ABSTRACT
51-year-old man (C.P.) had a diffuse-axonal-injury after falling from a 5-meter height, followed by a 22-minute anoxia due to a cardiac arrest. In the ICU, he tested positive to COVID-19, and needed intubation. After coronavirus infection, C.P. presented Guillain-Barre syndrome. 2months after discharge, he was admitted to rehabilitation. DTI tractography for evaluation of the structural integrity of white matter tracts revealed: i) Lesions in the basal ganglia;ii) Sequelary lesions in the right frontal, cortical, subcortical, temporal, parieto-occipital and cerebellar hemispheres;iii) Asymmetry of the corticospinal tracts - less fibers on the left;iv) Poor definition of the fibers of the right arcuate fasciculus;v)Asymmetrical thinning of the cortico-ponto-cerebellar tracts, worse on the left, and more discreetly in the spinocerebellar tracts. Based on this, C.P. underwent 4 different 30-session tDCS protocols consisting of twice-daily 20min 2mA sessions (10min interval), 5days/week (120sessions total), combined with physiotherapy, cognitive, swallowing and speech therapy. Montages: Pr1 (anode: Cz - 5x10cm;cathode: 10th Thoracic Vertebra - 5x7cm);Pr2 (1 - anode:C3;cathode:Fp2 / 2 - anode: Cerebellum;cathode:Fp2);Pr3 (anode:F3;cathode:Fp2) and Pr4 (anode:Cp5;cathode:Fp2). Except for Pr1, electrode size for all protocols were 5x7cm. We used the Coma Recovery Scale (CRS-R) and Rancho Los Amigos Scale (RLAS) for clinical assessments at the baseline and after every 10 sessions until the end of the intervention. At the baseline, C.P. presented a minimal responsive state of consciousness (CRS-R: 3;RLAS: Level 1) and tolerated well the tDCS interventions. CRS-R scores gradually improved in various domains during the treatment. At the end, RLAS score was level 5 and CRS-R, 19. Our preliminary results suggest DTI tractography may be a potential biomarker to guide more personalized tDCS interventions for complex cases of patients with acquired brain injuries. A second DTI tractography will be made in the future for comparison purposes. Research Category and Technology and Methods Clinical Research: 9. Transcranial Direct Current Stimulation (tDCS) Keywords: Acquired Brain Injury, Traumatic Brain Injury, COVID-19, Guillain Barre SyndromeCopyright © 2023
ABSTRACT
Objective: To describe cases of transverse myelitis (TM) associated with mild COVID-19 in adults. Background: Post-infectious TM is described after various infections but is not as well-known after COVID-19. Design/Methods: We present a series of 2 cases who developed TM after infection with SARS-CoV-2. Case 1: 55-year-old male with coronary artery disease presented with worsening paraparesis over 4 months, T4 sensory level and urinary retention, starting two weeks after mild COVID-19 illness. MRI showed T2 hyperintensity extending from the lower medulla to T3 spinal cord. CSF analysis revealed elevated protein and pleocytosis. His functional status improved after plasma exchange. Subsequently, his symptoms worsened and was treated with multiple courses of glucocorticoids. He recently started Rituximab and continues to have leg weakness with urinary retention. Case 2: 66-year-old male with diabetes mellitus presented in a wheelchair with rapidly progressive paraparesis over 10 days, starting six weeks after mild COVID-19 illness. He was initially diagnosed with GBS and received IVIG with no improvement. MRI revealed T2 hyperintensity in the lateral corticospinal tracts of cervical and thoracic spinal cord. Somatosensory evoked potential testing showed mild bilateral demyelinating lesions involving the dorsal columns between the C6-parietal cortex. CSF analysis was normal. Plasma exchange therapy provided minimal improvement. He remains wheelchair bound with urinary urgency. In both cases, other causes of TM including neuromyelitis optica, myelin oligodendrocyte associated disease, neurosarcoidosis and paraneoplastic myelopathy were ruled out. Conclusions: SARS-CoV2 may cause a post-infectious TM. While causation remains difficult to prove, our cases suggest TM was precipitated by COVID-19 given the temporal association and no other identified etiology. Our cases continued to have significant neurologic deficits likely due to delayed diagnosis. These cases add to the growing body of evidence of neurologic complications associated with COVID-19. Further studies are needed to establish the incidence and outcomes of post-infectious TM after COVID-19.
ABSTRACT
This study aims to evaluate the impact of French national lockdown of 55 days on brain metabolism of patients with neurological disorders. Whole-brain voxel-based PET analysis was used to correlate 18 F-FDG metabolism to the number of days after March 17, 2020 (in 95 patients; mean age: 54.3 years ± 15.7; 59 men), in comparison to the same period in 2019 before the SARS-CoV-2 outbreak (in 212 patients; mean age: 59.5 years ± 15.8; 114 men), and to the first 55 days of deconfinement (in 188 patients; mean age: 57.5 years ± 16.5; 93 men). Lockdown duration was negatively correlated to the metabolism of the sensory-motor cortex with a prevailing effect on the left dominant pyramidal tract and on younger patients, also including the left amygdala, with only partial reversibility after 55 days of deconfinement. Weak overlap was found with the reported pattern of hypometabolism in long COVID (<9%). Restriction of physical activities, and possible related deconditioning, and social isolation may lead to functional disturbances of sensorimotor and emotional brain networks. Of note, this metabolic pattern seems distinct to those reported in long COVID. Further longitudinal studies with longer follow-up are needed to evaluate clinical consequences and relationships on cognitive and mental health against functional deactivation hypothesis, and to extend these findings to healthy subjects in the context of lockdown.