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1.
Int J Mol Sci ; 22(14)2021 Jul 06.
Article in English | MEDLINE | ID: covidwho-1485149

ABSTRACT

Chronic neurodegenerative diseases are complex, and their pathogenesis is uncertain. Alzheimer's disease (AD) is a neurodegenerative brain alteration that is responsible for most dementia cases in the elderly. AD etiology is still uncertain; however, chronic neuroinflammation is a constant component of brain pathology. Infections have been associated with several neurological diseases and viruses of the Herpes family appear to be a probable cause of AD neurodegenerative alterations. Several different factors may contribute to the AD clinical progression. Exogeneous viruses or other microbes and environmental pollutants may directly induce neurodegeneration by activating brain inflammation. In this paper, we suggest that exogeneous brain insults may also activate retrotransposons and silent human endogenous retroviruses (HERVs). The initial inflammation of small brain areas induced by virus infections or other brain insults may activate HERV dis-regulation that contributes to neurodegenerative mechanisms. Chronic HERV activation in turn may cause progressive neurodegeneration that thereafter merges in cognitive impairment and dementia in genetically susceptible people. Specific treatment for exogenous end endogenous pathogens and decreasing pollutant exposure may show beneficial effect in early intervention protocol to prevent the progression of cognitive deterioration in the elderly.


Subject(s)
Alzheimer Disease/pathology , Alzheimer Disease/virology , Brain/pathology , Brain/virology , Endogenous Retroviruses/pathogenicity , Virus Diseases/pathology , Virus Diseases/virology , Animals , Cognition Disorders/pathology , Cognition Disorders/virology , Encephalitis/pathology , Encephalitis/virology , Humans
3.
Med Clin (Barc) ; 157(3): 141-143, 2021 08 13.
Article in English, Spanish | MEDLINE | ID: covidwho-1340761

ABSTRACT

INTRODUCTION: In the context of the global COVID-19 pandemic, the different clinical manifestations of this infection pose a challenge for healthcare professionals. Respiratory involvement, the main symptom of SARS-CoV-2 infection, means that other manifestations, such as neurological, take a back seat, with the consequent delay in diagnosis and treatment. MATERIAL AND METHODS: All COVID-19 patients admitted with neurological symptoms or diagnosed with encephalitis since March 2020 in a tertiary hospital in Zaragoza, Spain. RESULTS: Two patients with COVID-19 infection confirmed by nasopharyngeal PCR and whose clinical picture consisted of neurological alterations compatible with encephalitis. Cerebrospinal fluid (CSF) microbiology was negative for bacteria and viruses, including SARS-CoV-2 but, given the clinical suspicion of encephalitis due to the latter, antiviral treatment with immunoglobulins and plasmapheresis was started early. Despite this, the evolution was not satisfactory. CONCLUSIONS: COVID-19 encephalitis is a recently described clinical entity, whose pathophysiology is still unknown and no treatment with clinical evidence is available to date.


Subject(s)
COVID-19 , Encephalitis , Nervous System Diseases , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/virology , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , Pandemics , Spain
4.
Med Sci Monit ; 27: e932962, 2021 Jun 19.
Article in English | MEDLINE | ID: covidwho-1278722

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the causative pathogen of the recent pandemic of coronavirus disease 19 (COVID-19). As the infection spreads, there is increasing evidence of neurological and psychiatric involvement in COVID-19. Headache, impaired consciousness, and olfactory and gustatory dysfunctions are common neurological manifestations described in the literature. Studies demonstrating more specific and more severe neurological involvement such as cerebrovascular insults, encephalitis and Guillain-Barre syndrome are also emerging. Respiratory failure, a significant condition that leads to mortality in COVID-19, is hypothesized to be partly due to brainstem impairment. Notably, some of these neurological complications seem to persist long after infection. This review aims to provide an update on what is currently known about neurological involvement in patients with COVID-19 due to SARS-CoV-2 infection. In this review, we demonstrate invasion routes of SARS-CoV-2, provide evidence to support the neurotropism hypothesis of the virus, and investigate the pathological mechanisms that underlie neurological complications associated with SARS-CoV-2.


Subject(s)
COVID-19/physiopathology , Nervous System Diseases/virology , Ageusia/virology , Anosmia/virology , COVID-19/complications , COVID-19/epidemiology , COVID-19/metabolism , COVID-19/virology , Encephalitis/virology , Headache/physiopathology , Headache/virology , Humans , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Neuroimmunomodulation/physiology , Pandemics , SARS-CoV-2/isolation & purification , Stroke/physiopathology , Stroke/virology
5.
Med Clin (Barc) ; 157(3): 141-143, 2021 08 13.
Article in English, Spanish | MEDLINE | ID: covidwho-1253373

ABSTRACT

INTRODUCTION: In the context of the global COVID-19 pandemic, the different clinical manifestations of this infection pose a challenge for healthcare professionals. Respiratory involvement, the main symptom of SARS-CoV-2 infection, means that other manifestations, such as neurological, take a back seat, with the consequent delay in diagnosis and treatment. MATERIAL AND METHODS: All COVID-19 patients admitted with neurological symptoms or diagnosed with encephalitis since March 2020 in a tertiary hospital in Zaragoza, Spain. RESULTS: Two patients with COVID-19 infection confirmed by nasopharyngeal PCR and whose clinical picture consisted of neurological alterations compatible with encephalitis. Cerebrospinal fluid (CSF) microbiology was negative for bacteria and viruses, including SARS-CoV-2 but, given the clinical suspicion of encephalitis due to the latter, antiviral treatment with immunoglobulins and plasmapheresis was started early. Despite this, the evolution was not satisfactory. CONCLUSIONS: COVID-19 encephalitis is a recently described clinical entity, whose pathophysiology is still unknown and no treatment with clinical evidence is available to date.


Subject(s)
COVID-19 , Encephalitis , Nervous System Diseases , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/virology , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , Pandemics , Spain
6.
Mol Neurobiol ; 58(7): 3417-3434, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1130917

ABSTRACT

There are regular reports of extrapulmonary infections and manifestations related to the ongoing COVID-19 pandemic. Coronaviruses are potentially neurotropic, which renders neuronal tissue vulnerable to infection, especially in elderly individuals or in those with neuro-comorbid conditions. Complaints of ageusia, anosmia, myalgia, and headache; reports of diseases such as stroke, encephalopathy, seizure, and encephalitis; and loss of consciousness in patients with COVID-19 confirm the neuropathophysiological aspect of this disease. The brain is linked to pulmonary organs, physiologically through blood circulation, and functionally through the nervous system. The interdependence of these vital organs may further aggravate the pathophysiological aspects of COVID-19. The induction of a cytokine storm in systemic circulation can trigger a neuroinflammatory cascade, which can subsequently compromise the blood-brain barrier and activate microglia- and astrocyte-borne Toll-like receptors, thereby leading to neuronal tissue damage. Hence, a holistic approach should be adopted by healthcare professionals while treating COVID-19 patients with a history of neurodegenerative disorders, neuropsychological complications, or any other neuro-compromised conditions. Imperatively, vaccines are being developed at top priority to contain the spread of the severe acute respiratory syndrome coronavirus 2, and different vaccines are at different stages of development globally. This review discusses the concerns regarding the neuronal complications of COVID-19 and the possible mechanisms of amelioration.


Subject(s)
Brain/virology , COVID-19/complications , Cytokine Release Syndrome/virology , Encephalitis/virology , Inflammation/virology , Stroke/virology , Humans , SARS-CoV-2
7.
Prog Neuropsychopharmacol Biol Psychiatry ; 109: 110276, 2021 07 13.
Article in English | MEDLINE | ID: covidwho-1065536

ABSTRACT

The encephalitis lethargica (EL) epidemic swept the world from 1916 to 1926 and is estimated to have afflicted between 80,000 to one million people. EL is an unusual neurological illness that causes profound sleep disorders, devastating neurological sequalae and, in many cases, death. Though uncommon, EL is still occasionally diagnosed today when a patient presents with an acute or subacute encephalitic illness, where all other known causes of encephalitis have been excluded and criteria for EL are met. However, it is impossible to know whether recent cases of EL-like syndromes result from the same disease that caused the epidemic. After more than 100 years of research into potential pathogen triggers and the role of autoimmune processes, the aetiology of EL remains unknown. The epidemic approximately coincided with the 1918 H1N1 influenza pandemic but the evidence of a causal link is inconclusive. This article reviews the literature on the causes of EL with a focus on autoimmune mechanisms. In light of the current pandemic, we also consider the parallels between the EL epidemic and neurological manifestations of COVID-19. Understanding how pathogens and autoimmune processes can affect the brain may well help us understand the conundrum of EL and, more importantly, will guide the treatment of patients with suspected COVID-19-related neurological disease, as well as prepare us for any future epidemic of a neurological illness.


Subject(s)
Autoimmune Diseases/immunology , Autoimmune Diseases/virology , Encephalitis/immunology , Encephalitis/virology , Pandemics/history , Autoimmune Diseases/history , COVID-19 , Encephalitis/history , History, 20th Century , Humans , Risk Factors
8.
J Infect Dis ; 223(1): 28-37, 2021 01 04.
Article in English | MEDLINE | ID: covidwho-1066338

ABSTRACT

BACKGROUND: Several preclinical and clinical investigations have argued for nervous system involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some sparse case reports have described various forms of encephalitis in coronavirus disease 2019 (COVID-19) disease, but very few data have focused on clinical presentations, clinical course, response to treatment, and outcomes. METHODS: The SARS-CoV-2 related encephalopaties (ENCOVID) multicenter study included patients with encephalitis with full infectious screening, cerebrospinal fluid (CSF), electroencephalography (EEG), and magnetic resonance imaging (MRI) data and confirmed SARS-CoV-2 infection recruited from 13 centers in northern Italy. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment, and outcomes were recorded. RESULTS: Twenty-five cases of encephalitis positive for SARS-CoV-2 infection were included. CSF showed hyperproteinorrachia and/or pleocytosis in 68% of cases whereas SARS-CoV-2 RNA by reverse-transcription polymerase chain reaction resulted negative. Based on MRI, cases were classified as acute demyelinating encephalomyelitis (ADEM; n = 3), limbic encephalitis (LE; n = 2), encephalitis with normal imaging (n = 13), and encephalitis with MRI alterations (n = 7). ADEM and LE cases showed a delayed onset compared to the other encephalitis cases (P = .001) and were associated with previous, more severe COVID-19 respiratory involvement. Patients with MRI alterations exhibited worse response to treatment and final outcomes compared to those with other encephalitis. CONCLUSIONS: SARS-CoV-2 infection is associated with a wide spectrum of encephalitis characterized by different clinical presentation, response to treatment, and outcomes.


Subject(s)
COVID-19/complications , Encephalitis/diagnosis , Aged , Aged, 80 and over , COVID-19/therapy , Electroencephalography , Encephalitis/classification , Encephalitis/virology , Female , Humans , Italy , Longitudinal Studies , Magnetic Resonance Imaging , Male , Middle Aged
12.
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
13.
J Neurovirol ; 26(5): 619-630, 2020 10.
Article in English | MEDLINE | ID: covidwho-728290

ABSTRACT

The recent pandemic outbreak of coronavirus is pathogenic and a highly transmittable viral infection caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV2). In this time of ongoing pandemic, many emerging reports suggested that the SARS-CoV-2 has inimical effects on neurological functions, and even causes serious neurological damage. The neurological symptoms associated with COVID-19 include headache, dizziness, depression, anosmia, encephalitis, stroke, epileptic seizures, and Guillain-Barre syndrome along with many others. The involvement of the CNS may be related with poor prognosis and disease worsening. Here, we review the evidence of nervous system involvement and currently known neurological manifestations in COVID-19 infections caused by SARS-CoV-2. We prioritize the 332 human targets of SARS-CoV-2 according to their association with brain-related disease and identified 73 candidate genes. We prioritize these 73 genes according to their spatio-temporal expression in the different regions of brain and also through evolutionary intolerance analysis. The prioritized genes could be considered potential indicators of COVID-19-associated neurological symptoms and thus act as a possible therapeutic target for the prevention and treatment of CNS manifestations associated with COVID-19 patients.


Subject(s)
Betacoronavirus/pathogenicity , Brain/metabolism , Coronavirus Infections/genetics , Host-Pathogen Interactions/genetics , Nerve Tissue Proteins/genetics , Pneumonia, Viral/genetics , Viral Proteins/genetics , Brain/pathology , Brain/virology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/pathology , Coronavirus Infections/virology , Depression , Dizziness/complications , Dizziness/genetics , Dizziness/pathology , Dizziness/virology , Encephalitis/complications , Encephalitis/genetics , Encephalitis/pathology , Encephalitis/virology , Guillain-Barre Syndrome/complications , Guillain-Barre Syndrome/genetics , Guillain-Barre Syndrome/pathology , Guillain-Barre Syndrome/virology , Headache/complications , Headache/genetics , Headache/pathology , Headache/virology , Humans , Nerve Tissue Proteins/classification , Nerve Tissue Proteins/metabolism , Olfaction Disorders/complications , Olfaction Disorders/genetics , Olfaction Disorders/pathology , Olfaction Disorders/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/pathology , Pneumonia, Viral/virology , Protein Interaction Mapping , SARS-CoV-2 , Seizures/complications , Seizures/genetics , Seizures/pathology , Seizures/virology , Severity of Illness Index , Stroke/complications , Stroke/genetics , Stroke/pathology , Stroke/virology , Viral Proteins/metabolism
14.
Rev. chil. pediatr ; 91(4): 614-619, ago. 2020.
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-727586

ABSTRACT

Resumen: La enfermedad por coronavirus ha extendido su compromiso más allá del sistema respiratorio con reportes crecientes de compromiso en diferentes sistemas, uno de ellos, el Sistema Nervioso. El potencial neuroinvasivo de este agente patógeno se explicaría por su neurotropismo dada la presencia de receptores de ACE2 a nivel de encéfalo y médula espinal, además del importante com promiso inflamatorio sistémico. El compromiso neurológico debido a la infección se ha dividido en Sistema Nervioso Central, destacando síntomas inespecíficos y leves como mareos y cefalea, así como cuadros graves con encefalitis y patología cerebrovascular, y Sistema Nervioso Periférico en donde la mayor relevancia guarda relación con la anosmia, ageusia y miositis. A nivel pediátrico el compromiso parece ser menor que en adultos, pero existe un reporte creciente en la literatura respecto a estos hallazgos. Es de gran importancia de contar con un adecuado registro y anamnesis que permita identificar precozmente el compromiso neurológico.


Abstract: Coronavirus disease has extended its involvement beyond the respiratory system, with increasing reports of involving different systems, such as Nervous System. The neuroinvasive potential of this pathogen would be explained by its neurotropism given the presence of ACE2 receptors in the brain and spinal cord, in addition to the important systemic inflammatory involvement. The neu rological involvement due to infection is divided between the central nervous system, highlighting non-specific and mild symptoms such as dizziness and headache, as well as severe symptoms with encephalitis and cerebrovascular pathology, and the peripheral nervous system, which mainly pre sents anosmia, ageusia, and myositis. Clinical symptomatology in pediatric patients seems to be less than in adults, but there is a growing report in the literature regarding these findings. There fore, it is very important to have an adequate registry and anamnesis that allow early identification of neurological involvement.


Subject(s)
Humans , Child , Pneumonia, Viral/complications , Coronavirus Infections/complications , Peptidyl-Dipeptidase A/metabolism , Nervous System Diseases/virology , Pediatrics , Age Factors , Encephalitis/virology , Headache/virology , Nervous System Diseases/physiopathology
15.
Medwave ; 20(7): e7984, 2020 Aug 03.
Article in Spanish | MEDLINE | ID: covidwho-724227

ABSTRACT

There are limited reports of neurological symptoms in the pediatric population with COVID-19. We report a 13-year-old girl with three days of illness characterized by headache, non-explosive vomiting, fever, and sudden-onset sensory disorder associated with difficulty in standing and hemiparesis in limbs without evidence of meningeal signs. Brain tomography revealed diffuse brain edema, and the cerebrospinal fluid study was consistent with a viral infection. COVID-19 was diagnosed based on serology. The patient had an untoward clinical course despite treatment with hydroxychloroquine, azithromycin, and corticosteroids, dying on the third day of hospitalization. Encephalitis in a patient with COVID-19 is not frequently reported in the pediatric population. It should be considered in the differential diagnosis in patients who arrives at the emergency with a sensory disorder or neurological symptomatology in the context of the COVID-19 pandemic.


Existen limitados reportes de síntomas neurológicos en la población pediátrica con COVID-19. Reportamos el caso de una niña de 13 años con tres días de enfermedad caracterizada por cefalea, vómitos no explosivos, fiebre y trastorno del sensorio de inicio brusco asociado a dificultad para la bipedestación y hemiparesia en extremidades, sin evidencia de signos meníngeos. La tomografía cerebral reveló edema cerebral difuso y el estudio de líquido cefalorraquídeo era concordante con una infección viral. El diagnóstico de COVID-19 fue mediante pruebas serológicas. La paciente tuvo una evolución clínica desfavorable a pesar del tratamiento con hidroxicloroquina, azitromicina y corticoides, falleciendo al tercer día de hospitalización. La encefalitis en un paciente con COVID-19 es una asociación poco descrita en la población pediátrica. Esta infección debe ser considerado como diagnóstico diferencial en los pacientes que llegan a la emergencia con trastorno de sensorio o sintomatología neurológica en el contexto de la actual pandemia.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Encephalitis/diagnosis , Pneumonia, Viral/complications , Adolescent , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Diagnosis, Differential , Encephalitis/virology , Fatal Outcome , Female , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , SARS-CoV-2
16.
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
17.
World Neurosurg ; 140: 46-48, 2020 08.
Article in English | MEDLINE | ID: covidwho-596185

ABSTRACT

BACKGROUND: Reports on neurologic manifestations of coronavirus disease 2019 (COVID-19) have attracted broad attention. We present an unusual case of COVID-19-associated encephalitis mimicking a glial tumor. CASE DESCRIPTION: A 35-year-old woman presented with headache and seizures. T2 fluid-attenuated inverse recovery imaging showed hyperintensities in the left temporal lobe. Magnetic resonance spectroscopy showed an elevated choline peak. Imaging findings were suggestive of high-grade glioma. Antiepileptic medication failed to achieve seizure control. A left anterior temporal lobectomy was performed. The patient had no postoperative deficits, and her symptoms completely improved. Histologic examination revealed encephalitis. Postoperatively, our patient tested positive for COVID-19. CONCLUSIONS: Our case raises awareness of neurologic manifestations of the disease and their potential to mimic glial tumors. For prompt diagnosis and prevention of transmission, clinicians should consider COVID-19 in patients with similar presentation.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Diagnosis, Differential , Encephalitis/virology , Glioma/diagnosis , Pneumonia, Viral/complications , Adult , COVID-19 , Coronavirus Infections/pathology , Encephalitis/diagnosis , Encephalitis/pathology , Female , Glioma/pathology , Headache/virology , Humans , Pandemics , Pneumonia, Viral/pathology , SARS-CoV-2 , Seizures/pathology , Seizures/virology , Temporal Lobe/pathology , Temporal Lobe/virology
18.
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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