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1.
Neurol India ; 70(1): 409-411, 2022.
Article in English | MEDLINE | ID: covidwho-1726256

ABSTRACT

Background: Postmarketing surveillance of COVID-19 vaccination reveals that the COVID-19 vaccine administration is associated with several rare but serious neurological complications. Case Report: We report a case of new-onset tumefactive demyelinating brain lesion that developed after administration of an adenovector-based COVID-19 vaccine. A middle-aged female presented with recent right hemiparesis, which was noticed 2 days after she received the first dose of the vaccine. Magnetic resonance imaging (MRI) revealed a large subcortical T2/FLAIR hyperintensities involving corpus callosum as well. The patient responded to oral methylprednisolone. At 4 weeks, a follow-up MRI revealed a reduction in size of the lesion. Conclusion: To conclude, adenovector-based COVID-19 vaccination may be associated with a tumefactive demyelinating lesion.


Subject(s)
COVID-19 Vaccines , COVID-19 , Demyelinating Diseases/chemically induced , Adenoviridae , Brain/diagnostic imaging , Brain/pathology , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Corpus Callosum/diagnostic imaging , Corpus Callosum/pathology , Female , Humans , Magnetic Resonance Imaging , Methylprednisolone/therapeutic use , Middle Aged , SARS-CoV-2
3.
Br J Clin Pharmacol ; 88(6): 2969-2972, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1672996

ABSTRACT

Mild encephalopathy with a reversible splenial lesion syndrome (MERS) is a rare clinico-radiological entity. Rituximab (RTX)-induced MERS has never been described before. Herein, we report the case of a 33-year-old patient diagnosed since 2017, with an IgG4-related disease (IgG4-RD). This diagnosis was retained in the face of a prolonged fever, sicca syndrome, hepatic damage and renal pseudotumour associated to a high level of IGg4 at 2.8 g/L with suggestive renal histology. The patient was treated with corticosteroid therapy with persistence of renal impairment and nephrotic syndrome indicating RTX therapy. The patient received his first dose of RTX and presented neurological and respiratory impairments a few hours afterwards. An infectious investigation comprising a SARS CoV-2 PCR and viral PCRs (VZV, herpes and CMV) on cerebrospinal fluid (CSF) were negative. The HBV, HCV, HIV, Parvo B19, CMV, EBV, herpes, mycoplasma and syphilis serologies as well as Legionella antigenuria were also negative. The patient had received intravenous immunoglobulins (IVIG) and methylprednisone, associated with sodium valproate with favourable outcome. The diagnosis of MERS induced by RTX was retained in our patient according to clinical and radiological features. We herein report the first case of MERS following RTX in a patient treated for IgG4-RD.


Subject(s)
Brain Diseases , COVID-19 , Cytomegalovirus Infections , Drug-Related Side Effects and Adverse Reactions , Encephalitis , Immunoglobulin G4-Related Disease , Adult , Brain Diseases/chemically induced , Brain Diseases/complications , Brain Diseases/diagnosis , Corpus Callosum/diagnostic imaging , Corpus Callosum/pathology , Encephalitis/complications , Encephalitis/diagnosis , Encephalitis/pathology , Humans , Immunoglobulin G4-Related Disease/complications , Immunoglobulin G4-Related Disease/pathology , Magnetic Resonance Imaging , Rituximab/adverse effects
6.
Brain Dev ; 43(9): 919-930, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1267615

ABSTRACT

OBJECTIVES: Cytotoxic lesions of the corpus callosum (CLOCCs) are secondary lesions associated with entities like infection manifested by restricted diffusion on diffusion-weighted cranial magnetic resonance imaging. Our objectives are to evaluate the clinic-radiological spectrum of pediatric patients with cytotoxic lesions of the corpus callosum (CC). METHODS: Children (0-18 years) admitted between February 2017 and May 2020 with splenial lesions showing diffusion restriction on MRI, either isolated or within involvement of other parts of the brain, were included retrospectively. The primary lesions of the CC (e.g. acute disseminated encephalomyelitis, acute ischemic infarction, and glioblastoma multiforme) were excluded. CLOCCs were divided into infection-associated, metabolic disorder-associated, and trauma-associated lesions, as well as CLOCCs involving other entities. Data were collected from the medical databases. RESULTS: Forty-one patients were determined to have CLOCCs. Twenty-five (61%) were infection-associated, nine (22%) were trauma-associated, and three (7%) were metabolic disorder-associated cases, including 2 inherited disorders of metabolism. There were four (10%) patients with other entities, three with epilepsy, and one had an apparent life-threatening event. Six patients had a known etiology among the infection-associated group; one had multisystem inflammatory syndrome caused by COVID-19 and one had been infected by COVID-19 without any complications. All the infection-associated patients with isolated splenial lesions recovered totally, although six patients required intensive care hospitalization. Four trauma-associated patients had sequela lesions. CONCLUSIONS: CLOCCs are associated with a spectrum of diseases, including the new coronavirus, COVID-19 infection. Infection-associated CLOCCs has the best prognosis, although severe cases may occur. Sequelae are possible based on the etiology.


Subject(s)
Brain Diseases/diagnosis , Brain Diseases/etiology , Brain Diseases/pathology , COVID-19/complications , Central Nervous System Infections/complications , Corpus Callosum/pathology , Adolescent , Child , Child, Preschool , Corpus Callosum/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Female , Humans , Infant , Male , Retrospective Studies , Systemic Inflammatory Response Syndrome/complications
12.
Am J Case Rep ; 21: e928798, 2020 Dec 14.
Article in English | MEDLINE | ID: covidwho-976580

ABSTRACT

BACKGROUND Cytotoxic lesions of the corpus callosum (CLOCC) is a rare clinical and radiological syndrome that has been associated with various infectious etiologies. CLOCC are among the recently described neurological associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with coronavirus disease 2019 (COVID-19). We report a case of CLOCC in a man with SARS-CoV-2 infection who presented with auditory hallucinations and rapidly developed systemic inflammatory response syndrome (SIRS). CASE REPORT A 23-year-old man with no past medical and psychiatric history presented with auditory hallucinations, restlessness, and suicidal ideations. A nasopharyngeal swab specimen tested using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay was positive for SARS-CoV-2. A brain MRI revealed an isolated oval-shaped lesion in the splenium of the corpus callosum, with hyperintense signal on diffusion-weighted imaging (DWI) and hypointense on apparent diffusion coefficient (ADC) maps, suggestive of CLOCC. After a dramatic hospital course associated with multiple organ dysfunction syndrome (MODS) and severe intra-abdominal and cerebral bleeding, he developed cardiac arrest and died on hospital day 15. CONCLUSIONS This case highlights the need for increased vigilance for the atypical manifestations of SARS-CoV-2 infection. In addition, it suggests that CLOCC can be considered as a differential diagnosis by clinicians in patients with SARS-CoV-2 infection who present with unexplained neurological and neuropsychiatric symptoms, leading to poor outcome.


Subject(s)
COVID-19/diagnostic imaging , Corpus Callosum/pathology , Hallucinations/virology , Corpus Callosum/diagnostic imaging , Corpus Callosum/virology , Fatal Outcome , Humans , Magnetic Resonance Imaging , Male , Young Adult
14.
Stroke Vasc Neurol ; 5(4): 315-322, 2020 12.
Article in English | MEDLINE | ID: covidwho-934125

ABSTRACT

BACKGROUND: Cerebral microhaemorrhages are increasingly being recognised as a complication of COVID-19. This observational retrospective study aims to further investigate the potential pathophysiology through assessing the pattern of microhaemorrhage and clinical characteristics of patients with COVID-19 and microhaemorrhage. By comparing with similar patterns of microhaemorrhage in other non-COVID-19 disease, this study aims to propose possible common pathogenic mechanisms. METHODS: A retrospective observational case series was performed identifying all patients with COVID-19 complicated by cerebral microhaemorrhage on MRI. The distribution and number of microhaemorrhages were recorded using the microbleed anatomical scale, and patients' baseline characteristics and salient test results were also recorded. RESULTS: Cerebral microhaemorrhages were noted to have a predilection for the corpus callosum, the juxtacortical white matter and brainstem. All patients had a preceding period of critical illness with respiratory failure and severe hypoxia necessitating intubation and mechanical ventilation. DISCUSSION: This study demonstrates a pattern of cerebral microhaemorrhage that is similar to the pattern reported in patients with non-COVID-19 related critical illness and other causes of severe hypoxia. This raises questions regarding whether microhaemorrhage occurs from endothelial dysfunction due the direct effect of SARS-CoV-2 infection or from the secondary effects of critical illness and hypoxia.


Subject(s)
COVID-19/complications , Cerebral Hemorrhage/etiology , Aged , Brain Stem/diagnostic imaging , COVID-19/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Corpus Callosum/diagnostic imaging , Critical Illness , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Respiration, Artificial , Respiratory Insufficiency/etiology , Retrospective Studies , Treatment Outcome , White Matter/diagnostic imaging
15.
Brain Dev ; 43(2): 230-233, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-856505

ABSTRACT

BACKGROUND: Reversible splenial lesion syndrome (RESLES) is characterized by a temporary lesion in the splenium of the corpus callosum, emerging related to encephalitis, seizures, antiepileptic drug withdrawal, or metabolic disturbances. Among RESLES, mild encephalitis/encephalopathy with reversible splenial lesion (MERS) has been defined as a distinct clinicoradiologic syndrome associated with viral infections. CASE PRESENTATION: We report two children with multisystem inflammatory syndrome-children related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed RESLES during the disease course. Encephalopathy was the main central nervous system symptom. Both of the children showed a rapid recovery, and brain magnetic resonance imaging revealed complete resolution of the splenial lesion within 1 week. CONCLUSION: The complete resolution of the splenial lesion and rapid recovery from encephalopathy in RESLES associated with SARS CoV-2 were similar to observed in MERS.


Subject(s)
Brain Diseases/diagnostic imaging , COVID-19/diagnosis , Corpus Callosum/diagnostic imaging , Systemic Inflammatory Response Syndrome/diagnostic imaging , Brain Diseases/drug therapy , Brain Diseases/physiopathology , COVID-19/diagnostic imaging , COVID-19/drug therapy , COVID-19/physiopathology , Child , Dyspnea/physiopathology , Electroencephalography , Exanthema/physiopathology , Female , Fever/physiopathology , Glucocorticoids/therapeutic use , Hallucinations/physiopathology , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Neurocognitive Disorders/diagnostic imaging , Neurocognitive Disorders/physiopathology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/physiopathology , Tachypnea/physiopathology
17.
AJNR Am J Neuroradiol ; 41(10): 1905-1907, 2020 10.
Article in English | MEDLINE | ID: covidwho-724485

ABSTRACT

There are very limited published data on the neurologic complications associated with coronavirus disease 2019 (COVID-19) in the pediatric population. Here we present the first 2 pediatric cases of presumed COVID-19 related cytotoxic lesions of the corpus callosum. Similar to reports in adults, these cases suggest that the COVID-19 infection in children may rarely mediate a hyperinflammatory response that can cause CNS pathology. As the pandemic continues further, the presentation of cytotoxic lesions of the corpus callosum should prompt radiologists to consider COVID-19, among other known causes.


Subject(s)
Betacoronavirus , Brain Diseases/diagnostic imaging , Brain Diseases/etiology , Coronavirus Infections/complications , Corpus Callosum/diagnostic imaging , Pneumonia, Viral/complications , COVID-19 , Child , Humans , Magnetic Resonance Imaging , Male , Pandemics , SARS-CoV-2
19.
AJNR Am J Neuroradiol ; 41(9): 1625-1628, 2020 09.
Article in English | MEDLINE | ID: covidwho-691006

ABSTRACT

Neurologic findings are being increasingly recognized in coronavirus disease 2019. We present a patient with a unique involvement of the corpus callosum that we relate to the cytokine storm seen in patients with Severe Acute Respiratory Syndrome coronavirus 2 infection. As the infection is increasingly seen around the world, recognition of these unique patterns may facilitate early identification of the progression of this disease and potentially facilitate appropriate management.


Subject(s)
Betacoronavirus , Coronavirus Infections , Corpus Callosum/diagnostic imaging , Cytokines/immunology , Pandemics , Pneumonia, Viral , Aged , COVID-19 , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/immunology , Corpus Callosum/immunology , Female , Humans , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/immunology , SARS-CoV-2 , Tomography, X-Ray Computed
20.
JAMA Neurol ; 77(11): 1440-1445, 2020 11 01.
Article in English | MEDLINE | ID: covidwho-626377

ABSTRACT

Importance: Neurological manifestations have been reported in adults with coronavirus disease 2019 (COVID-19), which is caused by the highly pathogenic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: To report the neurological manifestations of children with COVID-19. Design, Setting, and Participants: In this case-series study, patients younger than 18 years who presented with SARS-CoV-2 infection and neurological symptoms to Great Ormond Street Hospital for Children (London, UK) between March 1, 2020, and May 8, 2020, were included after infection was confirmed by either a quantitative reverse transcription-polymerase chain reaction assay by nasopharyngeal swab or a positive test result for IgG antibodies against SARS-CoV-2 in serum. Main Outcomes and Measures: Clinical and paraclinical features were retrieved from electronic patient records. Results: Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes. All 4 patients required intensive care unit admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome. Splenium signal changes were seen in all 4 patients on magnetic resonance imaging of the brain. In the 2 patients whose cerebrospinal fluid was tested, samples were acellular, with no evidence of infection on polymerase chain reaction or culture (including negative SARS-CoV-2 polymerase chain reaction results) and negative oligoclonal band test results. In all 3 patients who underwent electroencephalography, a mild excess of slow activity was found. Tests for N-methyl-d-aspartate receptor, myelin oligodendrocyte glycoprotein, and aquaporin-4 autoantibodies had negative results in all patients. In all 3 patients who underwent nerve conduction studies and electromyography, mild myopathic and neuropathic changes were seen. Neurological improvement was seen in all patients, with 2 making a complete recovery by the end of the study. Conclusions and Relevance: In this case-series study, children with COVID-19 presented with new neurological symptoms involving both the central and peripheral nervous systems and splenial changes on imaging, in the absence of respiratory symptoms. Additional research is needed to assess the association of neurological symptoms with immune-mediated changes among children with COVID-19.


Subject(s)
COVID-19/complications , Central Nervous System Diseases/diagnosis , Central Nervous System Diseases/etiology , Corpus Callosum/diagnostic imaging , Peripheral Nervous System Diseases/diagnosis , Peripheral Nervous System Diseases/etiology , Systemic Inflammatory Response Syndrome/complications , Adolescent , Central Nervous System Diseases/diagnostic imaging , Central Nervous System Diseases/physiopathology , Child , Electroencephalography , Electromyography , Humans , Magnetic Resonance Imaging , Neural Conduction/physiology , Peripheral Nervous System Diseases/physiopathology
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