cover image European Journal of Neurology

European Journal of Neurology

2020 - Volume 27
Issue 9 | September 2020
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Issue Information

Issue Information

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Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.13999

Letters To The Editor

Novel coronavirus and the central nervous system

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Authors:
T. Sun and J. Guan
Article first published online:
24 Apr 2020 | DOI: 10.1111/ene.14227

Letters To The Editor

The need for neurologists in the care of COVID‐19 patients

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Authors:
J. Sellner, P. Taba, S. Öztürk and R. Helbok
Article first published online:
12 May 2020 | DOI: 10.1111/ene.14257

Letters To The Editor

Lack of dyspnea in patients with Covid‐19: another neurological conundrum?

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Authors:
B. Bertran Recasens, J. M. Martinez‐Llorens, J. J. Rodriguez‐Sevilla and M. A. Rubio
Article first published online:
12 May 2020 | DOI: 10.1111/ene.14265

Short Communication

Background and purpose

Specific respiratory tract infections, including COVID‐19, may cause smell and/or taste disorders (STDs) with increased frequency. The aim was to determine whether new‐onset STDs are more frequent amongst COVID‐19 patients than influenza patients.

Method

This was a case–control study including hospitalized patients of two tertiary care centres. Consecutive patients positive for COVID‐19 polymerase chain reaction (cases) and patients positive for influenza polymerase chain reaction (historical control sample) were assessed during specific periods, employing a self‐reported STD questionnaire.

Results

Seventy‐nine cases and 40 controls were included. No significant differences were found in basal features between the two groups. New‐onset STDs were significantly more frequent amongst cases (31, 39.2%) than in the control group (5, 12.5 %) [adjusted odds ratio 21.4 (2.77–165.4,  = 0.003)]. COVID‐19 patients with new‐onset STDs were significantly younger than COVID‐19 patients without STDs (52.6 ± 17.2 vs. 67.4 ± 15.1,  < 0.001). Amongst COVID‐19 patients who presented STDs, 22 (70.9%) recalled an acute onset and it was an initial manifestation in 11 (35.5%). Twenty‐five (80.6%) presented smell disorders (mostly anosmia, 14, 45.2%) and 28 (90.3%) taste disorders (mostly ageusia, 14, 45.2%). Only four (12.9 %) reported concomitant nasal obstruction. The mean duration of STD was 7.5 ± 3.2 days and 12 patients (40%) manifested complete recovery after 7.4 ± 2.3 days of onset.

Conclusion

New‐onset STDs were significantly more frequent amongst COVID‐19 patients than influenza patients; they usually had an acute onset and were commonly an initial manifestation. The use of STD assessment in anamnesis as a hint for COVID‐19 and to support individuals’ self‐isolation in the current epidemic context is suggested.

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Authors:
Á. Beltrán‐Corbellini, J. L. Chico‐García, J. Martínez‐Poles, F. Rodríguez‐Jorge, E. Natera‐Villalba, J. Gómez‐Corral, A. Gómez‐López, E. Monreal, P. Parra‐Díaz, J. L. Cortés‐Cuevas, J. C. Galán, C. Fragola‐Arnau, J. Porta‐Etessam, J. Masjuan and A. Alonso‐Cánovas
Article first published online:
16 May 2020 | DOI: 10.1111/ene.14273

Letters To The Editor

COVID‐19: what if the brain had a role in causing the deaths?

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Authors:
C. Tassorelli, F. Mojoli, F. Baldanti, R. Bruno and M. Benazzo
Article first published online:
14 May 2020 | DOI: 10.1111/ene.14275

Review Article

Abstract

The current coronavirus disease (COVID‐19) outbreak, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), has raised the possibility of potential neurotropic properties of this virus. Indeed, neurological sequelae of SARS‐CoV‐2 infection have already been reported and highlight the relevance of considering the neurological impact of coronavirus (CoV) from a translational perspective. Animal models of SARS and Middle East respiratory syndrome, caused by structurally similar CoVs during the 2002 and 2012 epidemics, have provided valuable data on nervous system involvement by CoVs and the potential for central nervous system spread of SARS‐CoV‐2. One key finding that may unify these pathogens is that all require angiotensin‐converting enzyme 2 as a cell entry receptor. The CoV spike glycoprotein, by which SARS‐CoV‐2 binds to cell membranes, binds angiotensin‐converting enzyme 2 with a higher affinity compared with SARS‐CoV. The expression of this receptor in neurons and endothelial cells hints that SARS‐CoV‐2 may have higher neuroinvasive potential compared with previous CoVs. However, it remains to be determined how such invasiveness might contribute to respiratory failure or cause direct neurological damage. Both direct and indirect mechanisms may be of relevance. Clinical heterogeneity potentially driven by differential host immune‐mediated responses will require extensive investigation. Development of disease models to anticipate emerging neurological complications and to explore mechanisms of direct or immune‐mediated pathogenicity in the short and medium term is therefore of great importance. In this brief review, we describe the current knowledge from models of previous CoV infections and discuss their potential relevance to COVID‐19.

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Authors:
S. Natoli, V. Oliveira, P. Calabresi, L. F. Maia and A. Pisani
Article first published online:
22 May 2020 | DOI: 10.1111/ene.14277

Commentary

Of mice and men: COVID‐19 challenges translational neuroscience

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Authors:
J. Sellner
Article first published online:
20 May 2020 | DOI: 10.1111/ene.14278

Letters to the Editor

Emergency room neurology in times of COVID‐19: malignant ischaemic stroke and SARS‐CoV‐2 infection

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Authors:
T. González‐Pinto, A. Luna‐Rodríguez, A. Moreno‐Estébanez, G. Agirre‐Beitia, A. Rodríguez‐Antigüedad and M. Ruiz‐Lopez
Article first published online:
19 May 2020 | DOI: 10.1111/ene.14286

Letters To The Editor

Two patients with acute meningoencephalitis concomitant with SARS‐CoV‐2 infection

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Authors:
R. Bernard‐Valnet, B. Pizzarotti, A. Anichini, Y. Demars, E. Russo, M. Schmidhauser, J. Cerutti‐Sola, A. O. Rossetti and R. Du Pasquier
Article first published online:
30 May 2020 | DOI: 10.1111/ene.14298

Letters To The Editor

COVID‐19 and neurodegeneration: what can we learn from the past?

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Authors:
E. M. Gatto and J. Fernandez Boccazzi
Article first published online:
08 Jun 2020 | DOI: 10.1111/ene.14311

Original Article

Background and purpose

To date, no study has attempted to quantify the impact of the COVID‐19 outbreak on the incidence and treatment of acute stroke.

Methods

This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1–31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume.

Results

Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (−0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%),  = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions.

Conclusion

These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID‐19 outbreak on acute stroke care.

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Authors:
R. Pop, V. Quenardelle, A. Hasiu, D. Mihoc, F. Sellal, M. H. Dugay, P. A. Lebedinsky, E. Schluck, A. LA Porta, S. Courtois, R. Gheoca, V. Wolff and R. Beaujeux
Article first published online:
03 Jun 2020 | DOI: 10.1111/ene.14316

Letters To The Editor

Disability through COVID‐19 pandemic: neurorehabilitation cannot wait

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Authors:
L. Leocani, K. Diserens, M. Moccia and C. Caltagirone
Article first published online:
25 Jun 2020 | DOI: 10.1111/ene.14320

Short Communication

Background and purpose

Stroke assistance is facing changes and new challenges since COVID‐19 became pandemic. A variation on the patient influx might be one of the greater concerns, due to fewer people coming to emergency departments or coming too late. However, no data quantifying this have been published until now. The aim was to analyse the impact of the COVID‐19 epidemic outbreak on hospital stroke admissions and their characteristics in our region.

Methods

The data of every patient admitted to any hospital of our healthcare system with a diagnosis of ischaemic stroke between 30 December 2019 and 19 April 2020 were reviewed. Demographic and clinical data were recorded and compared between periods before and after the setting of the state of emergency secondary to the COVID‐19 outbreak.

Results

In total, 354 patients with ischaemic stroke were admitted in our study period. There was a weekly average of 27.5 cases before the setting of the state of emergency against 12 afterwards ( < 0.001). This drop in stroke cases occurred progressively from week 11, persisting in time despite the decrease in confirmed cases of COVID‐19. No differences in the proportion of intravenous thrombolysis (21.1% vs. 21.5%,  = 0.935) or endovascular therapy (12.4% vs. 15.2%,  = 0.510) were found, nor in other demographic or clinical characteristics except for median onset‐to‐door time (102 vs. 183 min,  = 0.015).

Conclusions

This observational study offers the perspective of a whole region in one of the countries more heavily stricken by the SARS‐CoV‐2 epidemic and shows that the decrease of stroke events, since the beginning of the COVID‐19 outbreak, happened globally and without any specific patient distribution.

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Authors:
H. Tejada Meza, Á. Lambea Gil, A. Sancho Saldaña, C. Villar Yus, B. Pardiñas Barón, D. Sagarra Mur, J. Marta Moreno, Olalla Alberti González, Juan Carlos Aragües Bravo, Jorge Artal Roy, Laura Ballester Marco, María Rosario Barrena Caballo, María Bestué Cardiel, Isabel Campello Morer, Carolina García Arguedas, María José Gimeno Peribáñez, Antonio Goméz Peligros, Belen Gros Bañeres, Natalia Hernando Quintana, María José Lafuente González, Javier Marta Moreno, Gloria Martínez Borobio, Marta Palacín Larroy, Cristina Pérez Lázaro, Pilar Ruiz Palomino, Marta Sampériz Murillo and Marta Serrano Ponz
Article first published online:
18 Jun 2020 | DOI: 10.1111/ene.14327

Short Communication

Background and purpose

Patients with acute ischemic stroke are at high‐risk for contracting COVID‐19 infection. Additionally, healthcare professionals including neurovascular ultrasound providers are also at risk of being infected by SARS‐CoV‐2 virus. Yet, preparedness to continue to guarantee hyperacute treatment is vital for patients outcome. In light of this situation, the European Society of Neurosonology and Cerebral Hemodynamic (ESNCH) appointed a task force to provide consensus recommendations for the performance of neurovascular ultrasound investigations in acute ischemic stroke during the COVID‐19 pandemic with the aim of protecting both patients and ultrasound providers.

Methods

The “ultrasound in acute stroke working group” of the ESNCH examined literature articles and reviews using the following key words: “corona virus” or “COVID‐19” or “SARS‐CoV‐2 virus”, and “acute stroke” or “cerebrovascular disease”, and “ultrasound”. Thereafter, a thorough discussion was conducted with the “education and guidelines working group” of the ESNCH.

Results

We propose rapid up‐to‐date recommendations for healthcare personnel involved in the pre‐hospital and intra‐hospital assessment of stroke patients, with a particular attention to neurovascular ultrasound performance.

Conclusion

The ESNCH provides a guidance summary for the performance of neurovascular ultrasound investigations in acute ischemic stroke in the time of COVID‐19.

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Authors:
C. Baracchini, A. Pieroni, M. Kneihsl, E. Azevedo, M. Diomedi, L. Pascazio, J. Wojczal, C. Lucas, E. Bartels, NM. Bornstein, L. Csiba, J. Valdueza, G. Tsivgoulis and B. Malojcic
Article first published online:
18 Jun 2020 | DOI: 10.1111/ene.14334

Short Communication

Background and purpose

The COVID‐19 epidemic is affecting almost all individuals worldwide, and patients with Alzheimer’s disease (AD) and amnesic mild cognitive impairment (MCI) are particularly at risk due to their characteristics and age. We analysed the impact of the pandemic on these patients’ neuropsychiatric symptoms and their quality of life after 5 weeks of lockdown in Spain.

Methods

A total of 40 patients with a diagnosis of MCI ( 20) or mild AD ( 20) from the Cognitive Stimulation Program of the Cognitive Disorders Unit were evaluated. All patients had undergone a previous evaluation during the month before the lockdown, and were re‐evaluated after 5 weeks of lockdown. The Neuropsychiatric Inventory (NPI) and EuroQol‐5D questionnaire (EQ‐5D) were used to assess neuropsychiatric symptoms in patients and the quality of life in patients as well in caregivers.

Results

The mean (SD) total baseline NPI score was 33.75 (22.28), compared with 39.05 (27.96) after confinement ( = 0.028). The most frequently affected neuropsychiatric symptoms were apathy [4.15 (3.78) vs. 5.75 (4.02);  = 0.002] and anxiety [3.95 (3.73) vs. 5.30 (4.01);  = 0.006] in patients with MCI, and apathy [2.35 (2.70) vs. 3.75 (3.78);  = 0.036], agitation [0.45 (1.14) vs. 1.50 (2.66);  = 0.029] and aberrant motor behaviour [1.25 (2.86) vs. 2.00 (2.93);  = 0.044] in patients with AD. We did not observe differences in EQ‐5D scores during the re‐evaluation. The 30% of patients and 40% of caregivers reported a worsening of the patients' health status during confinement.

Conclusions

The results of this study show the worsening of neuropsychiatric symptoms in patients with AD and MCI during 5 weeks of lockdown, with agitation, apathy and aberrant motor activity being the most affected symptoms.

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Authors:
B. Lara, A. Carnes, F. Dakterzada, I. Benitez and G. Piñol‐Ripoll
Article first published online:
24 Jun 2020 | DOI: 10.1111/ene.14339

Letters To The Editor

Lung ultrasonography in COVID‐19: a game changer in the stroke unit?

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Authors:
C. Lugnan, V. Tommasini, G. Furlanis, M. Naccarato, P. Caruso, I. Scali, A. Buoite Stella, M. Ajčević, T. Cillotto and P. Manganotti
Article first published online:
15 Jun 2020 | DOI: 10.1111/ene.14352

Letters To The Editor

Letter to the Editor about the Beltrán‐Corbellini . publication: ‘Acute‐onset smell and taste disorders in the context of Covid‐19: a pilot multicenter PCR‐based case‐control study’ ( 2020. doi: 10.1111/ene.14273)

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Authors:
J. R. Lechien, C. Hopkins and S. Saussez
Article first published online:
19 Jun 2020 | DOI: 10.1111/ene.14357

Letters To The Editor

Reply to letter on Acute‐onset smell and taste disorders in the context of COVID‐19: a pilot multicentre polymerase chain reaction based case–control study

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Authors:
Á. Beltrán‐Corbellini, J. L. Chico‐García, J. Martínez‐Poles, F. Rodríguez‐Jorge and A. Alonso‐Cánovas
Article first published online:
07 Jul 2020 | DOI: 10.1111/ene.14359

Case Study

Background

Varicella‐zoster virus (VZV) is a human neurotropic virus that remains in a latent state within ganglionic neurons throughout the entire neuroaxis after the primary infection. When herpes zoster (HZ) leads to trigeminal involvement, the ophthalmic division is the most implicated. COVID‐19 has emerged as a viral cause of severe acute respiratory syndrome that has spread all over the world in the last months. Co‐infection with COVID‐19 and other viruses has been reported, but sparsely, and involving the respiratory viruses.

Methods

The case of a co‐infection of COVID‐19 with VZV is reported, and the literature reviewed.

Results

A 39‐year‐old immunocompetent man presented with oligosymptomatic infection with COVID‐19, which evolved to left facial HZ, affecting the three divisions of the trigeminal nerve. The co‐infection was remotely registered, being the respiratory viruses, especially influenza, the most commonly cited association. However, the present case illustrates the emergence of a latent virus infection, which might be favored by the inflammatory response to the former agent (COVID‐19). This reaction ascended from the nasal cavity, where trigeminal branches are also placed.

Conclusions

The emergence of latent VZV infection in this rare presentation might illustrate an effect, at least locally, of COVID‐19. This virus possibly induced a retrograde reactivation of VZV in a young immunocompetent patient.

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Authors:
A. C. A. de F. Ferreira, T. T. Romão, Y. S. Macedo, C. Pupe and O. J. M. Nascimento
Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.14361

Commentary

COVID‐19 – neurologists stay aware!

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Authors:
T. J. von Oertzen
Article first published online:
17 Jun 2020 | DOI: 10.1111/ene.14365

Letters To The Editor

Dysphagia in COVID‐19 –multilevel damage to the swallowing network?

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Authors:
R. Dziewas, T. Warnecke, P. Zürcher and J. C. Schefold
Article first published online:
13 Jun 2020 | DOI: 10.1111/ene.14367

Case Study

Background and purpose

The spectrum of COVID‐19, caused by severe acute respiratory syndrome coronavirus 2 infection (SARS‐CoV‐2), includes different neurologic manifestations of the central and peripheral nervous system.

Methods

From March through April 2020, in two university hospitals located in western Switzerland, we examined three patients with Guillain–Barré syndrome (GBS) following SARS‐CoV‐2.

Results

These cases were characterized by a primary demyelinating electrophysiological pattern (Acute inflammatory demyelinating polyneuropathy or AIDP) and a less severe disease course compared to recently published case series. Clinical improvement was observed in all patients at week five. One patient was discharged from hospital after full recovery with persistence of minor neurological signs (areflexia). Two of the three patients remained hospitalized: one was able to walk and the other could stand up with assistance.

Conclusions

We report three cases of typical GBS (AIDP) occurring after SARS‐CoV‐2 infection and presenting with a favourable clinical course. Given the interval between COVID‐19‐related symptoms and neurological manifestations (mean of 15 days) we postulate a secondary immune‐mediated mechanism rather than direct viral damage.

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Authors:
A. M. Lascano, J.‐B. Epiney, M. Coen, J. Serratrice, R. Bernard‐Valnet, P. H. Lalive, T. Kuntzer and A. Hübers
Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.14368

Commentary

How to support the quality of life of people living with cognitive disorders: a (k)new challenge in the post‐COVID‐19 world

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Authors:
Y. Chen and C. Chen
Article first published online:
25 Jun 2020 | DOI: 10.1111/ene.14373

Review Article

Abstract

In order to cope with the exponentially increasing number of patients infected with SARS‐CoV‐2, European countries made enormous efforts to reorganize medical assistance and several diseases, including stroke, were particularly impacted. We report the experience of stroke neurologists from three European countries (Italy, France and Germany) that faced the pandemic at diverse time points and with different approaches, depending on their resources and healthcare system organization. Pre‐hospital and in‐hospital acute stroke pathways were reorganized to prioritize COVID‐19 management and, in severely affected regions of Italy and France, stroke care was centralized to a limited number of centers, whereas the remaining stroke units were dedicated to patients with COVID‐19. Access to acute stroke diagnostics and time‐dependent therapies was limited or delayed because of reduced capacities of emergency services due to the burden of patients with COVID‐19. A marked reduction in the number of patients presenting with transient ischaemic attack and stroke was noted in the emergency departments of all three countries. Although we only have preliminary data, these conditions may have affected stroke outcome. These indirect effects of the COVID‐19 pandemic could negate the efforts of stroke neurologists over the last few years to improve outcome and reduce mortality of stroke patients. Although the SARS‐CoV‐2 infection rate is slowing down in Europe, the effects of ending lockdown in the next months are unpredictable. It is important for the European and world stroke community to share what has been learned so far to be plan strategies to ensure stroke care in the future and upcoming challenging times.

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Authors:
A. Bersano, M. Kraemer, E. Touzé, R. Weber, S. Alamowitch, I. Sibon and L. Pantoni
Article first published online:
27 Jun 2020 | DOI: 10.1111/ene.14375

Letters To The Editor

Concomitant brain arterial and venous thrombosis in a COVID‐19 patient

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Authors:
M. Malentacchi, D. Gned, V. Angelino, S. Demichelis, A. Perboni, A. Veltri, A. Bertolotto and M. Capobianco
Article first published online:
30 Jun 2020 | DOI: 10.1111/ene.14380

Original Article

Background and purpose

We systematically reviewed available evidence for reports of neurological signs and symptoms in patients with COVID‐19 to identify cases with severe acute respiratory syndrome coronavirus (SARS‐CoV)‐2 infection or immune‐mediated reaction in the nervous system.

Methods

We followed PRISMA guidelines and used the MEDLINE, EMBASE, Google Scholar, MedRxiv and ChinaXiv databases to search for articles on COVID‐19 and nervous system involvement that were published from 1 January to 24 April 2020. Data on design, sample size, neurological assessment and related work‐up were extracted. Biases were assessed with the Newcastle–Ottawa scale.

Results

We analysed 27 publications on potential neuroinvasive or parainfectious neurological complications of COVID‐19. The reports focused on smell and taste ( = 5) and evaluation of neurological symptoms and signs in cohorts ( = 5). There were cases of Guillain‐Barré syndrome/Miller‐Fisher syndrome/cranial neuropathy (seven cases), meningitis/encephalitis (nine cases) and various other conditions (five cases). The number of patients with examination of cerebrospinal fluid and, in particular, SARS‐CoV‐2 polymerase chain reaction was negligible. Two had a positive SARS‐CoV‐2 polymerase chain reaction examination of cerebrospinal fluid specimen. Study of potential parenchymal involvement with magnetic resonance imaging was rare. Only four reports received a rating of the highest quality standards.

Conclusions

This systematic review failed to establish comprehensive insights into nervous system manifestations of COVID‐19 beyond immune‐mediated complications in the aftermath of respiratory symptoms. The authors therefore provide guidance for more careful clinical, diagnostic and epidemiological studies to characterize the manifestations and burden of neurological disease caused by SARS‐CoV‐2 on behalf of the Infectious Disease Panel of the European Academy of Neurology.

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Authors:
M. Romoli, I. Jelcic, R. Bernard‐Valnet, D. García Azorín, L. Mancinelli, T. Akhvlediani, S. Monaco, P. Taba and J. Sellner
Article first published online:
30 Jun 2020 | DOI: 10.1111/ene.14382

Case Study

Introduction

On March 11th, 2020, the WHO declared the SARS‐Cov‐2 pandemic. Syndromes have been detected in relation to COVID‐19 such as encephalitis, acute necrotizing hemorrhagic encephalopathy and cerebrovascular complications. There are also cases of peripheral nervous system involvement.

Methods

Our case would be the 3rd patient with MFS associated with COVID‐19 as far as we know.

Results

We present a 51 years old female diagnosed with MFS two weeks after COVID‐19. RTPCR to SARS‐CoV‐2 was negative but IgG was positive.

Conclusion

Most of the cases were mild or moderate with typical signs and symptoms. All were treated with IV immunoglobulin with good response in most cases. Despite the short evolution time of the cases surviving the current pandemic, the description of cases of post‐infectious neurological syndromes suggests that this is probably not an infrequent complication in the subacute stage of Covid‐19 disease.

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Authors:
J. A. Reyes‐Bueno, L. García‐Trujillo, P. Urbaneja, N. L. Ciano‐Petersen, M. J. Postigo‐Pozo, C. Martínez‐Tomás and P. J. Serrano‐Castro
Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.14383

Case Study

Guillain‐Barré syndrome in a patient with antibodies against SARS‐COV‐2

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Authors:
R. Helbok, R. Beer, W. Löscher, S. Boesch, M. Reindl, R. Hornung, A.J. Schiefecker, F. Deisenhammer and B. Pfausler
Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.14388

Commentary

Impact of the SARS‐CoV‐2 pandemic on stroke care: a warning message

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Authors:
A. Bersano and L. Pantoni
Article first published online:
14 Jul 2020 | DOI: 10.1111/ene.14394

Case Study

Guillain–Barré syndrome after SARS‐CoV‐2 infection

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Authors:
D. Kilinc, S. van de Pasch, A. Y. Doets, B. C. Jacobs, J. van Vliet and M. P. J. Garssen
Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.14398

Commentary

Stroke care in Europe during the COVID‐19 pandemic

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Authors:
D. Aguiar de Sousa and H. B. van der Worp
Article first published online:
12 Jul 2020 | DOI: 10.1111/ene.14401

Letters To The Editor

COVID‐19 and the state of African neurology

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Authors:
B. A. Ayele, M. Rizig, W. Amogne, Y. Zenebe, H. Demissie, D. Gams Massi, S. El‐Sadig, A. Charway‐Felli and F. Abd‐Allah
Article first published online:
26 Jul 2020 | DOI: 10.1111/ene.14404

Original Article

Background and purpose

Although the main clinical features of COVID‐19 infection are pulmonary, several associated neurological signs, symptoms and diseases are emerging. The incidence and characteristics of neurological complications are unclear. For this reason, the European Academy of Neurology (EAN) core COVID‐19 Task Force initiated a survey on neurological symptoms observed in patients with COVID‐19 infection.

Methods

A 17‐question online survey was made available on the EAN website and distributed to EAN members and other worldwide physicians starting on 9 April 2020.

Results

By 27 April 2020, proper data were collected from 2343 responders (out of 4199), of whom 82.0% were neurologists, mostly from Europe. Most responders (74.7%) consulted patients with COVID‐19 mainly in emergency rooms and in COVID‐19 units. The majority (67.0%) had evaluated fewer than 10 patients with neurological manifestations of COVID‐19 (neuro COVID‐19). The most frequently reported neurological findings were headache (61.9%), myalgia (50.4%), anosmia (49.2%), ageusia (39.8%), impaired consciousness (29.3%) and psychomotor agitation (26.7%). Encephalopathy and acute cerebrovascular disorders were reported at 21.0%. Neurological manifestations were generally interpreted as being possibly related to COVID‐19; they were most commonly recognized in patients with multiple general symptoms and occurred at any time during infection.

Conclusion

Neurologists are currently and actively involved in the management of neurological issues related to the COVID‐19 pandemic. This survey justifies setting up a prospective registry to better capture the prevalence of patients with neuro COVID‐19, neurological disease characteristics and the contribution of neurological manifestations to outcome.

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Authors:
E. Moro, A. Priori, E. Beghi, R. Helbok, L. Campiglio, C. L. Bassetti, E. Bianchi, L. F. Maia, S. Ozturk, F. Cavallieri, M. Zedde, J. Sellner, D. Bereczki, M. Rakusa, G. Di Liberto, A. Sauerbier, A. Pisani, A. Macerollo, R. Soffietti, P. Taba, M. Crean, A. Twardzik, C. Oreja‐Guevara, B. Bodini, T. M. Jenkins and T. J. von Oertzen
Article first published online:
23 Jul 2020 | DOI: 10.1111/ene.14407

Commentary

Neurosonology during the COVID‐19 pandemic (Editorial commentary from the chairs of the ultrasound panel of the European Academy of Neurology)

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Authors:
D. Školoudík and M. Mijajlović
Article first published online:
20 Jul 2020 | DOI: 10.1111/ene.14410

Editorial

A special issue on SARS‐CoV‐2

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Authors:
Didier Leys
Article first published online:
20 Aug 2020 | DOI: 10.1111/ene.14455