To: Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens - Critical Care Science (CCS)

To: Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens |

To the Editor

With interest, we read the article by Teixeira-Vaz et al. on a prospective, single-center cohort study among 27 coronavirus disease 2019 (COVID-19) patients requiring mechanical ventilation > 48 hours for acute respiratory distress syndrome (ARDS).⁽⁾ Compared to a disease control cohort, COVID-19 ARDS patients had an increased risk of neurological complications and corticospinal tract dysfunction.⁽⁾ It was concluded that patients with severe COVID-19 should be systematically examined neurologically.⁽⁾ The study is excellent but has limitations that are a cause for concern and should be discussed.

The main limitation of the study is that the clinical neurological examination was incomplete.⁽⁾ The exam included only assessment of the sedation level, excitability of tendon reflexes, and presence/absence of Babinski’s sign.⁽⁾ By evaluating only these three points, it is impossible to decide whether an individual patient has developed central nervous system or peripheral nervous system complications. A comprehensive clinical neurological examination is required to assess whether COVID-19 is complicated by neurological impairment. If the clinical examination indicates neurological abnormalities, instrumental investigations, such as cerebral imaging, electrophysiology, and cerebrospinal fluid studies, need to be initiated. Regarding the clinical exam, it is not clear why only the cortico-spinal tract functions were assessed. SARS-CoV-2 infections affect not only motor functions but also the entire body, particularly the entire central nervous system and peripheral nervous system.

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