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

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 nev-ertheless severe complications, such as inflammation of the brain parenchyma (with or without cerebrovascular in-volvement), demyelination, or seizures, which may be dis-proportionate to COVID-19 severity and require specific management. Given the large number of patients hospital-ized with severe acute respiratory syndrome coronavirus-2 infection, even these relatively unlikely complications are increasingly recognized and are particularly important be-cause they require specific management. Therefore, the aim of this review is to provide pragmatic guidance on the management of COVID-19 encephalopathy through con-sensus agreement of the Global COVID-19 Neuro Re-search Coalition. A systematic literature search of MEDLINE, medRxiv, and bioRxiv was conducted between January 1, 2020, and June 21, 2021, with additional review of refer-ences cited within the identified bibliographies. A modified Delphi approach was then undertaken to develop recom-mendations, 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 pathophysi-ology of COVID-19 encephalopathy and practical guidance for clinical assessment, investigation, and both acute and long-term management. J Neuropsychiatry Clin Neurosci 2023; 35:12-27;doi: 10.1176/appi.neuropsych.22010002

Automated summary

Encephalopathy is a common and challenging condition among hospitalized COVID-19 patients, which can have a negative impact on prognosis. This review provides practical guidance on the management of COVID-19 encephalopathy through consensus agreement of the Global COVID-19 Neuro Research Coalition, covering definition, epidemiology, pathophysiology, clinical assessment, investigation, and both acute and long-term management.