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2.
Pediatr Infect Dis J ; 40(7): e270-e271, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1201291

ABSTRACT

The majority of coronavirus disease 2019 (COVID-19) have been confirmed in adults, with only a few reported cases in children. In the pediatric population, COVID-19 infection appears to be often unremarkable or associated with mild respiratory symptoms. Little is known about neurologic complications related to COVID-19 in newborns. We present a case of severe encephalitis with cytotoxic brain edema in a newborn with COVID-19.


Subject(s)
Brain Edema/pathology , Brain Edema/virology , Brain/pathology , COVID-19/complications , Encephalitis, Viral/etiology , Acute Disease , Brain/diagnostic imaging , Brain/virology , Brain Edema/diagnostic imaging , COVID-19/diagnosis , Female , Humans , Infant, Newborn , Infectious Disease Transmission, Vertical , Magnetic Resonance Imaging , Male , Pregnancy , Pregnancy Complications, Infectious/virology , Seizures/virology
3.
Neurology ; 95(14): e2016-e2027, 2020 10 06.
Article in English | MEDLINE | ID: covidwho-1105774

ABSTRACT

OBJECTIVES: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered to have potential neuroinvasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID-19). This study investigates the occurrence of structural brain abnormalities in non-survivors of COVID-19 in a virtopsy framework. METHODS: In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS-CoV-2 detection on nasopharyngeal swab specimen, chest CT scan suggestive of COVID-19, absence of known focal brain lesion, and MRI compatibility. RESULTS: Among the 62 patients who died of COVID-19 from March 31, 2020, to April 24, 2020, at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical microbleeds and macrobleeds (2 decedents), cortico-subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES; 1 decedent), and nonspecific deep white matter changes (1 decedent). Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. CONCLUSIONS: Postmortem brain MRI demonstrates hemorrhagic and PRES-related brain lesions in non-survivors of COVID-19. SARS-CoV-2-related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain-related contribution to respiratory distress in COVID-19.


Subject(s)
Brain Edema/diagnostic imaging , Brain/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Olfactory Bulb/diagnostic imaging , Pandemics , Postmortem Changes , Prospective Studies , SARS-CoV-2 , White Matter/diagnostic imaging
4.
Curr Pain Headache Rep ; 25(3): 19, 2021 Feb 25.
Article in English | MEDLINE | ID: covidwho-1100995

ABSTRACT

PURPOSE OF REVIEW: This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion. RECENT FINDINGS: COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1-4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.


Subject(s)
Endothelium/physiopathology , Headache/physiopathology , Posterior Leukoencephalopathy Syndrome/physiopathology , Seizures/physiopathology , Vision Disorders/physiopathology , Acute Chest Syndrome/epidemiology , Aminolevulinic Acid/analogs & derivatives , Anemia, Sickle Cell/epidemiology , Autoimmune Diseases/epidemiology , Blood-Brain Barrier/metabolism , Brain Edema/diagnostic imaging , Brain Edema/physiopathology , COVID-19/epidemiology , Cerebrovascular Circulation/physiology , Cytokines/metabolism , Eclampsia/epidemiology , Female , Homeostasis/physiology , Humans , Hypertension/physiopathology , Magnetic Resonance Imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/epidemiology , Posterior Leukoencephalopathy Syndrome/therapy , Pre-Eclampsia/epidemiology , Pregnancy , Prognosis , Renal Insufficiency/epidemiology , SARS-CoV-2 , Vasospasm, Intracranial/physiopathology
5.
Seizure ; 84: 66-68, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1065590

ABSTRACT

Symptoms of COVID-19, as reported during the SARS-CoV-2 pandemic in 2019-2020, are primarily respiratory and gastrointestinal, with sparse reports on neurological manifestations. We describe the case of a 17-year old female with Cornelia de Lange syndrome and well controlled epilepsy, who sustained significant cortical injury during a COVID-19 associated multi-inflammatory syndrome.


Subject(s)
Brain Diseases/physiopathology , COVID-19/physiopathology , De Lange Syndrome/complications , Epilepsy/physiopathology , Seizures/physiopathology , Systemic Inflammatory Response Syndrome/physiopathology , Acute Kidney Injury/etiology , Adolescent , Airway Extubation , Anticonvulsants/therapeutic use , Blood Coagulation Disorders/etiology , Bone Marrow Failure Disorders , Brain Diseases/diagnostic imaging , Brain Diseases/etiology , Brain Diseases/pathology , Brain Edema/diagnostic imaging , Brain Edema/etiology , C-Reactive Protein/immunology , COVID-19/complications , COVID-19/immunology , COVID-19/therapy , Disease Progression , Electroencephalography , Epilepsy/complications , Epilepsy/drug therapy , Female , Ferritins/metabolism , Humans , Influenza B virus , Influenza, Human/complications , Levetiracetam/therapeutic use , Magnetic Resonance Imaging , Midazolam/therapeutic use , Necrosis , Phenobarbital/therapeutic use , Pseudomonas Infections/complications , Respiration, Artificial , Rhabdomyolysis/complications , Rhabdomyolysis/etiology , SARS-CoV-2 , Seizures/drug therapy , Seizures/etiology , Sepsis/etiology , Sepsis/physiopathology , Sepsis/therapy , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/immunology , Systemic Inflammatory Response Syndrome/therapy , Tachycardia, Ventricular/etiology , Tachycardia, Ventricular/physiopathology , Tachycardia, Ventricular/therapy
7.
J Stroke Cerebrovasc Dis ; 29(12): 105397, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-886527

ABSTRACT

SARS-CoV-2 infection has been associated with ischemic stroke as well as systemic complications such as acute respiratory failure; cytotoxic edema is a well-known sequelae of acute ischemic stroke and can be worsened by the presence of hypercarbia induced by respiratory failure. We present the case of a very rapid neurologic and radiographic decline of a patient with an acute ischemic stroke who developed rapid fulminant cerebral edema leading to herniation in the setting of hypercarbic respiratory failure attributed to SARS-CoV-2 infection. Given the elevated incidence of cerebrovascular complications in patients with COVID-19, it is imperative for clinicians to be aware of the risk of rapidly progressive cerebral edema in patients who develop COVID-19 associated acute respiratory distress syndrome.


Subject(s)
Brain Edema/etiology , Breast Neoplasms/complications , COVID-19/complications , Encephalocele/etiology , Intracranial Hemorrhages/etiology , Stroke/etiology , Aged , Brain Edema/diagnostic imaging , Breast Neoplasms/diagnosis , Breast Neoplasms/drug therapy , COVID-19/diagnosis , Disease Progression , Encephalocele/diagnostic imaging , Female , Humans , Intracranial Hemorrhages/diagnostic imaging , Risk Factors , Stroke/diagnostic imaging
9.
Neuroradiol J ; 33(5): 374-376, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-696870

ABSTRACT

We are reporting the imaging findings of the rare entity of critical illness-associated cerebral microbleeds in a COVID-19-positive 66-year-old woman with hypoxic respiratory failure, who was eventually intubated and ventilated. Multiple scattered cerebral microhaemorrhages diffusely distributed in the juxtacortical white matter and internal capsule region, sparing the deep and periventricular white matter, basal ganglia, thalami and cortex were seen, which is a unique imaging finding in critically ill patients with respiratory failure and hypoxemia requiring mechanical ventilation. The mechanism underlying these microhaemorrhages relates to the endpoint of critical illness, rather than a specific underlying disease.


Subject(s)
Brain Edema/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , White Matter/diagnostic imaging , Aged , Betacoronavirus , Brain Edema/complications , COVID-19 , Cerebral Hemorrhage/complications , Coronavirus Infections/complications , Coronavirus Infections/therapy , Critical Illness , Female , Humans , Hypoxia/etiology , Hypoxia/therapy , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , SARS-CoV-2 , Tomography, X-Ray Computed
10.
Acta Neurochir (Wien) ; 162(11): 2725-2729, 2020 11.
Article in English | MEDLINE | ID: covidwho-679403

ABSTRACT

The clinical manifestations of coronavirus disease 2019 (COVID-19) are non-specific and multi-inflammatory. They vary from mild to severe manifestations that can be life-threatening. The association of SARS-CoV-2 infection and pseudoaneurysm formation or rupture of an already existing aneurysm is still unexplored. Several mechanisms may be involved, including the direct destruction to the artery by the viral infection or through the release of the inflammatory cytokines. We are presenting a case of a 13-year-old girl with a ruptured cerebral pseudoaneurysm of the left middle cerebral artery (M2 segment) with severe intracerebral hemorrhage as the earliest manifestation of COVID-19 infection.


Subject(s)
Aneurysm, False/etiology , Aneurysm, Ruptured/etiology , Cerebral Hemorrhage/etiology , Coronavirus Infections/complications , Middle Cerebral Artery , Pneumonia, Viral/complications , Adolescent , Aneurysm, Dissecting/diagnostic imaging , Aneurysm, Dissecting/etiology , Aneurysm, Dissecting/surgery , Aneurysm, False/diagnostic imaging , Aneurysm, False/surgery , Aneurysm, Ruptured/diagnostic imaging , Aneurysm, Ruptured/surgery , Angiography, Digital Subtraction , Ascites/etiology , Betacoronavirus , Brain Edema/diagnostic imaging , Brain Edema/etiology , COVID-19 , Cerebral Angiography , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/surgery , Computed Tomography Angiography , Coronavirus , Coronavirus Infections/diagnosis , Craniotomy , Disease Progression , Female , Hepatomegaly/etiology , Humans , Kidney Diseases/etiology , Pandemics , Pneumonia, Viral/diagnosis , Respiratory Distress Syndrome/etiology , SARS-CoV-2 , Splenic Infarction/etiology , Tomography, X-Ray Computed
11.
Seizure ; 80: 53-55, 2020 08.
Article in English | MEDLINE | ID: covidwho-602007
12.
Neurol Neuroimmunol Neuroinflamm ; 7(5)2020 09 03.
Article in English | MEDLINE | ID: covidwho-381838

ABSTRACT

OBJECTIVE: To describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement. METHODS: Evaluation of cause, clinical symptoms, and treatment response. RESULTS: A 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission. CONCLUSIONS: COVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.


Subject(s)
Anemia, Aplastic/complications , Coronavirus Infections/complications , Leukoencephalitis, Acute Hemorrhagic/etiology , Pneumonia, Viral/complications , Amygdala/diagnostic imaging , Anemia, Aplastic/therapy , Brain Edema/diagnostic imaging , Brain Edema/etiology , Brain Edema/physiopathology , Brain Edema/therapy , Brain Stem/diagnostic imaging , COVID-19 , Coronavirus Infections/therapy , Dexamethasone/therapeutic use , Diffusion Magnetic Resonance Imaging , Fatal Outcome , Female , Glucocorticoids/therapeutic use , Humans , Intracranial Hemorrhages/diagnostic imaging , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/physiopathology , Leukoencephalitis, Acute Hemorrhagic/diagnostic imaging , Leukoencephalitis, Acute Hemorrhagic/physiopathology , Leukoencephalitis, Acute Hemorrhagic/therapy , Magnetic Resonance Imaging , Middle Aged , Pandemics , Platelet Transfusion , Pneumonia, Viral/therapy , Putaminal Hemorrhage/diagnostic imaging , Putaminal Hemorrhage/etiology , Putaminal Hemorrhage/physiopathology , Respiration, Artificial , Seizures/etiology , Thalamic Nuclei/diagnostic imaging , Tomography, X-Ray Computed
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