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December 21, 2020ArticleOpen Access

Prolonged Unconsciousness Following Severe COVID-19

Wilson F. Abdo, Catharina I. Broerse, Bart P. Grady, Agnes A.A.C.M. Wertenbroek, Onno Vijlbrief, Marc P. Buise, Menno Beukema, Mark van der Kuil, Anil M. Tuladhar, Frederick J.A. Meijer, Johannes G. van der Hoeven
First published December 21, 2020, DOI: https://doi.org/10.1212/WNL.0000000000011355
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Abstract

Objective: We report a case series of patients with prolonged but reversible unconsciousness following COVID-19 related severe respiratory failure.

Methods: A case series of patients who were admitted to the ICU due to COVID-19 related acute respiratory failure is described.

Results: After cessation of sedatives the described cases all showed a prolonged comatose state. Diagnostic neurological work-up did not show signs of devastating brain injury. The clinical pattern of awakening started with early eye opening without obeying commands and persistent flaccid weakness in all cases. Time between cessation of sedatives to the first moment of being fully responsive with obeying commands ranged from 8 to 31 days.

Conclusion: Prolonged unconsciousness in patients with severe respiratory failure due to COVID-19 can be fully reversible warranting a cautious approach for prognostication based on a prolonged state of unconsciousness.

  • Received August 14, 2020.
  • Accepted in final form November 23, 2020.

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License 4.0 (CC BY-NC-ND), which permits downloading and sharing the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

Disputes & Debates: Rapid online correspondence

  • Reader response: Prolonged Unconsciousness Following Severe COVID-19
    • Alberto Vogrig, Neurologist, Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
    • Mariarosaria Valente, Professor of Neurology, Neurology Unit, University of Udine Medical School, Udine, Italy
    • Annacarmen Nilo, Neurologist, Clinical Neurology Unit, Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
    • Gian Luigi Gigli, Professor of Neurology, Neurology Unit, University of Udine Medical School, Udine, Italy
    Submitted January 07, 2021
  • Reader response: Prolonged Unconsciousness Following Severe COVID-19
    • Calixto Machado, Senior Professor and Researcher in Neurology, Institute of Neurology and Neurosurgery, Department of Clinical Neurophysiology, Havana, Cuba
    Submitted December 29, 2020
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