases were encouraged to be reported prospectively, and recent cases could be notified retrospectively when linked to a confirmation date or admission or initial clinical assessment. Data collected were compared with overall laboratory-confirmed cases of COVID-19 as reported by the UK government’s public health bodies.   

In 2–26 April 2020, 153 cases (median age, 71 years) that met the clinical case definitions were notified on the CoroNerve study platforms, with an exponential growth of reported cases consistent with the overall COVID-19 data reported by public health bodies. Complete clinical datasets were available for 82 percent of patients, of which 91 percent met the criteria for confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Among 125 patients with complete clinical case datasets available, 62 percent presented with the broad clinical syndrome of cerebrovascular event, with ischaemic stroke and intracerebral haemorrahge seen in 74 percent and 12 percent of the patients, respectively. A clinical diagnosis of central vasculitis was reported in 1 percent of patients.

Following cerebrovascular events, 31 percent of patient presented with an altered mental state. Among them, 23 percent and 18 percent had unspecified encephalopathy and encephalitis, respectively. The remaining 59 percent of patients were found to have a neuropsychiatry disorder, with 43 percent, 26 percent and 30 percent of patients having new-onset psychosis, neurocognitive (dementia-like) syndrome and other psychiatric disorders, respectively. 

The incidence of an altered mental state was similar between younger (<60 years old) and older patients (>60 years old) (49 percent vs 51 percent), whereas older patients were much more likely to suffer from cerebrovascular events  (82 percent vs 18 percent) than younger patients.