Alpha coma EEG pattern in patients with severe COVID-19 related encephalopathy.
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.
['Koutroumanidis|Michail|M|', 'Gratwicke|James|J|', 'Sharma|Simeran|S|', 'Whelan|Aoife|A|', 'Tan|S Veronica|SV|', 'Glover|Guy|G|']
D000328:Adult D000368:Aged D000369:Aged, 80 and over D001921:Brain D001927:Brain Diseases D000086382:COVID-19 D003128:Coma D004569:Electroencephalography D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D012189:Retrospective Studies
Neurological manifestations Neurotropism SARS-CoV-2 Brainstem Ascending reticular formation Encephalitis Non-convulsive status Seizures