Abstracts

Rationale:
The pandemic caused by COVID-19 is an unprecedented global public health emergency with far-reaching effects. Patients most commonly present with fever and respiratory symptoms. However, neurologic symptoms have been observed. We aimed to describe the EEG and associated neuroimaging patterns of hospitalized patients with COVID-19.
Method:
We performed a retrospective chart review of patients who received VEEG monitoring at the Mount Sinai Hospital in New York City from March 15, 2020 to May 15, 2020. Patients with positive COVID PCR or antibody(Ab) during the study period were included. Reason for EEG monitoring, medical comorbidities, neuroimaging findings and final outcomes were collected. EEG findings were extracted from EEG reports and included background, interictal and ictal findings. Descriptive statistics were used to characterize the cohort and outcomes of interest. Results50 patients (mean age 62.6, 56% male) were monitored during the study period. 44 (88%) had a positive COVID PCR before their VEEG, while another 6 (12%) had either a positive Ab or tested positive later during the same admission. The most common reason for vEEG monitoring was persistent encephalopathy or coma (68%), witnessed seizure/shaking (24%), unexplained focal neurologic deficit(s) (20%) or prognostication after cardiac arrest (10%). 84% of participants had severe COVID, defined as requiring endotracheal intubation. Of all patients, 72% had acute kidney injury or renal failure, 60% were unresponsive/comatose, 24% had an acute ischemic stroke, 14% had intracranial hemorrhage or hemorrhagic transformation of ischemic infarcts and 6% had anoxic brain injury on neuroimaging. EEG background was abnormal in all patients: 98% has generalized slowing, 36% generalized attenuation, and 10% focal slowing/sharp waves. Additionally, 18% had generalized periodic discharges and 14% had generalized sharp waves. Lateralized periodic discharges and lateralized rhythmic delta activity were present in 2 and 4% of studies, respectively. Seizures were captured in 3 patients (6%). Of these 3 patients, two occurred in the setting of anoxic brain injury after cardiac arrest while the third occurred in the setting of acute renal failure and sepsis being treated with cefepime. 40% of pts who underwent VEEG monitoring were on at least one AED, most commonly levetiracetam, while 26% were on at least one sedating infusion. Of those monitored, 36% had died at the time of this analysis (June 2020).
Conclusion:
Our preliminary analysis demonstrates that most patients who underwent VEEG monitoring in the setting of COVID-19 had severe disease as well as renal dysfunction. The most common reasons for EEG monitoring were persistent encephalopathy or witnessed seizure/shaking activity. About a third of these patients had additional CNS injury including ischemic stroke or anoxic brain injury. EEG mostly showed generalized findings including diffuse slowing / attenuation, and generalized epileptiform discharges consistent with toxic-metabolic encephalopathy. Seizures were rare, seen only in 6% in this cohort, all of whom had acute secondary CNS or systemic injuries (anoxic brain injury, cefepime). Additional analyses are ongoing.
Funding:
:None