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

2021 ◽  
pp. 10.1212/CPJ.0000000000001136
Author(s):  
Sean T. Hwang ◽  
Ahmad A. Ballout ◽  
Anup N. Sonti ◽  
Amitha Kapyur ◽  
Claudia Kirsch ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Case Series ◽  
Medication Administration ◽  
Retrospective Case ◽  
Ventilator Support ◽  
Periodic Discharges ◽  
Epileptiform Discharges ◽  
Abnormal Movements ◽  
Eeg Abnormalities ◽  
Electrographic Seizures

ABSTRACT:Objective:To identify the prevalence of EEG abnormalities in patients with COVID-19 with neurologic changes, their associated neuroimaging abnormalities and rates of mortality.Methods:A retrospective case series of 192 adult COVID-19 positive inpatients with EEG performed between March and June 2020 at 4 hospitals: 161 undergoing continuous, 24 routine, and 7 reduced- montage EEG. Study indication, epilepsy history, intubation status, administration of sedatives or antiseizure medications, metabolic abnormalities, neuroimaging pathology associated with epileptiform abnormalities, and in-hospital mortality were analyzed.Results:EEG indications included encephalopathy (54.7%), seizure (18.2%), coma (17.2%), focal deficit (5.2%), and abnormal movements (4.6%). Epileptiform abnormalities occurred in 39.6% of patients: focal intermittent epileptiform discharges in 25.0%, lateralized periodic discharges in 6.3%, and generalized periodic discharges in 19.3%. Seizures were recorded in 8 patients, 3 with status epilepticus. Antiseizure medication administration, epilepsy history, and older age were associated with epileptiform abnormalities. Only 26.3% of patients with any epileptiform abnormality, 37.5% with electrographic seizures, and 25.7% patients with clinical seizures had known epilepsy. Background findings included generalized slowing (88.5%), focal slowing (15.6%), burst suppression (3.6%), attenuation (3.1%), and normal EEG (3.1%). Neuroimaging pathology was identified in 67.1% of patients with epileptiform abnormalities, over two-thirds acute. In-hospital mortality was 39.5% for patients with epileptiform abnormalities, 36.2% for those without. Risk factors for mortality were coma and ventilator support at time of EEG.Significance:This article highlights the range of EEG abnormalities frequently associated with acute neuroimaging abnormalities in COVID-19. Mortality rates were high, particularly for patients in coma requiring mechanical ventilation. These findings may guide the prognosis and management of patients with COVID-19 and neurologic changes.

scholarly journals Incidence of Electrographic Seizures in Patients With COVID-19

2021 ◽  
Vol 12 ◽  
Author(s):  
Brandon L. Waters ◽  
Andrew J. Michalak ◽  
Danielle Brigham ◽  
Kiran T. Thakur ◽  
Amelia Boehme ◽  
...  
Keyword(s):  
Critical Illness ◽  
Case Series ◽  
Nasopharyngeal Swab ◽  
Convulsive Status Epilepticus ◽  
Retrospective Case ◽  
Predictive Values ◽  
Electrographic Seizure ◽  
Epileptiform Discharges ◽  
Interictal Epileptiform Discharges ◽  
Electrographic Seizures

Critical illness and sepsis are commonly associated with subclinical seizures. COVID-19 frequently causes severe critical illness, but the incidence of electrographic seizures in patients with COVID-19 has been reported to be low. This retrospective case series assessed the incidence of and risks for electrographic seizures in patients hospitalized with COVID-19 who underwent continuous video electroencephalography monitoring (cvEEG) between March 1st, 2020 and June 30th, 2020. One hundred and twenty-two patients were initially identified who resulted SARS-CoV-2 nasopharyngeal RT-PCR swab positivity with any electroencephalography order placed in the EMR. Seventy-nine patients met study inclusion criteria: age ≥18 years, >1 h of cvEEG monitoring, and positive SARS-CoV-2 nasopharyngeal swab PCR. Six (8%) of the 79 patients suffered electrographic seizures (ES), three of whom suffered non-convulsive status epilepticus. Acute hyperkinetic movements were the most common reason for cvEEG in patients with ES (84%). None of the patients undergoing cvEEG for persistent coma (29% of all patients) had ES. Focal slowing (67 vs. 10%), sporadic interictal epileptiform discharges (EDs; 33 vs. 6%), and periodic/rhythmic EDs (67 vs. 1%) were proportionally more frequent among patients with electrographic seizures than those without these seizures. While 15% of patients without ES had generalized periodic discharges (GPDs) with triphasic morphology on EEG, none of the patients with ES had this pattern. Further study is required to assess the predictive values of these risk factors on electrographic seizure incidence and subsequent outcomes.

scholarly journals Estimated impact of maternal vaccination on global paediatric influenza-related in-hospital mortality: A retrospective case series

2021 ◽  
pp. 100945
Author(s):  
Yvette N Löwensteyn ◽  
Harish Nair ◽  
Marta C Nunes ◽  
Ichelle van Roessel ◽  
Femke S Vernooij ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Case Series ◽  
Retrospective Case ◽  
Maternal Vaccination ◽  
Retrospective Case Series

scholarly journals P.024 Stimulus-Induced Rhythmic, Periodic or Ictal Discharges (SIRPIDs): associated factors and prognostic implications

2016 ◽  
Vol 43 (S2) ◽  
pp. S27-S27
Author(s):  
S Braksick ◽  
D Burkholder ◽  
T Spyridoula ◽  
L Martineau ◽  
J Mandrekar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Mortality ◽  
Demographic Data ◽  
Clinical Predictors ◽  
Epileptiform Discharges ◽  
Electrographic Seizures ◽  
Alteration Of Consciousness ◽  
Prognostic Implications ◽  
Antiepileptic Medications

Background: SIRPIDS were first described in 2004 in patients admitted in an intensive care unit. Despite few studies attempting to better characterize SIRPIDS, their pathophysiology and clinical implication remain uncertain. Methods: Adult patients hospitalized in an intensive care unit with alteration of consciousness who underwent EEG recording in three separate centers were included in this retrospective study. Demographic data and EEG findings were noted. Characteristics of SIRPIDS were documented. The main outcome measures included the incidence of SIRPIDS, association of SIRPIDS with mortality and other EEG characteristics, EEG and clinical predictors of mortality. Results: 416 patients were included and SIRPIDs were identified in 43 patients (10.3%). The proportion of patients with SIRPIDs was not significantly different across the three sites (p=0.3351). Anoxia (p=0.0009), antiepileptic medications (p=0.0109), electrographic seizures (p=0.0259), triphasic waves (p=0.0012) and epileptiform discharges (p=0.0242) were independently associated with the presence of SIRPIDs. Older age (p=0.0050), anoxia (p=<0.0001) and absence of EEG reactivity (p<0.0001), but not SIRPIDs (p=0.1668), were independently associated with in-hospital mortality. Conclusions: In critically ill patients undergoing EEG, SIRPIDs occurred in 10% and were associated with other electrographic abnormalities previously reported to indicate poor prognosis. SIRPIDs were not independently associated with in-hospital mortality.

scholarly journals Risk factors for in-hospital mortality after coronary artery bypass grafting in patients 80 years old or older: a retrospective case-series study

PeerJ ◽  
2016 ◽  
Vol 4 ◽  
pp. e2667 ◽  
Author(s):  
Jacek Piątek ◽  
Anna Kędziora ◽  
Janusz Konstanty-Kalandyk ◽  
Grzegorz Kiełbasa ◽  
Marta Olszewska ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Hospital Mortality ◽  
Artery Bypass ◽  
Nyha Class ◽  
Case Series ◽  
Bypass Grafting ◽  
Retrospective Case ◽  
Case Series Study ◽  
Series Study

Background Age remains a significant and unmodifiable risk factor for cardiovascular diseases, and an increasing number of patients older than 80 years of age undergo Coronary Artery Bypass Grafting (CABG). Old age is also an independent risk factor for postoperative complications. The aim of this study is to describe the population of patients 80 years of age or older who underwent CABG procedure and to assess the mortality rate and risk factors for in-hospital mortality. Methods A retrospective case-series study analyzing 388 consecutive patients aged 80 years of age or older who underwent isolated CABG procedure between 2010 and 2014 in the Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow. Results In-hospital mortality stood at 7%, compared to 3.4% for all isolated CABG procedures at our Institution. In an univariate logistic regression analysis, risk factors for in-hospital mortality were as follows: NYHA class (p = 0.005, OR 1.95, 95% CI [1.23–3.1]), prolonged mechanical ventilation (p < 0.001, OR 7.08, 95% CI [2.47–20.3]), rethoracotomy (p = 0.04, OR 3.31, 95% CI [1.04–10.6]), duration of the procedure and ECC (for every 10 min p = 0.01, OR 1.01, 95% CI [1.0–1.01]; p = 0.03, OR 1.01, 95% CI [1.0–1.02], respectively), PRBC, FFP, and PLT transfusion (for every unit transfused p = 0.004, OR 1.42, 95% CI [1.12–1.8]; p = 0.002, OR 1.55, 95% CI [1.18–2.04]; p = 0.009, OR 1.93, 95% CI [1.18–3.14], respectively). Higher LVEF (p = 0.02, OR 0.97, 95% CI [0.94–0.99]) and LIMA graft implantation (p = 0.04, OR 0.36, 95% CI [0.13–0.98) decreased the in-hospital mortality. Death before discharge was more often observed in patients with multiple risk factors for cardiovascular diseases (0–2 –5.7%; 3–7.4%, 4–26.6%; p = 0.03). Conclusions Older age is associated with higher in-hospital mortality after isolated CABG at our Institution. Risk stratification scores and individualized risk evaluation, centered on comorbidities, NYHA class and left ventricular function, should be assessed in all cases. Whenever suitable, LIMA grafts should be used. Prolonged procedure and ECC time worsen the short-term outcome. Elderly individuals should be closely monitored postoperatively and the care should be focused on excessive blood loss and respiratory failure.

scholarly journals Warfarin Dose Requirements in Adults Hospitalized With COVID-19 Infection: A Retrospective Case Series

2021 ◽  
pp. 089719002110007
Author(s):  
Madison N. Irwin ◽  
Sarah Adie ◽  
Katherine Sandison ◽  
Sarah A. Alsomairy ◽  
Adamo Brancaccio
Keyword(s):  
Hospital Mortality ◽  
Case Series ◽  
Warfarin Dose ◽  
Retrospective Chart Review ◽  
Retrospective Case ◽  
Available N ◽  
Percentage Decrease ◽  
The Mean ◽  
Clinically Significant ◽  
The Impact

Purpose: To describe the impact of hospitalization with COVID-19 infection on warfarin dose requirements in adult inpatients. Summary: A retrospective chart review of 8 adults on warfarin admitted to Michigan Medicine with COVID-19 infection was conducted and reported as a case series. Outcomes of interest were difference in average daily dose of warfarin prior to admission (PTA) and while inpatient (IP), warfarin sensitivity, time in therapeutic range (TTR), confirmed or suspected thromboembolic event, any major or clinically significant bleeding episodes, and in-hospital mortality. IP average daily warfarin doses were lower when compared to PTA average daily doses [1.3 mg (1.3) vs. 6.2 mg (4.1)]. The mean percentage decrease in dose was 68.8% (23) and the mean absolute dose difference was 4.8 mg (4.3). Mean IP percentage tests in range was 30.8% (24.6) and mean IP warfarin sensitivity was 4.2 (3.8), both of which differed from PTA TTR and warfarin sensitivity for those with data available (n = 3, n = 6, respectively). One patient was treated for suspected acute pulmonary embolism while on warfarin and one patient experienced clinically relevant bleeding. In-hospital mortality was zero, mean length of stay (LOS) was 17 days (14.4), and mean intensive care unit (ICU) LOS for the 3 patients requiring ICU level care was 14.3 days (4.5). Conclusion: Decreased warfarin dose requirements were evident in this group of adults hospitalized with COVID-19 infection. These findings suggest lower doses of warfarin may be needed to achieve therapeutic anticoagulation while inpatient.

scholarly journals 399. Risk Factors for Mortality in COVID-19 Patients in a Community Teaching Hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S268-S268
Author(s):  
Justin A Andrade ◽  
Karina Muzykovsky ◽  
James Truong
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Logistic Regression ◽  
Hospital Mortality ◽  
Teaching Hospital ◽  
Case Series ◽  
Advanced Age ◽  
Retrospective Case ◽  
Multivariable Logistic Regression ◽  
Community Teaching

Abstract Background As of May 2020, there were over 190,000 confirmed COVID-19 cases in New York City (NYC) with approximately 13,000 deaths. Previously published literature identified risk factors (advanced age, higher severity of illness and elevated d-dimer) for mortality in a cohort of patients from Wuhan, China and mechanical ventilation in a case series from NYC. Another case series from NYC evaluated clinical outcomes only. There are limited published studies assessing clinical characteristics, outcomes and risk factors for mortality in COVID-19 patients in NYC. The objective of this study was to assess the risk factors for mortality in patients with confirmed COVID-19 infections. Methods This study was a single center retrospective case-control at The Brooklyn Hospital Center, a 464-bed community teaching hospital. Adult patients with confirmed COVID-19 infection, who received at least 24 hours of COVID-19 therapy were included. Endpoints assessed were risk factors for mortality in COVID-19 patients, increase in QTc, renal failure or renal replacement therapy, ventricular fibrillation or ventricular tachycardia. Baseline characteristics between survivor and non-survivors were analyzed utilizing Mann-Whitney U test/two-tailed t-tests for continuous data and Chi-square/Fisher’s exact test for categorical data. Univariable and multivariable logistic regression analyses were conducted to identify the risk factors for in-hospital mortality. Results Two-hundred and eighty six patients were included in this analysis, of whom 97 (33.9%) were non-survivors and 189 (66.1%) patients were survivors. Diabetes and coronary artery disease were more common in non-survivors compared to survivors (p = 0.003 and p &lt; 0.001, respectively). Multivariable logistic regression showed higher in-hospital mortality in patients with advanced age (odds ratio 5.779, 95 % confidence interval 1.369–24.407), vasopressor initiation (OR 28.301, 95 % CI 3.307–242.176), and development of renal failure (OR 30.927, 95 % CI 1.871–511.201). Conclusion Risk factors associated with mortality for COVID-19 patients in a community teaching hospital include advanced age, vasopressor therapy, and development of renal failure. Disclosures All Authors: No reported disclosures

scholarly journals Electroencephalographic abnormalities in COVID-19-related encephalopathies: A systematic review

2020 ◽  
Vol 8 (35) ◽  
pp. 36-41
Author(s):  
Jie Pan ◽  
Shazma Khan ◽  
Smathorn Thakolwiboon ◽  
Dargelis Chi
Keyword(s):  
Status Epilepticus ◽  
Case Reports ◽  
Neurological Complication ◽  
Case Series ◽  
Convulsive Status Epilepticus ◽  
Acute Encephalopathy ◽  
Case Control Studies ◽  
Retrospective Case ◽  
Epileptiform Discharges ◽  
Slow Activity

Background: Acute encephalopathy is a common neurological manifestation in coronavirus disease 2019 (COVID-19) patients and presents with confusion, delirium, or poor responsiveness. Non-convulsive status epilepticus (NCSE) is an important differential diagnosis in this situation. The electroencephalography (EEG) patterns in COVID-19 patients remain largely unknown. Method: A literature search was conducted on MEDLINE, EMBASE, and Cochrane database. Eligibility criteria included case series and case reports of COVID-19 patients with neurological complication who underwent EEG. Two authors screened all resulting studies and extracted the data independently. Results: Four retrospective case control studies and eleven case reports were identified. Background diffuse slow activity were seen in most of the COVID-19 patients. Other EEG patterns reported included status epilepticus, focal slow activity, rhythmic periodic discharges, and interictal epileptiform discharges. Imaging and CSF studies were available in only a few patients. Conclusions: Acute encephalopathy is common in the context of COVID-19. There is no specific EEG pattern found in these patients. Keywords: COVID-19, coronavirus, SAR-CoV-2, electroencephalogram, EEG

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