Electroencephalographic Abnormalites in SARS-CoV-2 Patients

Abstract

Viral infection with SARS-CoV-2 has a neurological tropism that may induce an encephalopathy. In this context, electroencephalographic exploration (EEG) is indicated as a diagnostic argument correlated with lumbar puncture, biology, and imaging. We performed a retrospective analysis of 42 patients explored by EEG and infected by COVID-19, according to the EEG abnormalities and clinical signs that motivated the examination. Confusion and epileptic seizures were the most common clinical indications, with 64% of the patients displaying these symptoms. The EEG was altered in 85% of the cases of confusion, in 57% of the cases of epileptic symptoms (general or focal seizure or prolonged loss of contact) and 20% of the cases of malaise or brief loss of consciousness. Nine EEG (21%) were in favor of an encephalopathy, two had de novo alterations in persistent consciousness and two had alterations in general states of confusion; one was very agitated and without history of epilepsy and combined eyelids clonia while a second one exhibited unconsciousness with left hemicorpus clonus. Two were being investigated for delayed awakening without sedation for more than 24 h. All of these patients were diagnosed COVID-19, some of them with associated mild to severe respiratory disorders. This work shows the interest of the EEG in exploring COVID-19 patients suffering from neurological or general symptoms looking for cerebral alteration.

Keywords: confusion; electroencephalography; encephalopathy; epileptic seizure; virus.

Figure 1

Encephalopathic pattern with triphasic frontal waves and a frequency of the basal rhythm from 1 to 7 Hz, in COVID patients suffering from suspicion of a status epilepticus (A), syncope (B), delayed awakening after reanimation and being weaned off anesthetic drugs (C), bilateral eyelid myoclonus during awakening following reanimation (D, artifacts on Fp1), altered consciousness (E), and confusion for 2 days (F).