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Neurology ; 98(3): e315-e325, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1551285


BACKGROUND AND OBJECTIVES: In patients with severe coronavirus disease 2019 (COVID-19), disorders of consciousness (DoC) have emerged as a serious complication. The prognosis and pathophysiology of COVID-DoC remain unclear, complicating decisions about continuing life-sustaining treatment. We describe the natural history of COVID-DoC and investigate its associated brain connectivity profile. METHODS: In a prospective longitudinal study, we screened consecutive patients with COVID-19 at our institution. We enrolled critically ill adult patients with a DoC unexplained by sedation or structural brain injury and who were planned to undergo a brain MRI. We performed resting-state fMRI and diffusion MRI to evaluate functional and structural connectivity compared to healthy controls and patients with DoC resulting from severe traumatic brain injury (TBI). We assessed the recovery of consciousness (command following) and functional outcomes (Glasgow Outcome Scale Extended [GOSE] and the Disability Rating Scale [DRS]) at hospital discharge and 3 and 6 months after discharge. We also explored whether clinical variables were associated with recovery from COVID-DoC. RESULTS: After screening 1,105 patients with COVID-19, we enrolled 12 with COVID-DoC. The median age was 63.5 years (interquartile range 55-76.3 years). After the exclusion of 1 patient who died shortly after enrollment, all of the remaining 11 patients recovered consciousness 0 to 25 days (median 7 [5-14.5] days) after the cessation of continuous IV sedation. At discharge, all surviving patients remained dependent: median GOSE score 3 (1-3) and median DRS score 23 (16-30). Ultimately, however, except for 2 patients with severe polyneuropathy, all returned home with normal cognition and minimal disability: at 3 months, median GOSE score 3 (3-3) and median DRS score 7 (5-13); at 6 months, median GOSE score 4 (4-5), median DRS score 3 (3-5). Ten patients with COVID-DoC underwent advanced neuroimaging; functional and structural brain connectivity in those with COVID-DoC was diminished compared to healthy controls, and structural connectivity was comparable to that in patients with severe TBI. DISCUSSION: Patients who survived invariably recovered consciousness after COVID-DoC. Although disability was common after hospitalization, functional status improved over the ensuing months. While future research is necessary, these prospective findings inform the prognosis and pathophysiology of COVID-DoC. TRIAL REGISTRATION INFORMATION: identifier: NCT04476589.

COVID-19 , Consciousness Disorders , Aged , Brain/diagnostic imaging , COVID-19/complications , Consciousness Disorders/diagnostic imaging , Consciousness Disorders/virology , Humans , Longitudinal Studies , Magnetic Resonance Imaging , Middle Aged , Prospective Studies , Recovery of Function
Rev Esp Anestesiol Reanim (Engl Ed) ; 67(9): 511-515, 2020 Nov.
Article in English, Spanish | MEDLINE | ID: covidwho-842508


We describe the case of a 24-year-old pregnant woman with no history of note who was admitted with a diagnosis of bilateral pneumonia caused by the new coronavirus. Due to clinical worsening, she required urgent cesarean section with general anaesthesia and intubation for decubitus intolerance. After extubation, she presented altered mental state that required a differential diagnosis of encephalitis/meningitis secondary to SARS-CoV-2. CT and CT-angiography were normal, spinal fluid tests were non-specific, and magnetic resonance imaging reported posterior reversible encephalopathy syndrome (PRES) (due to radiological features suggestive of white matter vasogenic edema affecting the parietal, temporal and occipital lobes, along with altered mental state) secondary to gestational hypertension. Eleven days after the cesarean section the patient began to develop hypertension that required treatment. PRES is associated with certain clinical (headache, altered mental state, visual disturbances and convulsions) and radiological (reversible changes in white substance mainly affecting the parietal, temporal, and occipital lobes) characteristics suggestive of vasogenic oedema In pregnant SARS-CoV-2 patients, the differential diagnosis of hypertension and altered mental state is often extremely complicated because complementary tests can be normal and there is no immediate sign of peripartum hypertension. SARS-CoV-2 genome sequencing in spinal fluid could have provided a definitive diagnosis, but the treatment would not have differed.

Betacoronavirus , Coronavirus Infections/complications , Pneumonia, Viral/complications , Posterior Leukoencephalopathy Syndrome/etiology , Pregnancy Complications, Infectious , Puerperal Disorders/etiology , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Consciousness Disorders/diagnostic imaging , Consciousness Disorders/etiology , Coronavirus Infections/diagnosis , Coronavirus Infections/diagnostic imaging , Diagnosis, Differential , Female , Humans , Magnetic Resonance Imaging , Pandemics , Pneumonia, Viral/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Pregnancy , Puerperal Disorders/diagnostic imaging , SARS-CoV-2 , Young Adult
Mult Scler Relat Disord ; 43: 102216, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-419863


The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity.

Consciousness Disorders/physiopathology , Coronavirus Infections/physiopathology , Encephalitis/physiopathology , Glucocorticoids/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Methylprednisolone/therapeutic use , Pneumonia, Viral/physiopathology , Seizures/physiopathology , Adult , Anti-Bacterial Agents/therapeutic use , Anticonvulsants/therapeutic use , Atazanavir Sulfate/therapeutic use , Betacoronavirus , Brain/diagnostic imaging , COVID-19 , Consciousness Disorders/diagnostic imaging , Consciousness Disorders/etiology , Consciousness Disorders/therapy , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/therapy , Diffusion Magnetic Resonance Imaging , Disease Progression , Encephalitis/diagnostic imaging , Encephalitis/etiology , Encephalitis/therapy , Female , HIV Protease Inhibitors/therapeutic use , Humans , Hydroxychloroquine/therapeutic use , Intensive Care Units , Levetiracetam/therapeutic use , Lung/diagnostic imaging , Magnetic Resonance Imaging , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/therapy , Pons/diagnostic imaging , Respiration, Artificial , SARS-CoV-2 , Seizures/drug therapy , Seizures/etiology , Temporal Lobe/diagnostic imaging , Thalamus/diagnostic imaging , Tomography, X-Ray Computed