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1.
Med J Malaysia ; 78(3): 421-426, 2023 05.
Article in English | MEDLINE | ID: covidwho-20235551

ABSTRACT

OBJECTIVES: Severe, acute, respiratory syndromecoronavirus- 2 (SARS-CoV-2) infections can be complicated by central nervous system (CNS) disease. One of the CNS disorders associated with Coronavirus Disease-19 (COVID- 19) is posterior reversible encephalopathy syndrome (PRES). This narrative review summarises and discusses previous and recent findings on SARS-CoV-2 associated PRES. METHODS: A literature search was carried out in PubMed and Google Scholar using suitable search terms and reference lists of articles found were searched for further articles. RESULTS: By the end of February 2023, 82 patients with SARS-CoV-2 associated PRES were recorded. The latency between the onset of COVID-19 and the onset of PRES ranged from 1 day to 70 days. The most common presentations of PRES were mental deterioration (n=47), seizures (n=46) and visual disturbances (n=18). Elevated blood pressure was reported on admission or during hospitalisation in 48 patients. The most common comorbidities were arterial hypertension, diabetes, hyperlipidemia and atherosclerosis. PRES was best diagnosed by multimodal cerebral magnetic resonance imaging (MRI). Complete recovery was reported in 35 patients and partial recovery in 21 patients, while seven patients died. CONCLUSIONS: PRES can be a CNS complication associated with COVID-19. COVID-19 patients with mental dysfunction, seizures or visual disturbances should immediately undergo CNS imaging through multimodal MRI, electroencephalography (EEG) and cerebrospinal fluid (CSF) studies in order not to miss PRES.


Subject(s)
COVID-19 , Hypertension , Posterior Leukoencephalopathy Syndrome , Humans , Posterior Leukoencephalopathy Syndrome/diagnosis , Posterior Leukoencephalopathy Syndrome/etiology , SARS-CoV-2 , COVID-19/complications , Seizures/etiology , Electroencephalography/adverse effects , Electroencephalography/methods , Hypertension/complications , Magnetic Resonance Imaging/methods
2.
Semin Neurol ; 43(2): 219-228, 2023 04.
Article in English | MEDLINE | ID: covidwho-2322304

ABSTRACT

COVID-19 has been associated with numerous neurological complications, with acute cerebrovascular disease being one of the most devastating complications. Ischemic stroke is the most common cerebrovascular complication of COVID-19, affecting between 1 and 6% of all patients. Underlying mechanisms for COVID-related ischemic strokes are thought to be due to vasculopathy, endotheliopathy, direct invasion of the arterial wall, and platelet activation. Other COVID-19-associated cerebrovascular complications include hemorrhagic stroke, cerebral microbleeds, posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis, and subarachnoid hemorrhage. This article discusses the incidence of these cerebrovascular complications, risk factors, management strategies, prognosis and future research directions, as well as considerations in pregnancy-related cerebrovascular events in the setting of COVID-19.


Subject(s)
COVID-19 , Cerebrovascular Disorders , Posterior Leukoencephalopathy Syndrome , Pregnancy Complications , Pregnancy , Female , Humans , COVID-19/complications , Posterior Leukoencephalopathy Syndrome/complications , Cerebrovascular Disorders/epidemiology , Cerebrovascular Disorders/etiology , Cerebrovascular Disorders/therapy , Prognosis
3.
Neurology ; 100(22): e2247-e2258, 2023 05 30.
Article in English | MEDLINE | ID: covidwho-2298629

ABSTRACT

BACKGROUND AND OBJECTIVES: To report the prevalence of acute encephalopathy and outcomes in patients with severe coronavirus disease 2019 (COVID-19) and to identify determinants of 90-day outcomes. METHODS: Data from adults with severe COVID-19 and acute encephalopathy were prospectively collected for patients requiring intensive care unit management in 31 university or university-affiliated intensive care units in 6 countries (France, United States, Colombia, Spain, Mexico, and Brazil) between March and September of 2020. Acute encephalopathy was defined, as recently recommended, as subsyndromal delirium or delirium or as a comatose state in case of severely decreased level of consciousness. Logistic multivariable regression was performed to identify factors associated with 90-day outcomes. A Glasgow Outcome Scale-Extended (GOS-E) score of 1-4 was considered a poor outcome (indicating death, vegetative state, or severe disability). RESULTS: Of 4,060 patients admitted with COVID-19, 374 (9.2%) experienced acute encephalopathy at or before the intensive care unit (ICU) admission. A total of 199/345 (57.7%) patients had a poor outcome at 90-day follow-up as evaluated by the GOS-E (29 patients were lost to follow-up). On multivariable analysis, age older than 70 years (odds ratio [OR] 4.01, 95% CI 2.25-7.15), presumed fatal comorbidity (OR 3.98, 95% CI 1.68-9.44), Glasgow coma scale score <9 before/at ICU admission (OR 2.20, 95% CI 1.22-3.98), vasopressor/inotrope support during ICU stay (OR 3.91, 95% CI 1.97-7.76), renal replacement therapy during ICU stay (OR 2.31, 95% CI 1.21-4.50), and CNS ischemic or hemorrhagic complications as acute encephalopathy etiology (OR 3.22, 95% CI 1.41-7.82) were independently associated with higher odds of poor 90-day outcome. Status epilepticus, posterior reversible encephalopathy syndrome, and reversible cerebral vasoconstriction syndrome were associated with lower odds of poor 90-day outcome (OR 0.15, 95% CI 0.03-0.83). DISCUSSION: In this observational study, we found a low prevalence of acute encephalopathy at ICU admission in patients with COVID-19. More than half of patients with COVID-19 presenting with acute encephalopathy had poor outcomes as evaluated by GOS-E. Determinants of poor 90-day outcome were dominated by older age, comorbidities, degree of impairment of consciousness before/at ICU admission, association with other organ failures, and acute encephalopathy etiology. TRIAL REGISTRATION INFORMATION: The study is registered with ClinicalTrials.gov, number NCT04320472.


Subject(s)
COVID-19 , Delirium , Posterior Leukoencephalopathy Syndrome , Adult , Humans , Aged , COVID-19/complications , Coma/epidemiology , Prospective Studies , Intensive Care Units
5.
J Child Neurol ; 38(3-4): 121-129, 2023 03.
Article in English | MEDLINE | ID: covidwho-2275833

ABSTRACT

Clinical guidance on outpatient follow-up of children hospitalized with acute neurologic complications of SARS-CoV2 infection is needed. We describe the clinical infrastructure of our pediatric neurology post-Covid clinic, including our clinical evaluation and cognitive testing battery specific to this patient population, and a case series of our initial patient cohort. Our findings demonstrate cognitive sequelae in all 4 of our patients months following acute SARS-CoV2 infection with neurologic complications including acute disseminated encephalomyelitis, posterior reversible encephalopathy syndrome, viral encephalitis, and gait difficulties. Verbal and executive function domains were predominantly affected in our cohort, even in patients who did not endorse symptomatic or academic complaints at follow-up. Our recommendations include systematic clinical follow-up for children following hospitalization with SARS-CoV2 infection with a comprehensive cognitive battery to monitor for cognitive sequalae and to assist with developing an individualized education plan for the child as they return to school.


Subject(s)
COVID-19 , Neurology , Posterior Leukoencephalopathy Syndrome , Humans , Child , Follow-Up Studies , RNA, Viral , COVID-19/complications , SARS-CoV-2
6.
BMC Neurol ; 23(1): 63, 2023 Feb 10.
Article in English | MEDLINE | ID: covidwho-2287879

ABSTRACT

BACKGROUND: Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder with complex physiopathological mechanisms that have not been fully understood. Early identification is of great prognostic significance, of which the symptoms and radiological abnormalities can be completely reversed. If the diagnosis and treatment are delayed, ischemia and massive infarction may be developed in some patients. Posterior reversible encephalopathy syndrome (PRES) has been reported mainly in association with postpartum eclampsia, which have been rarely reported, while the association with hypothyroidism has not been reported at home or abroad. CASE PRESENTATION: Here we report on a pregnant 29-year-old with multipara and a chief complication of hypothyroidism. She presented in the emergency department with frequent attacks of severe headache symptoms resulting from reversible cerebral vasoconstriction syndrome (RCVS), accompanied with prenatal eclampsia. PRES was determined by radiological examination. CONCLUSION: To the best of our knowledge, this is the first case of PRES complicated by hypothyroidism and prepartum eclampsia.Clinicians should be alert for the co-occurence of eclampsia, PRES, and RCVS when patients have convulsions after a typical throbbing headache. Moreover, regular monitoring of thyroid function during pregnancy should also occupy certain special attention.


Subject(s)
Eclampsia , Hypothyroidism , Posterior Leukoencephalopathy Syndrome , Puerperal Disorders , Pregnancy , Female , Humans , Adult , Eclampsia/diagnosis , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Seizures/complications , Puerperal Disorders/diagnosis , Puerperal Disorders/etiology , Headache/complications , Hypothyroidism/complications
7.
J Neurol ; 270(6): 2826-2852, 2023 Jun.
Article in English | MEDLINE | ID: covidwho-2252612

ABSTRACT

During the SARS-CoV2 pandemic, several cases of Posterior Reversible Encephalopathy Syndrome (PRES) and of Reversible Cerebral Vasoconstriction Syndrome (RCVS) in COVID-19 patients have been reported, but the link between these syndromes and COVID-19 is unclear. We performed a systematic review, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement to evaluate whether SARS-CoV2 infection or the drugs used to treat it could be deemed potential risk factors for PRES or RCVS. We performed a literature search. We found 70 articles (60 on PRES and 10 on RCVS) concerning n = 105 patients (n = 85 with PRES, n = 20 with RCVS). We analyzed the clinical characteristics of the two populations separately, then performed an inferential analysis to search for other independent risk factors. We found fewer than usual PRES-related (43.9%) and RCVS-related (45%) risk factors in patients with COVID-19. Such a low incidence of risk factors for PRES and RCVS might suggest the involvement of COVID-19 as an additional risk factor for both diseases due to its capability to cause endothelial dysfunction. We discuss the putative mechanisms of endothelial damage by SARS-CoV2 and antiviral drugs which may underlie the development of PRES and RCVS.


Subject(s)
COVID-19 , Cerebrovascular Disorders , Posterior Leukoencephalopathy Syndrome , Humans , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , COVID-19/complications , Vasoconstriction , RNA, Viral , SARS-CoV-2 , Cerebrovascular Disorders/complications
8.
BMJ Case Rep ; 15(8)2022 Aug 31.
Article in English | MEDLINE | ID: covidwho-2193658

ABSTRACT

A man in his 20s presented following a generalised tonic-clonic seizure on a background of a recent diagnosis of hepatitis B (HBV). During admission, he was severely hypertensive and imaging findings confirmed a diagnosis of posterior reversible leukoencephalopathy syndrome (PRES). The patient subsequently developed multiorgan involvement with an axonal sensorimotor neuropathy, vascular cutaneous lesions and multiple bilateral renal and splenic infarcts. Based on the 2012 Revised International Chapel Hill Consensus Criteria, a diagnosis of polyarteritis nodosa (PAN) with secondary PRES was made. The patient was given intravenous methylprednisolone, followed by a prolonged course of oral prednisolone, and tenofovir antiviral therapy to target HBV seroconversion. He made a good neurological recovery with resolution of imaging changes. This case highlights the importance of a low threshold for systemic screening for young patients presenting with PRES secondary to uncontrolled hypertension and the importance of viral screening, particularly for HBV.


Subject(s)
Polyarteritis Nodosa , Posterior Leukoencephalopathy Syndrome , Antiviral Agents/therapeutic use , Humans , Male , Methylprednisolone/therapeutic use , Polyarteritis Nodosa/complications , Polyarteritis Nodosa/diagnosis , Polyarteritis Nodosa/drug therapy , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/drug therapy , Tenofovir/therapeutic use
9.
Rev Esp Anestesiol Reanim (Engl Ed) ; 70(1): 51-55, 2023 01.
Article in English | MEDLINE | ID: covidwho-2165792

ABSTRACT

Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema. The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome. SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.


Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , Humans , COVID-19/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/etiology , SARS-CoV-2 , Magnetic Resonance Imaging , Brain
10.
J Biomed Sci ; 29(1): 72, 2022 Sep 21.
Article in English | MEDLINE | ID: covidwho-2064807

ABSTRACT

Reversible cerebral vasoconstriction syndrome (RCVS) is a complex neurovascular disorder being recognized during the past two decades. It is characterized by multiple abrupt severe headaches and widespread cerebral vasoconstrictions, with potential complications such as ischemic stroke, convexity subarachnoid hemorrhage, intracerebral hemorrhage and posterior reversible encephalopathy syndrome. The clinical features, imaging findings, and dynamic disease course have been delineated. However, the pathophysiology of RCVS remains elusive. Recent studies have had substantial progress in elucidating its pathogenesis. It is now believed that dysfunction of cerebral vascular tone and impairment of blood-brain barrier may play key roles in the pathophysiology of RCVS, which explains some of the clinical and radiological manifestations of RCVS. Some other potentially important elements include genetic predisposition, sympathetic overactivity, endothelial dysfunction, and oxidative stress, although the detailed molecular mechanisms are yet to be identified. In this review, we will summarize what have been revealed in the literature and elaborate how these factors could contribute to the pathophysiology of RCVS.


Subject(s)
Posterior Leukoencephalopathy Syndrome , Vasospasm, Intracranial , Brain , Cerebral Hemorrhage , Humans , Posterior Leukoencephalopathy Syndrome/complications , Vasoconstriction/physiology , Vasospasm, Intracranial/complications
11.
Rev Bras Ter Intensiva ; 34(2): 295-299, 2022.
Article in Portuguese, English | MEDLINE | ID: covidwho-1988383

ABSTRACT

Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.


A síndrome da encefalopatia posterior reversível é uma rara síndrome clínica e radiológica caracterizada por edema vasogênico da matéria branca dos lobos occipital e parietal, que geralmente são simétricos, resultante de uma manifestação secundária de disfunção aguda do sistema cerebrovascular posterior. Descrevemos um caso de síndrome de encefalopatia posterior reversível secundária à infecção por SARS-CoV-2 em um menino de 9 anos de idade que desenvolveu insuficiência respiratória hipoxêmica aguda e necessitou de ventilação mecânica assistida. A criança desenvolveu síndrome inflamatória multissistêmica e foi monitorada na unidade de terapia intensiva pediátrica, tendo-lhe sido fornecidos ventilação mecânica e agentes vasoativos para suporte hemodinâmico. Além disso, desenvolveu manifestações clínicas pulmonares e extrapulmonares juntamente de manifestações neuropsiquiátricas que necessitavam de seguimento cuidadoso, tendo sido verificadas por ressonância magnética cerebral para intervenção oportuna. Atualmente, há poucos relatos de crianças com síndrome da encefalopatia posterior reversível associada à síndrome inflamatória multissistêmica.


Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , COVID-19/complications , Child , Humans , Magnetic Resonance Imaging , Male , Posterior Leukoencephalopathy Syndrome/diagnosis , Posterior Leukoencephalopathy Syndrome/etiology , Posterior Leukoencephalopathy Syndrome/pathology , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
13.
Brain Nerve ; 74(7): 845-851, 2022 Jul.
Article in Japanese | MEDLINE | ID: covidwho-1954937

ABSTRACT

Coronavirus disease (COVID-19) causes neurological symptoms in a high percentage of patients and is associated with various types of encephalitides and encephalopathies, which are etiologically classified into (a)direct infection of the central nervous system with severe acute respiratory syndrome coronavirus 2 and resultant meningoencephalitis (this is a rare presentation), (b)COVID-19-induced cytokine storms, which trigger endothelial cell injury, blood-brain barrier disruption, and microangiopathy and consequent encephalopathy and, (c)autoimmune encephalitis secondary to para- or post-infectious mechanisms that play a key role during the acute or post-COVID-19 phase. Notably, some patients present with neurological symptoms as the first manifestation. Radiologically characteristic encephalitides and encephalopathies, such as acute necrotizing encephalopathy, acute disseminated encephalomyelitis, posterior reversible encephalopathy syndrome, and clinically mild encephalitis/encephalopathy with a reversible splenial lesion are also complicated by COVID-19. Further investigations and appropriate treatments are warranted in patients with COVID-19, who develop new neurological symptoms.


Subject(s)
Brain Diseases , COVID-19 , Encephalitis , Meningoencephalitis , Posterior Leukoencephalopathy Syndrome , Brain Diseases/etiology , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/etiology , Humans , Meningoencephalitis/complications
15.
Br J Radiol ; 95(1136): 20220101, 2022 Aug 01.
Article in English | MEDLINE | ID: covidwho-1910419

ABSTRACT

OBJECTIVE: To retrospectively evaluate the imaging and clinical findings of patients diagnosed with multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. METHODS: The clinical, laboratory and radiological data of 110 patients (74 male and 36 female) diagnosed with COVID-19-related MIS-C between June 2020 and November 2021 were evaluated retrospectively. Cases with a diagnosis of MIS-C based on a positive real time polymerase chain reaction (RT-PCR) test or serology results according to the WHO criteria were included in the study. All the radiological data were evaluated by a pediatric radiologist with 14 years of radiology experience. RESULTS: Peribronchial thickening and hyperinflation were the most common findings on chest X-ray, while atelectasis and pleural effusion were often present in thoracic CT. Cardiac involvement was detected in 30% of the patients, mainly with valve insufficiency and systolic dysfunction, and 7.2% of these patients had sequalae findings. The most common abdominal findings were hepatosplenomegaly, mesenteric inflammation, lymphadenomegaly, thickening of the intestinal walls and free fluid. 23 of the patients had comorbidities. Neurological radiological findings observed in a total of six patients were reversible splenial lesion syndrome, posterior reversible encephalopathy syndrome, meningitis, and cerebral edema. 37 patients were followed up in the intensive care unit and 2 of them died. CONCLUSION: Radiological findings seen in MIS-C vary according to the affected system. There is no specific radiologic finding for this disease, but radiological findings can assist in the evaluation of affected systems and guide treatment. ADVANCES IN KNOWLEDGE: Since there are few studies with a limited number of patients in the literature, data on this subject are limited. We aimed to contribute to the literature with our large patient data.


Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , COVID-19/complications , COVID-19/diagnostic imaging , Child , Female , Humans , Male , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
16.
Curr Neurol Neurosci Rep ; 22(8): 515-529, 2022 08.
Article in English | MEDLINE | ID: covidwho-1899317

ABSTRACT

PURPOSE OF REVIEW: To discuss the neurological complications of dengue virus (DENV) infection and their pathogenesis. RECENT FINDINGS: Include recognition of the four different serotypes of DENV and their epidemiology as well as recognition of the expanded dengue syndrome encompassing multisystem involvement in the severe form of the disease including involvement of the central nervous system (CNS). DENV is a neurotropic virus with the ability to infect the supporting cells of the CNS. Neural injury during the acute stage of the infection results from direct neuro-invasion and/or the phenomenon of antibody-dependent enhancement, resulting in plasma leakage and coagulopathy. Immune mechanisms have been implicated in the development of the delayed neurological sequelae through molecular mimicry. A myriad of neurological syndromes has been described as a result of the involvement of the CNS, the peripheral nervous system (PNS), or both. Neurological manifestations in DENV infection are increasingly being recognized, some of which are potentially fatal if not treated promptly. DENV encephalopathy and encephalitis should be considered in the differential diagnosis of other acute febrile encephalopathies, autoimmune encephalitides, and in cases of encephalopathy/encephalitis related to SARS-CoV2 infection, especially in dengue-endemic areas. Acute disseminated encephalomyelitis (ADEM) may be occasionally encountered. Clinicians should be knowledgeable of the expanded dengue syndrome characterized by the concurrent compromise of cardiac, neurological, gastrointestinal, renal, and hematopopoietic systems. Isolated cranial nerve palsies occur rather uncommonly and are often steroid responsive. These neuropathies may result from the direct involvement of cranial nerve nuclei or nerve involvement or may be immune-mediated. Even if the diagnosis of dengue is confirmed, it is absolutely imperative to exclude other well-known causes of isolated cranial nerve palsies. Ischemic and hemorrhagic strokes may occur following dengue fever. The pathogenesis may be beyond the commonly observed thrombocytopenia and include cerebral vasculitis. Involvement of ocular blood vessels may cause maculopathy or retinal hemorrhages. Posterior reversible encephalopathy syndrome (PRES) is uncommon and possibly related to dysregulated cytokine release phenomena. Lastly, any patient developing acute neuromuscular weakness during the course or within a fortnight of remission from dengue fever must be screened for acute inflammatory demyelinating polyneuropathy (AIDP), hypokalemic paralysis, or acute myositis. Rarely, a Miller-Fisher-like syndrome with negative anti-GQ1b antibody may develop.


Subject(s)
Brain Diseases , COVID-19 , Dengue , Encephalitis , Posterior Leukoencephalopathy Syndrome , Dengue/complications , Dengue/diagnosis , Dengue/pathology , Humans , Posterior Leukoencephalopathy Syndrome/complications , RNA, Viral , SARS-CoV-2
18.
Curr Neurol Neurosci Rep ; 22(8): 499-513, 2022 08.
Article in English | MEDLINE | ID: covidwho-1889030

ABSTRACT

PURPOSE OF REVIEW: To discuss the neurological complications and pathophysiology of organ damage following malaria infection. RECENT FINDINGS: The principal advancement made in malaria research has been a better understanding of the pathogenesis of cerebral malaria (CM), the most dreaded neurological complication generally caused by Plasmodium falciparum infection. However, no definitive treatment has yet been evolved other than the use of antimalarial drugs and supportive care. The development of severe cerebral edema in CM results from two distinct pathophysiologic mechanisms. First, the development of "sticky" red blood cells (RBCs) leads to cytoadherence, where red blood cells (RBCs) get stuck to the endothelial walls and between themselves, resulting in clogging of the brain microvasculature with resultant hypoxemia and cerebral edema. In addition, the P. falciparum-infected erythrocyte membrane protein 1 (PfEMP1) molecules protrude from the raised knob structures on the RBCs walls and are in themselves made of a combination of human and parasite proteins in a tight complex. Antibodies to surfins, rifins, and stevors from the parasite are also located in the RBC membrane. On the human microvascular side, a range of molecules involved in host-parasite interactions, including CD36 and intracellular adhesion molecule 1, is activated during interaction with other molecules such as endothelial protein C receptor and thrombospondin. As a result, an inflammatory response occurs with the dysregulated release of cytokines (TNF, interleukins 1 and 10) which damage the blood-brain barrier (BBB), causing plasma leakage and brain edema. This second mechanism of CNS injury often involves multiple organs in adult patients in endemic areas but remains localized only to the central nervous system (CNS) among African children. Neurological sequelae may follow both P. falciparum and P. vivax infections. The major brain pathology of CM is brain edema with diffuse brain swelling resulting from the combined effects of reduced perfusion and hypoxemia of cerebral neurons due to blockage of the microvasculature by parasitized RBCs as well as the neurotoxic effect of released cytokines from a hyper-acute immune host reaction. A plethora of additional neurological manifestations have been associated with malaria, including posterior reversible encephalopathy syndrome (PRES), reversible cerebral vasoconstriction syndrome (RCVS), malarial retinopathy, post-malarial neurological syndrome (PMNS), acute disseminated encephalomyelitis (ADEM), Guillain-Barré syndrome (GBS), and cerebellar ataxia. Lastly, the impact of the COVID-19 pandemic on worldwide malaria control programs and the possible threat from co-infections is briefly discussed.


Subject(s)
Brain Edema , COVID-19 , Malaria, Cerebral , Malaria, Falciparum , Posterior Leukoencephalopathy Syndrome , Adult , Child , Cytokines , Humans , Hypoxia , Malaria, Cerebral/complications , Malaria, Cerebral/parasitology , Malaria, Falciparum/complications , Malaria, Falciparum/parasitology , Pandemics , Plasmodium falciparum/physiology
19.
Einstein (Sao Paulo) ; 20: eAO6562, 2022.
Article in English | MEDLINE | ID: covidwho-1789932

ABSTRACT

OBJECTIVE: To describe cerebrovascular manifestations in patients hospitalized for treatment of severe COVID-19, highlighting the comorbidities observed, and those that may play a relevant role as risk factors for severe outcomes. METHODS: This case series retrospective analyzed, from June to November, 2020, ten patients admitted to the emergency department, with positive nasopharyngeal swab polymerase chain reaction assay for SARS-CoV-2, presenting with neurological symptoms and positive findings at brain imaging studies. RESULTS: In this sample, the clinical severity of the symptoms varied from mild to critical. Ischemic stroke was observed in four patients, hemorrhagic events occurred in five cases. Three patients evolved with large parenchymal hemorrhage, and one presented petechial bleeding foci. In one case, we observed subarachnoid hemorrhage associated with bilateral hypodensity in both globus pallidus. Typical posterior reversible encephalopathy syndrome findings were observed in one patient on brain computed tomography. CONCLUSION: Patients with neurovascular complications related to COVID-19 had positive findings in brain imaging and neurological symptoms. The pathological entities observed drew attention to the neurological risk of patients with SARS-CoV-2 infection, including worse outcomes in individuals whose medical history includes clinical comorbidities, especially hypertension and obesity.


Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , COVID-19/complications , Humans , Neuroimaging , Retrospective Studies , SARS-CoV-2
20.
Acta Neurol Scand ; 146(1): 6-23, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1779169

ABSTRACT

While neurologic complications are frequently reported among patients with COVID-19 in the general population, they are unknown in pregnant women. This paper summarizes the case reports of pregnant women with confirmed SARS-CoV-2 infection plus a specified neurologic diagnosis. Until November 2021, 18 case reports were found. Both the central and peripheral nervous systems were equally affected: delirium (n = 1), posterior reversible encephalopathy syndrome (n = 4), cerebrovascular disease (n = 2), acute cerebral demyelinating disease (n = 1), acute necrotizing encephalopathy (n = 1), Guillain-Barré syndrome (n = 5), including one patient who also had vestibular neuritis, Bell's palsy (n = 3), and rhabdomyolysis (n = 1). The median maternal age was 32.5 (25-35) years, the median gestational age was 34 (30-36.5) weeks, and 38.9% presented previous medical conditions. Respiratory symptoms were reported in 76.5%, and 76.5% received immunotherapies to treat the COVID-19 or the neurologic complications. Half the women required admission to ICU and, more often, were those with central nervous system involvement (77.8% vs. 22.2%; Chi-square test, p = .018). For 64.7% of women, the most common method of delivery was surgical, although just one case was due to the neurologic complication. There were reports of one spontaneous abortion, two fetal deaths, and no maternal deaths. Only one case presented a poor neurologic outcome. It is possible that our findings are underestimated, considering that there are thousands of reports regarding neurologic complications in the general population with COVID-19.


Subject(s)
Abortion, Spontaneous , COVID-19 , Posterior Leukoencephalopathy Syndrome , Pregnancy Complications , Abortion, Spontaneous/epidemiology , Adult , COVID-19/complications , Female , Humans , Infant , Pregnancy , Pregnancy Complications/epidemiology , Pregnancy Complications/etiology , Pregnancy Complications/therapy , Pregnancy Outcome , SARS-CoV-2
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