Elsevier

Clinical Neurophysiology

Volume 132, Issue 1, January 2021, Pages 218-225
Clinical Neurophysiology

Alpha coma EEG pattern in patients with severe COVID-19 related encephalopathy

https://doi.org/10.1016/j.clinph.2020.09.008Get rights and content

Highlights

  • Encephalopathy in severe COVID-19 is a primary cause of persisting coma off sedation.

  • Alpha coma (AC) EEG pattern may be a marker of SARS-CoV-2 related encephalopathy.

  • AC may indicate predilection of the SARS-CoV-2 for the brainstem reticular system.

Abstract

Objective

Encephalopathy is a major neurological complication of severe Coronavirus Disease 2019 (COVID-19), but has not been fully defined yet. Further, it remains unclear whether neurological manifestations are primarily due to neurotropism of the virus, or indirect effects, like cerebral hypoxia.

Methods

We analysed the electroencephalograms (EEGs) of 19 consecutive patients with laboratory-confirmed COVID-19, performed at peak disease severity as part of their clinical management. Disease severity, respiratory failure, immune and metabolic dysfunction, sedation status, and neurological examination on the day of the EEG were noted.

Results

Severe encephalopathy was confirmed in 13 patients, all with severe COVID-19; 10 remained comatose off sedation, and five of them had alpha coma (AC). Disease severity, sedation, immune and metabolic dysfunction were not different between those with AC and those without.

Conclusions

Severe COVID-19 encephalopathy is a principal cause of persisting coma after sedation withdrawal. The relatively high incidence of the rare AC pattern may reflect direct SARS-CoV-2 neurotropism with a predilection for the brainstem ascending reticular system.

Significance

Systematic early EEG detection of encephalopathy related to severe COVID-19 is important for the acute care and the management of long-term neurological and cognitive sequelae, and may help our better understanding of its pathophysiology.

Keywords

SARS-CoV-2
Neurotropism
Neurological manifestations
Brainstem
Ascending reticular formation
Encephalitis
Non-convulsive status
Seizures

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