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1.
Bull Exp Biol Med ; 172(4): 402-406, 2022 Feb.
Article in English | MEDLINE | ID: covidwho-1699129

ABSTRACT

We analyzed characteristics of diffusion and its kurtosis obtained using diffusion-kurtosis MRI in the hemisphere contralateral to the one affected by acute cerebrovascular accident. Diffusion characteristics in the white and gray matter were compared using analysis of covariance (ANCOVA) in healthy subjects and stroke patients with consideration for the age and sex factors. Significant differences between the groups were revealed for apparent diffusion coefficient and mean kurtosis in the white matter. Age dependence was studied using regression analysis and, according to the results of ANCOVA, this factor was found to be significant for apparent diffusion coefficient and diffusion kurtosis in the white matter. Metrics are proposed that can be used to determine the risk of stroke.


Subject(s)
Stroke , White Matter , Brain/diagnostic imaging , Diffusion Magnetic Resonance Imaging/methods , Gray Matter/diagnostic imaging , Humans , Stroke/diagnostic imaging , White Matter/diagnostic imaging
2.
Neurologist ; 26(6): 271-273, 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1501227

ABSTRACT

INTRODUCTION: Wake-up strokes are challenging to manage due to unknown time of onset. Recently, the wake-up trial demonstrated that recombinant tissue plasminogen activator (rtPA) could be administered based on the magnetic resonance imaging (MRI)- diffusion weighted imaging/fluid attenuated inversion recovery mismatch. Many still doubt the safety results due to the higher rate of hemorrhagic conversion reported. Although it was statistically insignificant, the study was terminated early. Furthermore, Corona virus disease-19 is associated with coagulopathy and a higher risk of hemorrhagic conversion. CASE REPORT: A 46-year-old fully functioning male presented with a wake-up right hemiparesis, right facial droop, and expressive aphasia. His National Institute of Health Stroke Scale was 4 upon arrival. Last known well state was >4.5 hours. He tested positive for SARS-CoV-2 viral infection. He had left distal-M2 occlusion. He was deemed not a candidate for rtPA. Hyperacute-MRI protocol showed diffusion weighted imaging/fluid attenuated inversion recovery mismatch. The patient received rtPA at 6.5 hours from the last knwn well state. Follow-up MRI-susceptibility weighted imaging revealed fragmented clot. The stroke burden was less than that shown on the initial computed tomography-perfusion scans implying saved penumbra. There was no hemorrhagic conversion despite low fibrinogen levels. CONCLUSION: The hyperacute-MRI protocol for wake-up COVID-19 associated strokes might be a safe option.


Subject(s)
Brain Ischemia , COVID-19 , Ischemic Stroke , Stroke , Brain Ischemia/drug therapy , Diffusion Magnetic Resonance Imaging , Humans , Magnetic Resonance Imaging , Male , Middle Aged , SARS-CoV-2 , Stroke/diagnostic imaging , Stroke/drug therapy , Thrombolytic Therapy , Tissue Plasminogen Activator/therapeutic use
3.
J Neural Transm (Vienna) ; 128(12): 1899-1906, 2021 12.
Article in English | MEDLINE | ID: covidwho-1491158

ABSTRACT

Encephalopathy is a neurological complication of COVID-19. The objective of this exploratory study is to investigate the link between systemic inflammation and brain microstructural changes (measured by diffusion-weighted imaging) in patients with COVID-19 encephalopathy. 20 patients with COVID-19 encephalopathy (age: 67.3 [Formula: see text] 10.0 years; 90% men) hospitalized in the Geneva University Hospitals for a SARS-CoV-2 infection between March and May 2020 were included in this retrospective cohort study. COVID-19 encephalopathy was diagnosed following a comprehensive neurobiological evaluation, excluding common causes of delirium, such as hypoxemic or metabolic encephalopathy. We investigated the correlation between systemic inflammation (measured by systemic C-reactive protein (CRP)) and brain microstructural changes in radiologically normal white matter (measured by apparent diffusion coefficient (ADC)) in nine spatially widespread regions of the white matter previously associated with delirium. Systemic inflammation (CRP = 60.8 ± 50.0 mg/L) was positively correlated with ADC values in the anterior corona radiata (p = 0.0089), genu of the corpus callosum (p = 0.0064) and external capsule (p = 0.0086) after adjusting for patients' age. No statistically significant association between CRP and ADC was found in the other six white matter regions. Our findings indicate high risk of white matter abnormalities in COVID-19 encephalopathy patients with high peripheral inflammatory markers, suggesting aggressive imaging monitoring may be warranted in these patients. Future studies should clarify a possible specificity of the spatial patterns of CRP-white matter microstructure association in COVID-19 encephalopathy patients and disentangle the role of individual cytokines on brain inflammatory mechanisms.


Subject(s)
Brain Diseases , COVID-19 , White Matter , Brain/diagnostic imaging , C-Reactive Protein , Child , Diffusion Magnetic Resonance Imaging , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , White Matter/diagnostic imaging
4.
Rinsho Shinkeigaku ; 61(7): 486-490, 2021 Jul 30.
Article in Japanese | MEDLINE | ID: covidwho-1278670

ABSTRACT

A 63-year-old man, who had persistent fever for a month, was admitted to the hospital with sudden left arm palsy with a National Institutes of Health Stroke Scale score of 3. Consequently, brain MRI showed hyperintensity of the bilateral occipital, right parietal, and right frontal lobes on diffusion-weighted imaging. Moreover, FLAIR presented hyperintensity of the left occipital lobe. Magnetic resonance angiography detected the deficit of the blood-flow signal of the horizontal segment of the middle cerebral artery. He was diagnosed with acute ischemic stroke. In addition, chest CT showed ground-glass opacities, and test to detect SARS-CoV-2 was positive. Cerebral embolism was suspected. However, the source was unknown. His ischemic stroke was possibly associated with coagulation abnormality caused by coronavirus disease 2019.


Subject(s)
COVID-19/complications , Intracranial Embolism/diagnostic imaging , Ischemic Stroke/diagnostic imaging , Diffusion Magnetic Resonance Imaging , Humans , Intracranial Embolism/virology , Ischemic Stroke/virology , Magnetic Resonance Angiography , Male , Middle Aged , Middle Cerebral Artery
5.
J Stroke Cerebrovasc Dis ; 30(9): 105944, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1267765

ABSTRACT

Ten days after SARS-Cov2 reinfection with mild gastrointestinal symptoms and headache that occurred 2 months after an initial infection, a previously healthy 37-year-old woman developed fluctuating facial and upper limb paresthesia and weakness. Diffusion-weighted magnetic resonance imaging revealed ischemic lesions in the right parietal region of different stages within the same vascular territory. A cerebral angiography demonstrated an isolated focal arteriopathy with no other arterial involvement. Focal cerebral arteriopathy is exceedingly rare among adults and most commonly triggered by varicella-zoster virus reactivation. We present a case of focal cerebral arteriopathy in a patient with a recent reinfection with SARS-CoV-2.


Subject(s)
COVID-19/complications , Cerebral Arterial Diseases/etiology , Ischemic Stroke/etiology , Reinfection , Adult , COVID-19/diagnosis , COVID-19/virology , Cerebral Angiography , Cerebral Arterial Diseases/diagnostic imaging , Cerebral Arterial Diseases/drug therapy , Diffusion Magnetic Resonance Imaging , Dual Anti-Platelet Therapy , Female , Humans , Ischemic Stroke/diagnostic imaging , Ischemic Stroke/drug therapy , Magnetic Resonance Angiography , Platelet Aggregation Inhibitors/administration & dosage , Tomography, X-Ray Computed , Treatment Outcome
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
8.
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
9.
Neuroradiol J ; 34(3): 245-248, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1041845

ABSTRACT

The severe acute respiratory syndrome coronavirus disease 2019 (COVID-19) pandemic, became rapidly recognised by variable phonotypic expressions that involve most major body organs. Neurological complications of severe acute respiratory syndrome coronavirus disease are increasingly encountered in patients with COVID-19 infection, more frequently in patients with severe infection, and develop as a consequence of the neurotropic potential of this virus, secondary cytokine storm and acquired syndrome of COVID-19 coagulopathy. Spinal cord involvement after COVID-19 more commonly includes infectious transverse myelitis, para and post infection myelopathy and, rarely, spinal cord ischaemia related to increased coagulopathy with thromboembolic consequences. We herein report a COVID-19-positive patient with increased coagulopathy and vertebral artery thrombosis leading to posterior circulation and subsequent spinal cord infarction.


Subject(s)
COVID-19/complications , Infarction/etiology , Spinal Cord Ischemia/etiology , Adult , Blood Coagulation Disorders/blood , Blood Coagulation Disorders/etiology , Diffusion Magnetic Resonance Imaging , Humans , Male , Thrombosis/blood , Thrombosis/etiology , Vertebral Artery
10.
BMJ Case Rep ; 14(1)2021 Jan 11.
Article in English | MEDLINE | ID: covidwho-1020901

ABSTRACT

A 19-year-old man was admitted with a 2-week history of continuous cough along with a day history of acute onset unsteadiness and hiccups. Given the current pandemic, he was initially suspected to have COVID-19, however he tested negative on two occasions. Subsequent brain magnetic resonance imaging (MRI)confirmed a small left acute and subacute lateral medullary infarction with chest X-ray suggesting aspiration pneumonia with right lower lobe collapse. This is a distinctive case of posterior circulation stroke presenting with a new continuous cough in this era of COVID-19 pandemic. We anticipate based on MRI findings that his persistent cough was likely due to silent aspiration from dysphagia because of the subacute medullary infarction. It is therefore imperative that healthcare workers evaluate people who present with new continuous cough thoroughly to exclude any other sinister pathology. We should also be familiar with the possible presentations of posterior circulation stroke in this pandemic era.


Subject(s)
COVID-19/diagnosis , Cough/physiopathology , Hiccup/physiopathology , Lateral Medullary Syndrome/diagnostic imaging , Pneumonia, Aspiration/diagnostic imaging , Sensation Disorders/physiopathology , Vertigo/physiopathology , Cough/etiology , Diagnosis, Differential , Diffusion Magnetic Resonance Imaging , Hiccup/etiology , Humans , Lateral Medullary Syndrome/complications , Lateral Medullary Syndrome/physiopathology , Magnetic Resonance Imaging , Male , Pneumonia, Aspiration/etiology , Postural Balance , SARS-CoV-2 , Sensation Disorders/etiology , Vertigo/etiology , Young Adult
11.
AJNR Am J Neuroradiol ; 42(4): 632-638, 2021 04.
Article in English | MEDLINE | ID: covidwho-1016049

ABSTRACT

BACKGROUND AND PURPOSE: Patients infected with the Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) can develop a spectrum of neurological disorders, including a leukoencephalopathy of variable severity. Our aim was to characterize imaging, lab, and clinical correlates of severe coronavirus disease 2019 (COVID-19) leukoencephalopathy, which may provide insight into the SARS-CoV-2 pathophysiology. MATERIALS AND METHODS: Twenty-seven consecutive patients positive for SARS-CoV-2 who had brain MR imaging following intensive care unit admission were included. Seven (7/27, 26%) developed an unusual pattern of "leukoencephalopathy with reduced diffusivity" on diffusion-weighted MR imaging. The remaining patients did not exhibit this pattern. Clinical and laboratory indices, as well as neuroimaging findings, were compared between groups. RESULTS: The reduced-diffusivity group had a significantly higher body mass index (36 versus 28 kg/m2, P < .01). Patients with reduced diffusivity trended toward more frequent acute renal failure (7/7, 100% versus 9/20, 45%; P = .06) and lower estimated glomerular filtration rate values (49 versus 85 mL/min; P = .06) at the time of MRI. Patients with reduced diffusivity also showed lesser mean values of the lowest hemoglobin levels (8.1 versus 10.2 g/dL, P < .05) and higher serum sodium levels (147 versus 139 mmol/L, P = .04) within 24 hours before MR imaging. The reduced-diffusivity group showed a striking and highly reproducible distribution of confluent, predominantly symmetric, supratentorial, and middle cerebellar peduncular white matter lesions (P < .001). CONCLUSIONS: Our findings highlight notable correlations between severe COVID-19 leukoencephalopathy with reduced diffusivity and obesity, acute renal failure, mild hypernatremia, anemia, and an unusual brain MR imaging white matter lesion distribution pattern. Together, these observations may shed light on possible SARS-CoV-2 pathophysiologic mechanisms associated with leukoencephalopathy, including borderzone ischemic changes, electrolyte transport disturbances, and silent hypoxia in the setting of the known cytokine storm syndrome that accompanies severe COVID-19.


Subject(s)
Acute Kidney Injury/diagnostic imaging , COVID-19/complications , Intensive Care Units , Leukoencephalopathies/complications , Acute Kidney Injury/complications , Adult , Diffusion Magnetic Resonance Imaging , Humans , Leukoencephalopathies/diagnostic imaging , Magnetic Resonance Imaging/methods , Male , Middle Aged , SARS-CoV-2 , White Matter/diagnostic imaging
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 24(4): 359-365, 2021 Apr 25.
Article in Chinese | MEDLINE | ID: covidwho-827753

ABSTRACT

Objective: Pelvic high-resolution magnetic resonance imaging (MRI) has now become a standard method for evaluating the efficacy of neoadjuvant treatment for locally advanced rectal cancer (LARC). However, this traditional morphological qualitative assessment method based on T2-weighted imaging (T2WI) is not effective in predicting pathological complete remission (pCR). The purpose of this study is to investigate whether combining the magnetic resonance tumor regression grade (mrTRG) with apparent diffusion coefficient (ADC) can improve diagnostic value for pCR after preoperative neoadjuvant chemoradiotherapy (nCRT) of LARC. Methods: This was a diagnostic study. Clinicopathological data of 134 LARC patients who received nCRT and radical surgery in the First Affiliated Hospital of Kunming Medical University from January 2017 to December 2019 were retrospectively analyzed. All the patients underwent MRI which included T2WI and DWI sequences before and 8 weeks after nCRT. Two radiologists independently drew ROIs on T2WI and DWI to estimate mrTRG stage and calculate the mean ADC value. Receiver operating characteristics (ROC) method was applied to evaluate the predict value of mrTRG combined with mean ADC value for pCR. Results: Of 134 LARC patients, 85 were male and 49 were female with median age of 58 (28-82) years. After nCRT, MRI suggested 21 patients (15.7%) had clinical complete remission (cCR), e.g. mrTRG stage 1-2. Postoperative pathology revealed 31 (23.1%) patients had pCR. The evaluations of mrTRG and ADC value by the two readers were highly consistent, and the intra-group correlation coefficients were 0.83 (95% CI: 0.703-0.881) and 0.96 (95% CI: 0.989-0.996), respectively. There was a negative correlation between mrTRG and pCR (r(s)=-0.505, P<0.01), and a positive correlation between mean ADC value and pCR (r(s)=0.693, P<0.01). The ROC curve showed that mrTRG alone had a medium predictive value for pCR, with an area under the curve (AUC) of 0.832 (95% CI: 0.743-0.921); the mean ADC value had a higher predictive value for pCR, with AUC of 0.906 (95% CI: 0.869-0.962). The predictive value of the combined model of mrTRG and ADC value for pCR was significantly better than that of mrTRG alone (P=0.015), and the AUC was 0.908 (95% CI: 0.849-0.968). Conclusion: Both mrTRG and mean ADC value can be non-invasive methods to predict the efficacy of nCRT for LARC. Combining the mean ADC value with mrTRG can result in better pCR prediction.


Subject(s)
Neoadjuvant Therapy , Rectal Neoplasms , Aged , Aged, 80 and over , Chemoradiotherapy , Diffusion Magnetic Resonance Imaging , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Rectal Neoplasms/drug therapy , Rectal Neoplasms/therapy , Retrospective Studies , Treatment Outcome
13.
Rinsho Shinkeigaku ; 60(10): 706-711, 2020 Oct 24.
Article in Japanese | MEDLINE | ID: covidwho-745654

ABSTRACT

During the COVID-19 pandemic in 2020, an 81-year-old afebrile woman was transported to our institute at 44 minutes after she was found to have global aphasia and weakness of the right extremities. The onset time was unclear. CT showed an occlusion of the left middle cerebral artery without early ischemic changes. MRI revealed a negative fluid-attenuated inversion recovery (FLAIR) pattern, in which several small acute infarcts were seen in diffusion-weighted images with no corresponding hyperintensity lesions on FLAIR. Accordingly, intravenous thrombolysis with alteplase (0.6 mg/kg, the dose approved in Japan) was administered at 1,660 minutes after the last known well and 116 minutes after the symptom recognition. An immediate internal carotid angiogram showed severe stenosis at the distal end of the horizontal portion of the left middle cerebral artery. In the follow-up angiogram at 164 minutes after the symptom recognition, the stenotic lesion almost resolved with the restoration of quick and nearly complete antegrade flow. Her symptoms also resolved promptly. Although the use of MRI is recommended to be minimized in the emergency stroke management during the COVID-19 pandemic, MRI is occasionally mandatory for patient selection, such as cases with unclear onset to perform intravenous thrombolysis. The individualized protected code stroke is essential and must be well considered by each institute for diagnosing patients by selecting appropriate modalities.


Subject(s)
Coronavirus Infections/prevention & control , Diffusion Magnetic Resonance Imaging , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Stroke/diagnostic imaging , Stroke/drug therapy , Thrombolytic Therapy/methods , Tissue Plasminogen Activator/therapeutic use , Aged, 80 and over , COVID-19 , Female , Humans , Infusions, Intravenous , Time Factors , Tissue Plasminogen Activator/administration & dosage
14.
Stroke ; 51(11): 3366-3370, 2020 11.
Article in English | MEDLINE | ID: covidwho-722391

ABSTRACT

BACKGROUND AND PURPOSE: Reports are emerging regarding the association of acute ischemic strokes with large vessel occlusion and coronavirus disease 2019 (COVID-19). While a higher severity of these patients could be expected from the addition of both respiratory and neurological injury, COVID-19 patients with strokes can present with mild or none respiratory symptoms. We aimed to compare anterior circulation large vessel occlusion strokes severity between patients with and without COVID-19. METHODS: We performed a comparative cohort study between patients with COVID-19 who had anterior circulation large vessel occlusion and early brain imaging within 3 hours from onset, in our institution during the 6 first weeks of the COVID-19 outbreak and a control group admitted during the same calendar period in 2019. RESULTS: Twelve COVID-19 patients with anterior circulation large vessel occlusion and early brain imaging were included during the study period and compared with 34 control patients with anterior circulation large vessel occlusion and early brain imaging in 2019. Patients in the COVID-19 group were younger (P=0.032) and had a history of diabetes mellitus more frequently (P=0.039). Patients did not significantly differ on initial National Institutes of Health Stroke Scale nor time from onset to imaging (P=0.18 and P=0.6, respectively). Patients with COVID-19 had more severe strokes than patients without COVID-19, with a significantly lower clot burden score (median: 6.5 versus 8, P=0.016), higher rate of multivessel occlusion (50% versus 8.8%, P=0.005), lower DWI-ASPECTS (Diffusion-Weighted Imaging-Alberta Stroke Program Early CT Scores; median: 5 versus 8, P=0.006), and higher infarct core volume (median: 58 versus 6 mL, P=0.004). Successful recanalization rate was similar in both groups (P=0.767). In-hospital mortality was higher in the COVID-19 patients' group (41.7% versus 11.8%, P=0.025). CONCLUSIONS: Early brain imaging showed higher severity large vessel occlusion strokes in patients with COVID-19. Given the massive number of infected patients, concerns should be raised about the coming neurovascular impact of the pandemic worldwide.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Stroke/diagnostic imaging , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Case-Control Studies , Cerebral Angiography , Computed Tomography Angiography , Diffusion Magnetic Resonance Imaging , Female , Hospital Mortality , Humans , Infarction, Anterior Cerebral Artery/complications , Infarction, Anterior Cerebral Artery/diagnostic imaging , Infarction, Anterior Cerebral Artery/physiopathology , Infarction, Anterior Cerebral Artery/therapy , Infarction, Middle Cerebral Artery/complications , Infarction, Middle Cerebral Artery/diagnostic imaging , Infarction, Middle Cerebral Artery/physiopathology , Infarction, Middle Cerebral Artery/therapy , Infarction, Posterior Cerebral Artery/complications , Infarction, Posterior Cerebral Artery/diagnostic imaging , Infarction, Posterior Cerebral Artery/physiopathology , Infarction, Posterior Cerebral Artery/therapy , Magnetic Resonance Angiography , Male , Middle Aged , Pandemics , SARS-CoV-2 , Severity of Illness Index , Stroke/complications , Stroke/physiopathology , Stroke/therapy , Thrombectomy , Thrombolytic Therapy
16.
J Stroke Cerebrovasc Dis ; 29(8): 104974, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-665314

ABSTRACT

Emerging evidence suggests that patients with coronavirus disease 2019 (COVID-19) are at risk of thromboembolic complications, including ischemic strokes. We present a case illustrating the value of CT perfusion to identify acute small subcortical infarcts in a patient with COVID-19 admitted to an intensive care unit for bilateral pneumonia and pulmonary embolism presenting with sudden right limb weakness.


Subject(s)
Betacoronavirus/isolation & purification , Brain Infarction/diagnostic imaging , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Perfusion Imaging/methods , Pneumonia, Viral/diagnosis , Thalamic Diseases/diagnostic imaging , Tomography, X-Ray Computed , Anticoagulants/therapeutic use , Antiviral Agents/therapeutic use , Brain Infarction/therapy , COVID-19 , COVID-19 Testing , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Coronavirus Infections/virology , Diffusion Magnetic Resonance Imaging , Host Microbial Interactions , Humans , Male , Middle Aged , Noninvasive Ventilation , Pandemics , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Predictive Value of Tests , Prosthesis Implantation/instrumentation , SARS-CoV-2 , Thalamic Diseases/therapy , Treatment Outcome , Vena Cava Filters
20.
Mult Scler Relat Disord ; 43: 102216, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-419863

ABSTRACT

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.


Subject(s)
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
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