Michael BD, Walton D, Westenberg E, García-Azorín D, Singh B, Tamborska A, Netravathi M, Chomba M, Wood G, Easton A, Siddiqi O, Jackson T, Pollak T, Nicholson T, Nair S, Breen G, Prasad K, Thakur K, Chou S, Schmutzhard E, Frontera J, Helbok R, Padovani A, Menon D, Solomon T, Winkler AS

J Neuropsychiatry Clin Neurosci. 2022 Jul. https://doi.org/10.1176/appi.neuropsych.22010002

Abstract: 

Encephalopathy is a common complication in patients hospitalised with COVID-19 that can both be a challenge to manage and also negatively impacts prognosis. While encephalopathy may present clinically as delirium, subsyndromal delirium, or coma and be due to systemic causes, such as hypoxia, COVID-19 has also been associated with more prolonged encephalopathy due to less common but nevertheless severe complications, such as inflammation of the brain parenchyma with or without cerebrovascular involvement,
demyelination and/or seizures, which may be disproportionate to COVID-19 severity and which require specific management. Given the large denominator of those hospitalised with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, even these relatively unlikely complications are increasingly recognised and are particularly important as they require specific management. Therefore, the aim of this review is to provide pragmatic guidance on the management of COVID-19 encephalopathy through consensus agreement of the Global COVID-19 Neuro-Research Coalition. A systematic literature search of Medline, MedRxiv, and BioRxiv was conducted between 1st January 2020 and 21st June 2021 with additional review of references cited within the identified bibliographies. A modified Delphi approach was then undertaken to develop recommendations along with a parallel approach to score the strength of both the recommendation and the supporting evidence. This manuscript presents analysis of contemporaneous evidence for definition, epidemiology, and pathophysiology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and both acute and long-term management.