More on Neurologic Features in Severe SARS-CoV-2 Infection
Julie Helms, Stéphane Kremer, Ferhat Meziani
Abstract
More on Neurologic Features in Severe SARS-CoV-2 InfectionTo the Editor: In a letter by Helms et al. (published on April 15 at NEJM.org), 1 neurologic features in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are described.We do not concur that there is clearly abnormal leptomeningeal or nodular enhancement in Figures S1 andS3 in the Supplementary Appendix (available with the full text of the letter at NEJM.org).In addition, the perfusion in the frontal and temporal lobes appears to be normal; specifically, these regions do not appear to be hypoperfused.The most common neurologic features in the patients involved in the study by Helms and colleagues were nonfocal: confusion, agitation, dysexecutive syndrome, and diffusely enhanced reflexes.These symptoms and signs do not typically relate to focal brain disease and are not necessarily in accord with the imaging findings.The findings of Helms et al. are concordant with the neurologic findings in patients with Covid-19 in another recent study, 2 and the incidence of these findings may not be disproportionate to the incidence among other critically ill patients.They may not definitively indicate a specific syndrome of brain involvement associated with SARS-CoV-2.