Brain MRI and EEG Can Help Diagnose COVID-19 Encephalopathy

Pairing brain MRI with EEG, clinical, and biological data can help providers pinpoint which COVID-19-positive patients have encephalopathy, potentially improving treatment efforts.

In an article published March 15 in JAMA Network Open, a research team from France conducted a retrospective cohort study to potentially identify biological, EEG, and MRI patterns present in patients who have COVID-19-related encephalopathy (CORE). The answer is yes.

“This study suggests that, although neurologic manifestations, EEG findings, and MRI findings may appear heterogeneous and non-specific, multi-modal monitoring may better identify patients with COVID-19-related encephalopathy and guide treatment strategy,” said the team led by Virginie Lambrecq, M.D., Ph.d., from Sorbonne Université, the Paris Brain Institute, and the clinical neurophysiology department of Pitié-Salpêtrière Hospital.

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For their study, the team examined 78 adult patients hospitalized in Paris for COVID-19 who underwent EEG between March 30, 2020, and June 11, 2020, for delirium, seizure-like events, and delayed waking after the cessation of sedatives. Of the group, 73 percent of whom were men with an average age of 61, 69 had pathologic EEG findings, such as metabolic-toxic encephalopathy features, frontal abnormalities, periodic discharges, and epileptic activities.

From the overall group, 57 patients also underwent brain MRI, and 41 showed abnormalities on those scans, including perfusion abnormalities, acute ischemic lesions, multiple micro-hemorrhages, and white matter-enhancing lesions. In addition, 55 patients had biological abnormalities – dysnatremia, kidney failure, and liver dysfunction, but cerebrospinal fluid analysis in all patients showed no evidence of the SARS-CoV-2 virus.

The remaining nine patients (1 percent of the hospitalized group) who had no identifiable cause of brain injury outside of COVID-19 received CORE diagnoses – six had movement disorders, seven had frontal syndrome, four had brainstem impairment, four had periodic EEG discharges, and three had MRI white matter-enhancing lesions.

“The results from this cohort of patients hospitalized with COVID-19 suggest there are clinical, EEG, and MRI patterns that could delineate specific COVID-19-related encephalopathy and guide treatment strategy,” the team said.

Specifically, the team found the most frequent EEG outcomes were abnormal background activity (81 percent) and frontal slow waves (60 percent) with the latter being linked to metabolic and toxic encephalopathies or frontal lesions. In addition, they discovered that patients with CORE had periodic EEG pattern more frequently than did other patients.

Frontal lobe EEG abnormalities paired with frontal syndrome in CORE patients pointed to front lobe dysfunction, the team said. Because inflammatory mechanisms, such as cytokine-mediated response or post-viral autoimmune process, could be at play, they noted that immunomodulator treatments, including plasma exchanges or intravenous immunoglobulins could be used as early treatments.

“In our study, we showed that patients with CORE mostly had movement disorders (mainly seizures and/or myorrhythmia), and brainstem impairment (oculomotor disorders, such as bobbing) and frontal syndrome (disinhibition and grasping),” the team said. “Our study suggests that EEG is a valuable procedure for patients with COVID-19 and neurological symptoms, to better identify different brain dysfunctions and CORE.”

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