ABSTRACT
Background Enforced national lockdown due to COVID-19 limited access to medical services. We evaluated the impact on those presenting with papilloedema, and those with a preexisting diagnosis of idiopathic intracranial hypertension. Design A single United Kingdom centre prospective cohort study between May 15, 2020 (start of emergency clinics after first 8 week national lockdown) and July 31, 2020. Demographics, diagnosis and outcomes were documented. Results The study recorded 130 individual patients, 123 with a diagnosis of idiopathic intracranial hyper-tension. 92% were female and mean age was 32.5 years. Emergency cerebrospinal fluid diversion surgery was required in 13% (17/130), a 4.7-fold (367%) increase compared to the same period in 2019. Weight increased in 58% (mean 6.2kg SD 4.6) and corresponded to a significant increase in papilloedema (Optical Coherence Tomography retinal nerve fibre layer 15mm SD 57.3, p=0.014). Elevated anxiety levels (hospital anxiety and depression scale >7) occurred in 64%. Conclusions There was a 367% increase in emergency shunting to save vision in idiopathic intracranial hypertension following national lockdown. Worsening of papilloedema, weight gain, and detrimental effects on mental health were recorded. Countermeasures should be implemented to minimise harm in this rare disease during future service restrictions and lockdowns.
ABSTRACT
AIM: To describe the neuroradiological changes in patients with coronavirus disease 2019 (COVID-19). MATERIALS AND METHODS: A retrospective review was undertaken of 3,403 patients who were confirmed positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and admitted to Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK between 1 March 2020 and 31 May 2020, and who underwent neuroimaging. Abnormal brain imaging was evaluated in detail and various imaging patterns on magnetic resonance imaging MRI were identified. RESULTS: Of the 3,403 patients with COVID-19, 167 (4.9%) had neurological signs or symptoms warranting neuroimaging. The most common indications were delirium (44/167, 26%), focal neurology (37/167, 22%), and altered consciousness (34/167, 20%). Neuroimaging showed abnormalities in 23% of patients, with MRI being abnormal in 20 patients and computed tomography (CT) in 18 patients. The most consistent neuroradiological finding was microhaemorrhage with a predilection for the splenium of the corpus callosum (12/20, 60%) followed by acute or subacute infarct (5/20, 25%), watershed white matter hyperintensities (4/20, 20%), and susceptibility changes on susceptibility-weighted imaging (SWI) in the superficial veins (3/20, 15%), acute haemorrhagic necrotising encephalopathy (2/20, 10%), large parenchymal haemorrhage (2/20, 10%), subarachnoid haemorrhage (1/20, 5%), hypoxic-ischaemic changes (1/20, 5%), and acute disseminated encephalomyelitis (ADEM)-like changes (1/20, 5%). CONCLUSION: Various imaging patterns on MRI were observed including acute haemorrhagic necrotising encephalopathy, white matter hyperintensities, hypoxic-ischaemic changes, ADEM-like changes, and stroke. Microhaemorrhages were the most common findings. Prolonged hypoxaemia, consumption coagulopathy, and endothelial disruption are the likely pathological drivers and reflect disease severity in this patient cohort.