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1.
Mult Scler Relat Disord ; 50: 102857, 2021 May.
Article in English | MEDLINE | ID: covidwho-1096170

ABSTRACT

A variety of neurologic manifestations of COVID-19 infections have been reported. Here, we present a case of steroid-responsive MOG-antibody associated encephalitis, characterized by cognitive decline, headaches, fever, unilateral FLAIR-hyperintensities, and leptomeningeal enhancement, that occurred in the setting of recent COVID-19 infection.


Subject(s)
COVID-19 , Encephalitis , Encephalitis/diagnostic imaging , Encephalitis/etiology , Headache , Humans , Magnetic Resonance Imaging , SARS-CoV-2
2.
3.
Neurosci Lett ; 742: 135529, 2021 01 18.
Article in English | MEDLINE | ID: covidwho-971460
5.
J Clin Neurosci ; 80: 280-281, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-816712

ABSTRACT

The etiological agent of coronavirus disease-19 (COVID-19), SARS-coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and quickly spread worldwide leading the World Health Organization (WHO) to recognize it not only as a pandemic but also as an important thread to public health. Beyond respiratory symptoms, new neurological manifestations are being identified such as headache, ageusia, anosmia, encephalitis or acute cerebrovascular disease. Here we report the case of an acute transverse myelitis (TM) in a patient with SARS-CoV-2 infection detected by the nasopharyngeal swab technique but not in cerebrospinal fluid (CSF) analysis. Anti-herpes simplex virus (HSV) 1 and varicella-zoster IgM antibodies were not detected in serum samples and spinal and brain magnetic resonance imaging (MRI) showed no abnormal findings. This case remarks that COVID-19 nervous system damage could be caused by immune-mediated mechanisms.


Subject(s)
Coronavirus Infections/complications , Myelitis/virology , Pneumonia, Viral/complications , Antibodies, Viral/blood , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/cerebrospinal fluid , Coronavirus Infections/diagnostic imaging , Encephalitis/blood , Encephalitis/diagnostic imaging , Encephalitis/virology , Headache/virology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myelitis/blood , Myelitis/diagnostic imaging , Nervous System Diseases/virology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/cerebrospinal fluid , Pneumonia, Viral/diagnostic imaging , SARS-CoV-2
7.
Am J Case Rep ; 21: e925641, 2020 Aug 16.
Article in English | MEDLINE | ID: covidwho-721632

ABSTRACT

BACKGROUND Acute hemorrhagic necrotizing encephalitis (AHNE) is a rare manifestation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. AHNE usually involves the subcortical white matter but not the cortical grey matter. This study describes the disruptive effects of AHNE associated with SARS-CoV-2 on cognitive function in a previously healthy and sound middle-aged woman resulting from alterations in cortical areas involved in the cognitive network. CASE REPORT A 44-year-old previously healthy woman with a history of inter-state travel developed a flu-like illness, followed by acute, steadily progressive cognitive impairment. She was admitted in a comatose state after a first tonic-clonic seizure. Blood tests were non-informative. Cerebral magnetic resonance imaging (MRI) was indicative of AHNE. Cerebrospinal fluid analysis showed mild lymphocytosis with normal protein and normal glucose but an elevated IgG index. After testing positive for SARS-CoV-2, she was administered steroids. Treatment was ineffective, and the patient died. CONCLUSIONS SARS-CoV-2 is a potential central nervous system (CNS) pathogen, which may manifest as AHNE. These patients may present with generalized tonic-clonic seizures and frontal dysexecutive syndrome, with cognitive impairment being the presenting feature of neuro-coronavirus disease-2019 (COVID-19). The patient described in this report is unique for acute-onset and isolated cognitive impairments due to SARS-CoV-2 infection in the absence of clinical or radiological respiratory manifestations. These findings may help in the early detection and diagnosis of neuro-COVID-19, especially among clinicians and neurologists working in areas of endemic SARS-CoV-2 infection.


Subject(s)
Betacoronavirus , Cerebral Hemorrhage/virology , Cognitive Dysfunction/virology , Coronavirus Infections/diagnosis , Encephalitis/virology , Pneumonia, Viral/diagnosis , Adult , COVID-19 , Cerebral Hemorrhage/diagnostic imaging , Encephalitis/diagnostic imaging , Fatal Outcome , Female , Humans , Immunoglobulin G/cerebrospinal fluid , Magnetic Resonance Imaging , Pandemics , SARS-CoV-2 , Seizures/virology
8.
Neurology ; 95(13): e1868-e1882, 2020 09 29.
Article in English | MEDLINE | ID: covidwho-653268

ABSTRACT

OBJECTIVE: To describe neuroimaging findings and to report the epidemiologic and clinical characteristics of patients with coronavirus disease 2019 (COVID-19) with neurologic manifestations. METHODS: In this retrospective multicenter study (11 hospitals), we included 64 patients with confirmed COVID-19 with neurologic manifestations who underwent a brain MRI. RESULTS: The cohort included 43 men (67%) and 21 women (33%); their median age was 66 (range 20-92) years. Thirty-six (56%) brain MRIs were considered abnormal, possibly related to severe acute respiratory syndrome coronavirus. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurologic manifestation, followed by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from that of other patients with abnormal brain imaging: the former less frequently had acute respiratory distress syndrome (p = 0.006) and more frequently had corticospinal tract signs (p = 0.02). Patients with encephalitis were younger (p = 0.007), whereas agitation was more frequent for patients with leptomeningeal enhancement (p = 0.009). CONCLUSIONS: Patients with COVID-19 may develop a wide range of neurologic symptoms, which can be associated with severe and fatal complications such as ischemic stroke or encephalitis. In terms of meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology seems to involve an immune or inflammatory process given the presence of signs of inflammation in both CSF and neuroimaging but the lack of virus in CSF. CLINICALTRIALSGOV IDENTIFIER: NCT04368390.


Subject(s)
Brain Ischemia/diagnostic imaging , Brain/diagnostic imaging , Coronavirus Infections/diagnostic imaging , Meningoencephalitis/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Stroke/diagnostic imaging , Adult , Aged , Aged, 80 and over , Betacoronavirus , Brain Ischemia/physiopathology , COVID-19 , Confusion/physiopathology , Consciousness Disorders/physiopathology , Coronavirus Infections/physiopathology , Encephalitis/diagnostic imaging , Encephalitis/physiopathology , Female , France , Headache/physiopathology , Humans , Magnetic Resonance Imaging , Male , Meningitis/diagnostic imaging , Meningitis/physiopathology , Meningoencephalitis/physiopathology , Middle Aged , Pandemics , Pneumonia, Viral/physiopathology , Psychomotor Agitation/physiopathology , Pyramidal Tracts/diagnostic imaging , Pyramidal Tracts/physiopathology , Respiratory Distress Syndrome/physiopathology , Retrospective Studies , SARS-CoV-2 , Stroke/physiopathology , Young Adult
9.
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
11.
Radiology ; 297(1): E223-E227, 2020 10.
Article in English | MEDLINE | ID: covidwho-327353

ABSTRACT

Diffuse leukoencephalopathy and juxtacortical and/or callosal microhemorrhages were brain imaging features in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy. Herein, the authors report brain imaging features in 11 critically ill patients with COVID-19 with persistently diminished mental status who underwent MRI between April 5 and April 25, 2020. These imaging features include (a) confluent T2 hyperintensity and mild restricted diffusion in bilateral supratentorial deep and subcortical white matter (in 10 of 11 patients) and (b) multiple punctate microhemorrhages in juxtacortical and callosal white matter (in seven of 11 patients). The authors also discuss potential pathogeneses.


Subject(s)
Brain , Cerebral Hemorrhage , Coronavirus Infections , Leukoencephalopathies , Pandemics , Pneumonia, Viral , Adult , Betacoronavirus , Brain/diagnostic imaging , Brain/pathology , COVID-19 , Cerebral Hemorrhage/diagnostic imaging , Cerebral Hemorrhage/pathology , Cerebral Hemorrhage/virology , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Encephalitis/diagnostic imaging , Encephalitis/pathology , Encephalitis/virology , Female , Humans , Leukoencephalopathies/diagnostic imaging , Leukoencephalopathies/pathology , Leukoencephalopathies/virology , Magnetic Resonance Imaging , Male , Middle Aged , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Retrospective Studies , SARS-CoV-2
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