Consensus Clinical Guidance for Diagnosis and Management of Adult COVID-19 Encephalopathy Patients

Authors:
  • BMBenedict D. Michael
    Benedict D. Michael
  • DWDean Walton
    Dean Walton
  • EWErica Westenberg
    Erica Westenberg
  • DGDavid García-Azorín
    David García-Azorín
  • BSBhagteshwar Singh
    Bhagteshwar Singh
  • ATArina A. Tamborska
    Arina A. Tamborska
  • MNM. Netravathi
    M. Netravathi
  • MCMashina Chomba
    Mashina Chomba
  • GWGreta K. Wood
    Greta K. Wood
  • AEAva Easton
    Ava Easton
  • OSOmar K. Siddiqi
    Omar K. Siddiqi
  • TJThomas A. Jackson
    Thomas A. Jackson
Publisher website
Google Scholar
Abstract
Encephalopathy, a common condition among patients hospitalized with COVID-19, can be a challenge to manage and negatively affect prognosis. While encephalopathy may present clinically as delirium, subsyndromal delirium, or coma and may be a result of 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, or seizures, which may be disproportionate to COVID-19 severity and require specific management. Given the large number of patients hospitalized with severe acute respiratory syndrome coronavirus–2 infection, even these relatively unlikely complications are increasingly recognized and are particularly important because 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 January 1, 2020, and June 21, 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 recommendations and the supporting evidence. This review presents analysis of contemporaneous evidence for the definition, epidemiology, and pathophysiology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and both acute and long-term management.

This publication has 122 references indexed in Scilit: