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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 06.
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
4.
J Neurol ; 269(3): 1071-1092, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1377603

ABSTRACT

The literature on cases of acute disseminated encephalomyelitis (ADEM) associated with SARS-CoV-2 infection has been rapidly increasing. However, the specific clinical features of ADEM associated with SARS-CoV-2 (SARS-CoV-2-ADEM) have not been previously evaluated. We screened all articles resulting from a search of PubMed and Web of Science databases looking for reports of ADEM published between December 01, 2019, and June 5, 2021. Of the 48 ADEM cases identified from 37 studies, 34 (71%) had ADEM while 14 (29%) were of AHLE. RT-PCR for SARS-CoV-2 was positive in 83% (n = 19) of patients. 26 patients (54%) were male, and 18 patients (38%) were female, with a male to female sex ratio of 1.4:1; median age was 44 (1.4-71) years. 9 patients (19%, 9/48) were children. Of the 9 children patients, their median age was 9 years (range 1.4-13 years), 6 patients (67%) were female, and 2 patients (22%) were male, with a female to male sex ratio of 3:1.39 patients (81%) was performed CSF analysis. PCR for SARS-CoV-2 tested positive in 3 patients (14%, 3/22) on CSF sample. 31 (64%) of patients had a poor outcome on discharge from hospital. Five (10%) patients died in hospital. Compared to classic ADEM, SARS-CoV-2-ADEM have a more longer duration between the onset of the antecedent infective symptoms and the start of ADEM symptoms, the older age distribution of the patients, relatively poor outcome, a lower full recovery rate, a more frequently brain lesions involved the periventricular white matter and corpus callosum, and less frequently affected the deep gray matter. Taken together, the present comprehensive review reveals that although rare, ADEM can be associated with SARS-CoV-2 infection. SARS-CoV-2-ADEM seems to share most features of classic ADEM, with moderate discrepancies from the classical ADEM.


Subject(s)
COVID-19 , Encephalomyelitis, Acute Disseminated , Nervous System Diseases , Adolescent , Adult , Child , Child, Preschool , Corpus Callosum/pathology , Encephalomyelitis, Acute Disseminated/pathology , Female , Humans , Infant , Male , SARS-CoV-2
5.
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
6.
Pan Afr Med J ; 38: 263, 2021.
Article in English | MEDLINE | ID: covidwho-1266944

ABSTRACT

Neurovascular involvement is a frequent occurring reported in COVID-19 patients. However, spontaneous hematomas of the corpus callosum are exceptionally seen. The authors of this article aim to report an unusual case of corpus callosum hematoma in a COVID-19 patient and discuss potential etiologies and mechanisms responsible for intracranial hemorrhage.


Subject(s)
COVID-19/complications , Corpus Callosum/pathology , Hematoma/diagnosis , Intracranial Hemorrhages/diagnosis , Corpus Callosum/virology , Hematoma/etiology , Hematoma/virology , Humans , Intracranial Hemorrhages/etiology , Intracranial Hemorrhages/virology , Male , Middle Aged
8.
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
10.
AJNR Am J Neuroradiol ; 41(11): 2017-2019, 2020 11.
Article in English | MEDLINE | ID: covidwho-724937

ABSTRACT

Multisystem inflammatory syndrome in children is a recently described complication in the late phase of Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection involving systemic hyperinflammation and multiorgan dysfunction. The extent of its clinical picture is actively evolving and has yet to be fully elucidated. While neurologic manifestations of SARS-CoV-2 are well-described in the adult population, reports of neurologic complications in pediatric patients with SARS-CoV-2 infection are limited. We present a pediatric patient with SARS-CoV-2 infection with development of multisystem inflammatory syndrome and acute encephalopathy causing delirium who was found to have a cytotoxic lesion of the corpus callosum on neuroimaging. Cytotoxic lesions of the corpus callosum are a well-known, typically reversible entity that can occur in a wide range of conditions, including infection, seizure, toxins, nutritional deficiencies, and Kawasaki disease. We hypothesized that the cytotoxic lesion of the corpus callosum, in the index case, was secondary to the systemic inflammation from SARS-CoV-2 infection, resulting in multisystem inflammatory syndrome in children.


Subject(s)
Coronavirus Infections/complications , Corpus Callosum/pathology , Pneumonia, Viral/complications , Systemic Inflammatory Response Syndrome/pathology , Adolescent , Betacoronavirus , COVID-19 , Female , Humans , Pandemics , SARS-CoV-2
11.
Stroke ; 51(9): e223-e226, 2020 09.
Article in English | MEDLINE | ID: covidwho-656606

ABSTRACT

BACKGROUND AND PURPOSE: Ischemic infarction of the corpus callosum is rare and infarction isolated to the corpus callosum alone rarer still, accounting for much <1% of ischemic stroke in most stroke registries. About half of callosal infarctions affect the splenium. METHODS: During a 2-week period, at the height of the coronavirus disease 2019 (COVID-19) pandemic in New York City, 4 patients at Montefiore Medical Center in the Bronx were found to have ischemic lesions of the splenium of the corpus callosum, 2 with infarction isolated to the corpus callosum. RESULTS: All patients tested positive for COVID-19 and 3 had prolonged periods of intubation. All had cardiovascular risk factors. Clinically, all presented with encephalopathy and had evidence of coagulopathy and raised inflammatory markers. CONCLUSIONS: Infarction of the splenium of the corpus callosum is exceedingly rare and a cluster of such cases suggests COVID-19 as an inciting agent, with the mechanisms to be elucidated.


Subject(s)
Cerebral Infarction/complications , Cerebral Infarction/pathology , Coronavirus Infections/complications , Corpus Callosum/pathology , Pneumonia, Viral/complications , Aged , Aged, 80 and over , Brain Ischemia/complications , Brain Ischemia/pathology , COVID-19 , Diabetes Complications/complications , Fatal Outcome , Female , Humans , Hypertension/complications , Hypothyroidism/complications , Inflammation/blood , Intubation, Intratracheal , Middle Aged , Pandemics , Risk Factors , Stroke/etiology , Stroke/pathology , Stroke Rehabilitation
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