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1.
Intern Med ; 60(19): 3167-3170, 2021 Oct 01.
Article in English | MEDLINE | ID: covidwho-1511912

ABSTRACT

We herein report a 49-year-old man with a fever, diagnosed with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. After two weeks of hospitalization, he suddenly mentioned visual field impairment. Computed tomography and magnetic resonance imaging revealed white matter damage and vasogenic edema. Cerebrospinal fluid showed increased levels of interleukin (IL)-6. His symptoms and white matter lesion deteriorated. After treatment with intravenous methylprednisolone therapy and plasmapheresis, his symptoms and white matter lesion improved gradually. We suspect that our patient was affected by a secondary hyperinflammatory syndrome related to cytokines, alone or in combination with direct viral injury through endothelial cell damage. The IL-6 levels were elevated only in the cerebrospinal fluid, suggesting focal central nervous system inflammation.


Subject(s)
COVID-19 , Interleukin-6/cerebrospinal fluid , White Matter , COVID-19/complications , COVID-19/pathology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , White Matter/diagnostic imaging , White Matter/pathology
2.
J Clin Invest ; 131(8)2021 04 15.
Article in English | MEDLINE | ID: covidwho-1291498

ABSTRACT

BACKGROUNDThe coronavirus disease 2019 (COVID-19) rapidly progressed to a global pandemic. Although some patients totally recover from COVID-19 pneumonia, the disease's long-term effects on the brain still need to be explored.METHODSWe recruited 51 patients with 2 subtypes of COVID-19 (19 mild and 32 severe) with no specific neurological manifestations at the acute stage and no obvious lesions on the conventional MRI 3 months after discharge. Changes in gray matter morphometry, cerebral blood flow (CBF), and white matter (WM) microstructure were investigated using MRI. The relationship between brain imaging measurements and inflammation markers was further analyzed.RESULTSCompared with healthy controls, the decrease in cortical thickness/CBF and the changes in WM microstructure were more severe in patients with severe disease than in those with mild disease, especially in the frontal and limbic systems. Furthermore, changes in brain microstructure, CBF, and tract parameters were significantly correlated (P < 0.05) with the inflammatory markers C-reactive protein, procalcitonin, and interleukin 6.CONCLUSIONIndirect injury related to inflammatory storm may damage the brain, altering cerebral volume, CBF, and WM tracts. COVID-19-related hypoxemia and dysfunction of vascular endothelium may also contribute to neurological changes. The abnormalities in these brain areas need to be monitored during recovery, which could help clinicians understand the potential neurological sequelae of COVID-19.FUNDINGNatural Science Foundation of China.


Subject(s)
COVID-19/diagnostic imaging , Cerebrovascular Circulation/physiology , SARS-CoV-2 , Aged , Brain/blood supply , Brain/diagnostic imaging , Brain/pathology , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/physiopathology , Case-Control Studies , China/epidemiology , Diffusion Tensor Imaging , Echo-Planar Imaging , Female , Follow-Up Studies , Gray Matter/diagnostic imaging , Gray Matter/pathology , Humans , Imaging, Three-Dimensional , Inflammation Mediators/blood , Interleukin-6/blood , Male , Middle Aged , Neuroimaging , Pandemics , Procalcitonin/blood , Severity of Illness Index , Time Factors , White Matter/diagnostic imaging , White Matter/pathology
3.
Pediatr Infect Dis J ; 40(7): e268-e269, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1201334

ABSTRACT

Coronavirus disease 2019 (COVID-19) symptoms in newborn infants are incompletely described. We present the first case of neuroradiologic abnormality associated with COVID-19 in a newborn infant with afebrile seizure. This case underlines the possible neurologic involvement of severe acute respiratory syndrome coronavirus 2 in this age group.


Subject(s)
COVID-19/complications , Seizures/virology , White Matter/pathology , White Matter/virology , Brain/diagnostic imaging , Brain/pathology , Brain/virology , COVID-19/diagnosis , COVID-19/physiopathology , Fever , Humans , Infant, Newborn , Magnetic Resonance Imaging , Male , Seizures/etiology
4.
AJNR Am J Neuroradiol ; 42(7): 1190-1195, 2021 07.
Article in English | MEDLINE | ID: covidwho-1200066

ABSTRACT

BACKGROUND: Neurologic events have been reported in patients with coronavirus disease 2019 (COVID-19). However, a model-based evaluation of the spatial distribution of these events is lacking. PURPOSE: Our aim was to quantitatively evaluate whether a network diffusion model can explain the spread of small neurologic events. DATA SOURCES: The MEDLINE, EMBASE, Scopus, and LitCovid data bases were searched from January 1, 2020, to July 19, 2020. STUDY SELECTION: Thirty-five case series and case studies reported 317 small neurologic events in 123 unique patients with COVID-19. DATA ANALYSIS: Neurologic events were localized to gray or white matter regions of the Illinois Institute of Technology (gray-matter and white matter) Human Brain Atlas using radiologic images and descriptions. The total proportion of events was calculated for each region. A network diffusion model was implemented, and any brain regions showing a significant association (P < .05, family-wise error-corrected) between predicted and measured events were considered epicenters. DATA SYNTHESIS: Within gray matter, neurologic events were widely distributed, with the largest number of events (∼10%) observed in the bilateral superior temporal, precentral, and lateral occipital cortices, respectively. Network diffusion modeling showed a significant association between predicted and measured gray matter events when the spread of pathology was seeded from the bilateral cerebellum (r = 0.51, P < .001, corrected) and putamen (r = 0.4, P = .02, corrected). In white matter, most events (∼26%) were observed within the bilateral corticospinal tracts. LIMITATIONS: The risk of bias was not considered because all studies were either case series or case studies. CONCLUSIONS: Transconnectome diffusion of pathology via the structural network of the brain may contribute to the spread of neurologic events in patients with COVID-19.


Subject(s)
Brain/diagnostic imaging , Brain/pathology , COVID-19/diagnostic imaging , COVID-19/pathology , Cerebral Cortex/diagnostic imaging , Cerebral Cortex/pathology , Gray Matter/diagnostic imaging , Gray Matter/pathology , Humans , Magnetic Resonance Imaging/methods , White Matter/diagnostic imaging , White Matter/pathology
5.
J Clin Invest ; 131(8)2021 04 15.
Article in English | MEDLINE | ID: covidwho-1186424

ABSTRACT

BACKGROUNDThe coronavirus disease 2019 (COVID-19) rapidly progressed to a global pandemic. Although some patients totally recover from COVID-19 pneumonia, the disease's long-term effects on the brain still need to be explored.METHODSWe recruited 51 patients with 2 subtypes of COVID-19 (19 mild and 32 severe) with no specific neurological manifestations at the acute stage and no obvious lesions on the conventional MRI 3 months after discharge. Changes in gray matter morphometry, cerebral blood flow (CBF), and white matter (WM) microstructure were investigated using MRI. The relationship between brain imaging measurements and inflammation markers was further analyzed.RESULTSCompared with healthy controls, the decrease in cortical thickness/CBF and the changes in WM microstructure were more severe in patients with severe disease than in those with mild disease, especially in the frontal and limbic systems. Furthermore, changes in brain microstructure, CBF, and tract parameters were significantly correlated (P < 0.05) with the inflammatory markers C-reactive protein, procalcitonin, and interleukin 6.CONCLUSIONIndirect injury related to inflammatory storm may damage the brain, altering cerebral volume, CBF, and WM tracts. COVID-19-related hypoxemia and dysfunction of vascular endothelium may also contribute to neurological changes. The abnormalities in these brain areas need to be monitored during recovery, which could help clinicians understand the potential neurological sequelae of COVID-19.FUNDINGNatural Science Foundation of China.


Subject(s)
COVID-19/diagnostic imaging , Cerebrovascular Circulation/physiology , SARS-CoV-2 , Aged , Brain/blood supply , Brain/diagnostic imaging , Brain/pathology , C-Reactive Protein/metabolism , COVID-19/epidemiology , COVID-19/physiopathology , Case-Control Studies , China/epidemiology , Diffusion Tensor Imaging , Echo-Planar Imaging , Female , Follow-Up Studies , Gray Matter/diagnostic imaging , Gray Matter/pathology , Humans , Imaging, Three-Dimensional , Inflammation Mediators/blood , Interleukin-6/blood , Male , Middle Aged , Neuroimaging , Pandemics , Procalcitonin/blood , Severity of Illness Index , Time Factors , White Matter/diagnostic imaging , White Matter/pathology
6.
Neurol Neurochir Pol ; 54(4): 312-322, 2020.
Article in English | MEDLINE | ID: covidwho-1067910

ABSTRACT

AIM: To evaluate five illustrative cases and perform a literature review to identify and describe a working approach to adult-onset white matter diseases (WMD). STATE OF THE ART: Inherited WMD are a group of disorders often seen in childhood. In adulthood, progressive WMDs are rare, apart from the common nonspecific causes of hypertension and other cerebrovascular diseases. The pattern of WMDs on neuroimaging can be an important clue to the final diagnosis. Due to the adoption of a combined clinical-imaging-laboratory approach, WMD is becoming better recognised, in addition to the rapidly evolving field of genomics in this area. CLINICAL IMPLICATIONS: While paediatric WMDs have a well-defined and literature-based clinical-laboratory approach to diagnosis, adult-onset WMDs remain an important, pathologically diverse, radiographic phenotype, with different and distinct neuropathologies among the various subtypes of WMD. Adult-onset WMDs comprise a wide collection of both acquired and inherited aetiologies. While severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neurological complications are emerging, we are as yet unaware of it causing WMD outside of post-anoxic changes. It is important to recognise WMD as a potentially undefined acquired or genetic syndrome, even when extensive full genome testing reveals variants of unknown significance. FUTURE DIRECTIONS: We propose a combined clinical-imaging-laboratory approach to WMD and continued exploration of acquired and genetic factors. Adult-onset WMD, even given this approach, can be challenging because hypertension is often comorbid. Therefore, we propose that undiagnosed patients with WMD be entered into multicentre National Organisation for Rare Diseases registries to help researchers worldwide make new discoveries that will hopefully translate into future cures.


Subject(s)
Leukoencephalopathies/diagnosis , Leukoencephalopathies/etiology , Adult , Betacoronavirus , COVID-19 , Coronavirus Infections , Humans , Pandemics , Pneumonia, Viral , SARS-CoV-2 , White Matter/pathology
7.
Neurology ; 96(10): e1437-e1442, 2021 03 09.
Article in English | MEDLINE | ID: covidwho-1027729

ABSTRACT

OBJECTIVE: We report a case series of patients with prolonged but reversible unconsciousness after coronavirus disease 2019 (COVID-19)-related severe respiratory failure. METHODS: A case series of patients who were admitted to the intensive care unit due to COVID-19-related acute respiratory failure is described. RESULTS: After cessation of sedatives, the described cases all showed a prolonged comatose state. Diagnostic neurologic workup did not show signs of devastating brain injury. The clinical pattern of awakening started with early eye opening without obeying commands and persistent flaccid weakness in all cases. Time between cessation of sedatives to the first moment of being fully responsive with obeying commands ranged from 8 to 31 days. CONCLUSION: Prolonged unconsciousness in patients with severe respiratory failure due to COVID-19 can be fully reversible, warranting a cautious approach for prognostication based on a prolonged state of unconsciousness.


Subject(s)
COVID-19/complications , Coma/etiology , Respiratory Insufficiency/complications , Adult , Aged , Coma/diagnostic imaging , Coma/pathology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Respiratory Insufficiency/etiology , Time Factors , Treatment Outcome , White Matter/diagnostic imaging , White Matter/pathology
9.
Neuroradiol J ; 33(6): 528-531, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-760511

ABSTRACT

A wide range of neurological complications of coronavirus disease 2019 (COVID-19) is increasingly recognised. Although the majority of these remain ischaemic and haemorrhagic events, various disorders are being reported. In particular, several cases of diffuse acute leukoencephalopathy have been observed in critically ill patients with COVID-19 disease. We report the case of a 59-year-old man with multiple comorbidities and severe COVID-19 pneumonia who developed a diffuse leukoencephalopathy with microhaemorrhages and extensive associated white matter necrosis. Although this is the first documented case of extensive COVID-19-associated white matter necrosis, we highlight the relatively constant features of this injury similar to previously reported cases, including symmetrical involvement of the supratentorial white matter, sparing of the peripheral subcortical regions except in the precentral gyri, frequently associated microhaemorrhages, relative sparing of the deep gray matter structures and infratentorial structures, and lack of enhancement.


Subject(s)
Brain/diagnostic imaging , COVID-19/diagnostic imaging , Cerebral Hemorrhage/diagnostic imaging , Leukoencephalopathies/diagnostic imaging , White Matter/diagnostic imaging , Bacteremia/complications , COVID-19/complications , COVID-19/physiopathology , Candidemia/complications , Cerebral Hemorrhage/etiology , Diabetes Mellitus , Humans , Hypertension/complications , Kidney Failure, Chronic/complications , Kidney Failure, Chronic/therapy , Leukoencephalopathies/etiology , Magnetic Resonance Imaging , Male , Middle Aged , Necrosis , Renal Dialysis , Severity of Illness Index , Tomography, X-Ray Computed , White Matter/pathology
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