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1.
Int J Infect Dis ; 116: 151-153, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1587626

ABSTRACT

SARS-CoV-2 infection in healthy children is usually benign. However, severe, life-threatening cases have previously been reported, notably in infants. We must be aware that data on the natural history of COVID-19 are still full of gaps, especially as far as the pediatric population is concerned. Therefore, it is important to describe rare manifestations of SARS-CoV-2 acute infection in children. Here we present the case of acute hemorrhagic necrotizing encephalitis (AHNE) in a previously healthy, 2-month-old male infant with SARS-CoV-2 infection. After 2 days of fever with signs of respiratory tract infection, neurological manifestations appeared: irritability, nystagmus, agitation then apathy. As a consequence of apnea, he required emergent intubation and was transferred to our PICU. Brain MRI revealed diffuse areas of oedema associated with numerous symmetrical changes with punctate hemorrhages in basal ganglia, thalami, brainstem, and cerebral gray matter. CSF was clear with pleocytosis 484 cells/µl, elevated lactic acid and protein. Despite broad microbiological testing, only SARS-CoV2 was detected in PCR nasal swab. Therefore, acute hemorrhagic necrotizing encephalitis (AHNE) as a result of COVID-19 was the most probable diagnosis. The outcome was unfavorable - brain death was confirmed, life support was withdrawn.


Subject(s)
COVID-19 , Encephalitis, Viral , COVID-19/complications , Child , Encephalitis, Viral/diagnosis , Hemorrhage , Humans , Infant , Male , RNA, Viral , SARS-CoV-2
2.
Ocul Immunol Inflamm ; 29(6): 1225-1233, 2021 Aug 18.
Article in English | MEDLINE | ID: covidwho-1467232

ABSTRACT

The novel pandemic coronavirus disease 2019 (COVID-19) leading to health and economic problems worldwide is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although COVID-19 mainly occurs as a lower respiratory tract infection, there is multiorgan involvement in infected patients. The disease is transmitted from person to person through air droplets or contact with contaminated surfaces. SARS-CoV-2 leads to this systemic involvement by attaching to angiotensin-converting enzyme 2 (ACE2) receptors located on several human cells. Since SARS-CoV-2 RNA has been found in tears of infected patients, ocular surface may allow the virus to transmit to nasopharynx via the nasolacrimal duct. This narrative review aims to sum up all segmental ocular complications, ocular adverse effects of COVID-19 treatment, and preventive measures suggested to minimize the SARS-CoV-2 transmission between patients and ophthalmologists by reviewing currently available literature.


Subject(s)
COVID-19/diagnosis , Eye Infections, Viral/diagnosis , SARS-CoV-2 , Tears/virology , COVID-19/prevention & control , COVID-19/virology , COVID-19 Nucleic Acid Testing , Conjunctivitis, Viral/diagnosis , Conjunctivitis, Viral/prevention & control , Conjunctivitis, Viral/virology , Encephalitis, Viral/diagnosis , Encephalitis, Viral/prevention & control , Encephalitis, Viral/virology , Eye Infections, Viral/prevention & control , Eye Infections, Viral/virology , Humans , Preventive Medicine/methods , Retinal Diseases/diagnosis , Retinal Diseases/prevention & control , Retinal Diseases/virology , SARS-CoV-2/pathogenicity
3.
J Stroke Cerebrovasc Dis ; 30(9): 105915, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1253282

ABSTRACT

We report the case of a 35-year-old male with COVID-19 encephalitis presenting as a stroke mimic with sudden-onset expressive and receptive dysphasia, mild confusion and right arm incoordination. The patient received thrombolysis for a suspected ischaemic stroke, but later became febrile and SARS-CoV-2 was detected in cerebrospinal fluid. Electroencephalography demonstrated excess in slow waves, but neuroimaging was reported as normal. Respiratory symptoms were absent throughout and nasopharyngeal swab was negative for SARS-CoV-2. At the most recent follow-up, the patient had made a full neurological recovery. Clinicians should therefore consider testing for SARS-CoV-2 in CSF in patients who present with acute focal neurology, confusion and fever during the pandemic, even when there is no evidence of respiratory infection.


Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Encephalitis, Viral/diagnosis , Ischemic Stroke/diagnosis , RNA, Viral/cerebrospinal fluid , SARS-CoV-2/genetics , Adult , COVID-19/cerebrospinal fluid , COVID-19/virology , Diagnosis, Differential , Electroencephalography , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/virology , Humans , Magnetic Resonance Imaging , Male , Predictive Value of Tests , Tomography, X-Ray Computed
5.
Rev Neurol ; 71(12): 431-437, 2020 12 16.
Article in Spanish | MEDLINE | ID: covidwho-977846

ABSTRACT

INTRODUCTION: The coronavirus disease 2019 (COVID-19) caused a collapse situation in many hospitals around the world. The aim of this study is to analyse the utility of the electroencephalogram (EEG) in the management of the neurological patient during the COVID-19 pandemic. PATIENTS AND METHODS: The Clinical Neurophysiology Department of the Hospital Central de la Defensa Gomez Ulla was dissolved due to the hospital collapse situation. Therefore, the EEG was performed exceptionally in those cases with the greatest probability of providing a benefit in its management. We describe seven patients (four in ICU and three hospitalized) diagnosed with COVID-19, who underwent through an EEG. RESULTS: The EEG showed abnormalities in all cases, including one case of brain death. The EEG resulted in a change in clinical management in four of the patients (57%) and helped the clinician provide information to the family. In the other three cases, a toxic-metabolic origin was suspected before the EEG was performed, so it did not imply a change in the clinical management already proposed, although it facilitated a prognostic orientation. Slow polymorphic waves were evident in five cases. Five patients were unresponsive. Currently, one patient remain hospitalized and four have died. CONCLUSIONS: The EEG was useful and facilitated decision making in COVID-19 patients in whom it was requested. It guided the diagnosis in cases where CT was non-contributory and led to a change in therapeutic management in most patients. The most frequent findings were signs of encephalopathy and epileptiform discharges.


TITLE: Utilidad y valor pronóstico del electroencefalograma en la COVID-19 y la encefalopatía: patrones electroencefalográficos en una serie de casos.Introducción. La enfermedad por coronavirus 2019 (COVID-19) causó el colapso de muchos hospitales. El objetivo de este estudio es analizar la utilidad del electroencefalograma (EEG) en el tratamiento del paciente neurológico durante la pandemia de COVID-19. Pacientes y métodos. El Servicio de Neurofisiología Clínica del Hospital Central de la Defensa Gómez Ulla fue disuelto debido a la situación de saturación hospitalaria. En consecuencia, se realizó un EEG excepcionalmente a los pacientes a los que tenía mayor probabilidad de aportar un beneficio en su tratamiento. Se describen siete pacientes (cuatro en cuidados intensivos y tres hospitalizados) diagnosticados con COVID-19 a quienes se les realizó un EEG. Resultados. El EEG mostró anormalidades en todos los casos, incluyendo un caso de muerte cerebral. El EEG supuso un cambio en el tratamiento clínico en cuatro de los pacientes (57%) y ayudó al clínico a informar a la familia. En los otros tres casos, se sospechó un origen tóxico-metabólico previo al EEG, por lo que no implicó un cambio en el tratamiento ya propuesto, aunque facilitó una orientación pronóstica. Se evidenciaron ondas lentas polimorfas en cinco casos. Actualmente, un paciente permanece hospitalizado y cuatro han fallecido. Conclusiones. El EEG fue de utilidad y facilitó la toma de decisiones en los pacientes con COVID-19 en los que se solicitó. Orientó al diagnóstico en casos en los que la tomografía computarizada no contribuyó y supuso un cambio en el tratamiento terapéutico en la mayoría de los pacientes. Los hallazgos más frecuentes fueron signos de encefalopatía y descargas epileptiformes.


Subject(s)
COVID-19/physiopathology , Electroencephalography , Encephalitis, Viral/diagnosis , SARS-CoV-2/isolation & purification , Aged , COVID-19/complications , COVID-19/diagnosis , COVID-19 Nucleic Acid Testing , Comorbidity , Consciousness Disorders/etiology , Consciousness Disorders/physiopathology , Encephalitis, Viral/etiology , Female , Heart Arrest , Humans , Male , Middle Aged , Movement Disorders/etiology , Movement Disorders/physiopathology , Nasopharynx/virology , Pandemics , Prognosis , Retrospective Studies
6.
BMJ Case Rep ; 13(9)2020 Sep 16.
Article in English | MEDLINE | ID: covidwho-772246

ABSTRACT

The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19's classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.


Subject(s)
Coronavirus Infections/complications , Encephalitis, Viral/cerebrospinal fluid , Pneumonia, Viral/complications , Adult , COVID-19 , Coronavirus Infections/drug therapy , Encephalitis, Viral/diagnosis , Encephalitis, Viral/drug therapy , Encephalitis, Viral/virology , Humans , Male , Pandemics , Pneumonia, Viral/drug therapy , Remission Induction
7.
Pediatr Infect Dis J ; 39(10): e320-e321, 2020 10.
Article in English | MEDLINE | ID: covidwho-710288

ABSTRACT

We report a 20-year-old female with SARS-CoV-2 encephalitis who presented with 4 days of upper respiratory symptoms, fevers and sudden acute altered mental status. An extensive work up led to the most likely cause for the neurologic decompensation to be viewed as SARS-CoV-2 symptomology.


Subject(s)
Coronavirus Infections/complications , Encephalitis, Viral/complications , Pneumonia, Viral/complications , Betacoronavirus/genetics , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Encephalitis, Viral/diagnosis , Encephalitis, Viral/therapy , Female , Humans , Mental Disorders/diagnosis , Mental Disorders/etiology , Mental Disorders/therapy , Nasopharynx/virology , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , SARS-CoV-2 , Treatment Outcome , Young Adult
8.
Acta Virol ; 64(2): 261-263, 2020.
Article in English | MEDLINE | ID: covidwho-610210

ABSTRACT

Coronaviruses are widespread in nature and can infect several different species, causing mainly respiratory and enteric diseases. The respiratory involvement of human coronaviruses has been clearly established since the 1960s. Three of the six coronaviruses that infect humans have been shown to be neuroinvasive and neurotropic in humans: HCoV-229E, HCoV-OC43, and SARS-CoV. No reports exist on the detection of HCoV-HKU1 in the human central nervous system (CNS). We report a case of a patient, in whose cerebrospinal fluid (CSF) was detected Coronavirus NL63/HKU1. Coronavirus HKU1 was detected in the sputum. With effective antiviral therapy and the use of glucocorticoids, the patient was eventually discharged from the hospital. This study might help understand more about coronavirus and improve the awareness of pathogen detection in patients with coronavirus encephalitis. Keywords: coronavirus HKU1; encephalitis.


Subject(s)
Coronavirus Infections , Coronavirus , Encephalitis, Viral , Encephalitis , Coronavirus/isolation & purification , Encephalitis, Viral/diagnosis , Humans
10.
J Neurovirol ; 26(2): 143-148, 2020 04.
Article in English | MEDLINE | ID: covidwho-343416

ABSTRACT

A pandemic due to novel coronavirus arose in mid-December 2019 in Wuhan, China, and in 3 months' time swept the world. The disease has been referred to as COVID-19, and the causative agent has been labelled SARS-CoV-2 due to its genetic similarities to the virus (SARS-CoV-1) responsible for the severe acute respiratory syndrome (SARS) epidemic nearly 20 years earlier. The spike proteins of both viruses dictate tissue tropism using the angiotensin-converting enzyme type 2 (ACE-2) receptor to bind to cells. The ACE-2 receptor can be found in nervous system tissue and endothelial cells among the tissues of many other organs.Neurological complications have been observed with COVID-19. Myalgia and headache are relatively common, but serious neurological disease appears to be rare. No part of the neuraxis is spared. The neurological disorders occurring with COVID-19 may have many pathophysiological underpinnings. Some appear to be the consequence of direct viral invasion of the nervous system tissue, others arise as a postviral autoimmune process, and still others are the result of metabolic and systemic complications due to the associated critical illness. This review addresses the preliminary observations regarding the neurological disorders reported with COVID-19 to date and describes some of the disorders that are anticipated from prior experience with similar coronaviruses.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Encephalitis, Viral/epidemiology , Meningitis/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Stroke/epidemiology , Angiotensin-Converting Enzyme 2 , Betacoronavirus/genetics , Betacoronavirus/metabolism , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Encephalitis, Viral/complications , Encephalitis, Viral/diagnosis , Encephalitis, Viral/virology , Headache/complications , Headache/diagnosis , Headache/epidemiology , Headache/virology , Host-Pathogen Interactions/genetics , Humans , Meningitis/complications , Meningitis/diagnosis , Meningitis/virology , Myalgia/complications , Myalgia/diagnosis , Myalgia/epidemiology , Myalgia/virology , Myositis/complications , Myositis/diagnosis , Myositis/epidemiology , Myositis/virology , Nervous System/pathology , Nervous System/virology , Peptidyl-Dipeptidase A/genetics , Peptidyl-Dipeptidase A/metabolism , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Protein Binding , Receptors, Virus/genetics , Receptors, Virus/metabolism , SARS-CoV-2 , Spike Glycoprotein, Coronavirus/genetics , Spike Glycoprotein, Coronavirus/metabolism , Stroke/complications , Stroke/diagnosis , Stroke/virology , Virus Internalization
11.
J Neurovirol ; 26(3): 324-329, 2020 06.
Article in English | MEDLINE | ID: covidwho-276266

ABSTRACT

Coronavirus disease 2019 (COVID-19) was reported at the end of 2019 in China for the first time and has rapidly spread throughout the world as a pandemic. Since COVID-19 causes mild to severe acute respiratory syndrome, most studies in this field have only focused on different aspects of pathogenesis in the respiratory system. However, evidence suggests that COVID-19 may affect the central nervous system (CNS). Given the outbreak of COVID-19, it seems necessary to perform investigations on the possible neurological complications in patients who suffered from COVID-19. Here, we reviewed the evidence of the neuroinvasive potential of coronaviruses and discussed the possible pathogenic processes in CNS infection by COVID-19 to provide a precise insight for future studies.


Subject(s)
Ataxia/epidemiology , Brain Edema/epidemiology , Coronavirus Infections/epidemiology , Encephalitis, Viral/epidemiology , Epilepsy/epidemiology , Multiple Sclerosis/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Severe Acute Respiratory Syndrome/epidemiology , Ataxia/complications , Ataxia/diagnosis , Ataxia/virology , Betacoronavirus/drug effects , Betacoronavirus/immunology , Betacoronavirus/pathogenicity , Blood-Brain Barrier/pathology , Blood-Brain Barrier/virology , Brain Edema/complications , Brain Edema/diagnosis , Brain Edema/virology , COVID-19 , Central Nervous System/pathology , Central Nervous System/virology , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Encephalitis, Viral/complications , Encephalitis, Viral/diagnosis , Encephalitis, Viral/virology , Epilepsy/complications , Epilepsy/diagnosis , Epilepsy/virology , Humans , Multiple Sclerosis/complications , Multiple Sclerosis/diagnosis , Multiple Sclerosis/virology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Prevalence , SARS-CoV-2 , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/diagnosis , Severe Acute Respiratory Syndrome/transmission
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