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EEG Abnormalities and Their Radiographic Correlates in a COVID-19 Inpatient Cohort.

Sean T Hwang1, Ahmad A Ballout1, Anup N Sonti1

  • 1Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY.

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Electroencephalogram (EEG) abnormalities are common in COVID-19 patients with neurological symptoms, often linked to neuroimaging findings. High mortality rates were observed, especially in those with coma and on ventilators.

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Area of Science:

  • Neurology
  • Infectious Diseases
  • Neurophysiology

Background:

  • Coronavirus disease 2019 (COVID-19) can present with diverse neurological manifestations.
  • Understanding the electrophysiological correlates of these neurological changes is crucial for patient management.

Purpose of the Study:

  • To determine the prevalence of electroencephalogram (EEG) abnormalities in COVID-19 patients with neurological symptoms.
  • To investigate the association between EEG findings and neuroimaging abnormalities.
  • To analyze in-hospital mortality rates in relation to EEG findings.

Main Methods:

  • Retrospective case series of 192 adult COVID-19 inpatients who underwent EEG.
  • Analysis of EEG indications, epilepsy history, medication use, and neuroimaging findings.
  • Correlation of EEG abnormalities with clinical status and mortality.

Main Results:

  • EEG abnormalities were frequent, with generalized slowing (88.5%) and epileptiform abnormalities (39.6%) being common.
  • Epileptiform abnormalities were associated with older age, epilepsy history, and antiseizure medication (ASM) use.
  • Neuroimaging pathology was present in 67.1% of patients with epileptiform abnormalities.
  • In-hospital mortality was 39.5% for patients with epileptiform abnormalities, with coma and ventilator support as risk factors.

Conclusions:

  • A wide spectrum of EEG abnormalities is associated with neuroimaging findings in COVID-19 patients.
  • High mortality rates underscore the severity of neurological involvement in severe COVID-19.
  • These findings can inform prognosis and management strategies for COVID-19 patients with neurological complications.