Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 16 de 16
Filter
1.
Epileptic Disord ; 24(3): 595-601, 2022 06 01.
Article in English | MEDLINE | ID: covidwho-1875224

ABSTRACT

Unilateral hemispheric edema may occur with or without seizures. It is a rare entity, found more often in children, than in adults. As many of these patients develop pronounced unilateral complete cortical hemispheric (uni-hemispheric) edema on MRI, we have used the term "cortical unihemispheric brain edema" (CUBE) to describe this entity. We describe a case of CUBE occurring along with a post COVID multi-system inflammatory syndrome in adults (MIS-A). A 30-year-old man was admitted with status epilepticus. He was found to have CUBE and features of MIS-A. He had a history of mild COVID-19 illness one month earlier. He was noted to have persistently elevated inflammatory markers and multiorgan dysfunction compatible with MIS-A. We review the cases of CUBE in the literature and describe the features and etiology of this uncommon syndrome. Furthermore, we discuss the differences between two types of CUBE;cytotoxic CUBE (CUBE-C) and vasogenic CUBE (CUBE-V).


Subject(s)
Brain Edema , COVID-19 , Adult , Brain Edema/etiology , COVID-19/complications , Child , Humans , Male , Syndrome , Systemic Inflammatory Response Syndrome
2.
Medicina (Kaunas) ; 58(5)2022 May 05.
Article in English | MEDLINE | ID: covidwho-1820334

ABSTRACT

Background and Objectives: The incidence of severe and moderate forms of DKA as the initial presentation of type 1 diabetes mellitus (T1D) is increasing, especially during the COVID-19 pandemic. This poses a higher risk of developing cerebral edema as a complication of diabetic ketoacidosis (DKA), as well as morbidity and mortality rates. The aim of this study was to determine the trend and clinical features of children treated in the last 10 years in the Pediatric Intensive Care Unit (PICU) due to the development of DKA. Materials and Methods: This retrospective study was performed in the PICU, Clinical Hospital Centre Rijeka, in Croatia. All children diagnosed with DKA from 2011-2020 were included in this study. Data were received from hospital medical documentation and patient paper history. The number of new cases and severity of DKA were identified and classified using recent International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. Results: In this investigation period, 194 children with newly diagnosed T1D were admitted to our hospital: 58 of them were treated in the PICU due to DKA; 48 had newly diagnosed T1D (48/58); and ten previously diagnosed T1D (10/58). DKA as the initial presentation of T1D was diagnosed in 24.7% (48/194). Moderate or severe dehydration was present in 76% of the children at hospital admission. Polyuria, polydipsia, and Kussmaul breathing were the most common signs. Three patients (5.2%) developed cerebral edema, of whom one died. Conclusions: During the investigation period a rising trend in T1D was noted, especially in 2020. About one quarter of children with T1D presented with DKA at initial diagnosis in western Croatia, most of them with a severe form. Good education of the general population, along with the patients and families of children with diabetes, is crucial to prevent the development of DKA and thus reduce severe complications.


Subject(s)
Brain Edema , COVID-19 , Diabetes Mellitus, Type 1 , Diabetic Ketoacidosis , Adolescent , Brain Edema/complications , Brain Edema/etiology , Child , Croatia/epidemiology , Diabetes Mellitus, Type 1/complications , Diabetes Mellitus, Type 1/epidemiology , Diabetic Ketoacidosis/diagnosis , Diabetic Ketoacidosis/epidemiology , Diabetic Ketoacidosis/therapy , Humans , Intensive Care Units, Pediatric , Pandemics , Retrospective Studies
3.
BMJ Case Rep ; 15(4)2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1774938

ABSTRACT

We present an unusual case of a woman in her 30s who was admitted for diabetic ketoacidosis (DKA) in the setting of newly diagnosed but late COVID-19 infection with associated Klebsiella pneumoniae infection. Her altered mental status, out of proportion with her metabolic decompensation, revealed a superimposed cerebral venous sinus thrombosis (CVST) with fulminant cerebral oedema and ultimately brain death. This unusual and fulminant case of cerebral oedema in the setting of COVID-19 infection with bacterial infection, DKA and CVST was the perfect storm with multiple interwoven factors. It offered diagnostic and treatment challenges with an unfortunate outcome. This unique case is a reminder that it is important to consider a broad neurological differential in patients with COVID-19 with unexplained neurological manifestations, which may require specific neurointensive care management.


Subject(s)
Brain Edema , COVID-19 , Diabetes Mellitus , Diabetic Ketoacidosis , Sinus Thrombosis, Intracranial , Brain Edema/complications , Brain Edema/etiology , COVID-19/complications , Diabetic Ketoacidosis/complications , Diabetic Ketoacidosis/diagnosis , Female , Humans , Klebsiella pneumoniae , Sinus Thrombosis, Intracranial/complications , Sinus Thrombosis, Intracranial/diagnostic imaging
4.
Medwave ; 21(3): e8176, 2021 Apr 23.
Article in Spanish, English | MEDLINE | ID: covidwho-1256962

ABSTRACT

INTRODUCTION: The association of COVID-19 with diabetes mellitus is bidirectional. In one direction, diabetes mellitus is associated with an increased risk of severe COVID-19. In the opposite direction, in patients with COVID-19 new-onset diabetes mellitus, severe diabetic ketoacidosis and severe metabolic complications have been described. CLINICAL CASE: This report describes two patients with diabetes mellitus who came to our hospital with ketoacidosis resulting from new-onset diabetes mellitus. We describe the clinical course and the management approach during the COVID-19 pandemic. CONCLUSION: COVID-19 is associated with metabolic complications such as severe diabetic ketoacidosis.


INTRODUCCIÓN: La relación entre la enfermedad por el coronavirus de 2019 (COVID-19) secundaria a SARS-CoV-2 y la diabetes mellitus es bidireccional. Por un lado, la diabetes mellitus se asocia con un mayor riesgo de COVID-19 grave. Por otro lado, en pacientes con COVID-19 se han observado diabetes mellitus de nueva aparición con presentaciones de cetoacidosis diabética y complicaciones metabólicas graves de dicha presentación. CASOS CLÍNICOS: En este informe, describimos a dos pacientes pediátricos con diabetes mellitus que acudieron a nuestro hospital con cetoacidosis diabética, de debut inicial. Describimos la evolución y el manejo clínico y terapéutico durante la pandemia de COVID-19. CONCLUSIÓN: La infección por COVID-19 puede precipitar complicaciones como cetoacidosis diabética severa.


Subject(s)
COVID-19/complications , Diabetic Ketoacidosis/etiology , Brain Edema/etiology , Child , Female , Humans , Hypoxia, Brain/etiology , Male
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
8.
J Stroke Cerebrovasc Dis ; 29(12): 105419, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-885361

ABSTRACT

INTRODUCTION: Apnea testing remains essential for the clinical evaluation of brain death determination. In patients who test positive for SARS-CoV-2, disconnecting the patient from the ventilator and introducing high flow oxygen into the endotracheal tube increases the risk for aerosolization of airway secretions and exposure of the examiner. METHODS: Case report of a patient with an intracerebral hemorrhage that evolved to significant cerebral edema and herniation, who underwent apnea test using a method involving a t-piece and an HME filter. RESULTS: Patient successfully pronounced brain dead using a safe method to minimize exposure to SARS-CoV-2. CONCLUSION: At a time where healthcare workers are at high risk of exposure to COVID-19, the above described method is a safe process for apnea testing in declaration of brain death.


Subject(s)
Apnea/diagnosis , Brain Death/diagnosis , Brain Edema/etiology , COVID-19/complications , Cerebral Hemorrhage/etiology , Encephalocele/etiology , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Occupational Health , Apnea/etiology , Brain Edema/diagnosis , COVID-19/diagnosis , COVID-19/transmission , Cerebral Hemorrhage/diagnosis , Encephalocele/diagnosis , Fatal Outcome , Humans , Male , Middle Aged
9.
J Stroke Cerebrovasc Dis ; 29(12): 105307, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-753198

ABSTRACT

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) initially most appreciated for its pulmonary symptoms, is now increasingly recognized for causing multi-organ disease and stroke in the setting of a hypercoagulable state. We report a case of 33-year-old African American woman with COVID-19 who developed acute malignant middle cerebral artery infarction due to thromboembolic occlusion of the left terminal internal carotid artery and middle cerebral artery stem. Mechanical thrombectomy was challenging and ultimately unsuccessful resulting in limited reperfusion of <67% of the affected vascular territory, and thrombectomized clot was over 50 mm in length, at least three times the average clot length. The final stroke size was estimated at 224 cubic centimeters. On admission her D-dimer level was 94,589 ng/mL (normal 0-500 ng/ml). Throughout the hospitalization D-dimer decreased but never reached normal values while fibrinogen trended upward. Hypercoagulability panel was remarkable for mildly elevated anticardiolipin IgM of 16.3 MPL/mL (normal: 0-11.0 MPL/mL). With respect to remaining stroke workup, there was no evidence of clinically significant stenosis or dissection in the proximal internal carotid artery or significant cardioembolic source including cardiomyopathy, atrial fibrillation, cardiac thrombus, cardiac tumor, valvular abnormality, aortic arch atheroma, or patent foramen ovale. She developed malignant cytotoxic cerebral edema and succumbed to complications. This case underscores the importance of recognizing hypercoagulability as a cause of severe stroke and poor outcome in young patients with COVID-19 and highlights the need for further studies to define correlation between markers of coagulopathy in patients with COVID-19 infection and outcome post stroke.


Subject(s)
Blood Coagulation , COVID-19/complications , Carotid Stenosis/etiology , Infarction, Middle Cerebral Artery/etiology , Thrombophilia/etiology , Adult , Biomarkers/blood , Brain Edema/etiology , COVID-19/blood , COVID-19/diagnosis , COVID-19/therapy , Carotid Stenosis/blood , Carotid Stenosis/diagnostic imaging , Carotid Stenosis/therapy , Disease Progression , Fatal Outcome , Female , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Infarction, Middle Cerebral Artery/blood , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/therapy , Thrombectomy , Thrombophilia/complications , Thrombophilia/diagnosis , Treatment Outcome
10.
Eur J Neurol ; 28(1): 248-258, 2021 01.
Article in English | MEDLINE | ID: covidwho-732119

ABSTRACT

BACKGROUND AND PURPOSE: Neurological manifestations in coronavirus disease (COVID)-2019 may adversely affect clinical outcomes. Severe COVID-19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID-19 and to gain pathophysiological insights with respect to CRS. METHODS: In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. RESULTS: Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood-brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS-CoV2 was undetectable in 88 of the 90 patients with COVID-19 who underwent Reverse Transcription-PCR testing of CSF. CONCLUSIONS: Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T-cell-related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.


Subject(s)
Brain Diseases/etiology , COVID-19/complications , Cytokine Release Syndrome/etiology , Adrenal Cortex Hormones/therapeutic use , Aged , Blood-Brain Barrier/physiopathology , Brain/diagnostic imaging , Brain Diseases/physiopathology , Brain Edema/etiology , COVID-19/metabolism , COVID-19/physiopathology , Cytokine Release Syndrome/metabolism , Cytokine Release Syndrome/physiopathology , Female , Humans , Immunoglobulins/therapeutic use , Ischemic Stroke/diagnosis , Longitudinal Studies , Magnetic Resonance Imaging , Male , Middle Aged , Nervous System Diseases/etiology , Nervous System Diseases/physiopathology , Treatment Outcome
12.
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
14.
Seizure ; 80: 53-55, 2020 08.
Article in English | MEDLINE | ID: covidwho-602007
15.
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
SELECTION OF CITATIONS
SEARCH DETAIL