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1.
J Pers Med ; 11(6)2021 May 21.
Article in English | MEDLINE | ID: covidwho-1244055

ABSTRACT

From the beginning of SARS-CoV-2 virus pandemic, it was clear that respiratory symptoms are often accompanied with neurological symptoms. Neurological manifestations can occur even after mild forms of respiratory disease, and neurological symptoms are very often associated with worsening of the patient's condition. The aim of this study was to show abnormal brain neuroimaging findings evaluated by MRI in patients after SARS-CoV-2 infection and neurological symptoms. Methods: Sixteen patients after mild forms of SARS-CoV-2 infection, twenty-three patients after moderate forms of SARS-CoV-2 infection as well as sixteen healthy participants in the control group underwent MRI 3T brain scan. All subjects in the SARS-CoV-2 group had small, punctuate, strategically located and newly formed hyperintense lesions on T2 and FLAIR sequences. New lesions were formed more often in the bilateral frontal subcortical and bilateral periventricular, correlated with the severity of the clinical picture. These changes indicate an example of silent cerebrovascular disease related to SARS-CoV-2 and once again emphasize the neurotropism of the virus.

2.
AJR Am J Roentgenol ; 216(4): 1046-1047, 2021 04.
Article in English | MEDLINE | ID: covidwho-1088880

ABSTRACT

Among 2820 inpatients with coronavirus disease (COVID-19), 59 (2.1%) underwent brain MRI. Of them, six (10.2%) had MRI findings suspicious for COVID-19-related disseminated leukoencephalopathy (CRDL), which is characterized by extensive confluent or multifocal white matter lesions (with characteristics and locations atypical for other causes), microhemorrhages, diffusion restriction, and enhancement. CRDL is an uncommon but important differential consideration in patients with neurologic manifestations of COVID-19.


Subject(s)
Brain/diagnostic imaging , COVID-19/complications , Leukoencephalopathies/etiology , Magnetic Resonance Imaging/methods , Pandemics , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Female , Humans , Leukoencephalopathies/diagnosis , Male , Middle Aged , Retrospective Studies
3.
J Neurol Sci ; 421: 117308, 2021 02 15.
Article in English | MEDLINE | ID: covidwho-1033825

ABSTRACT

We evaluated the incidence, distribution, and histopathologic correlates of microvascular brain lesions in patients with severe COVID-19. Sixteen consecutive patients admitted to the intensive care unit with severe COVID-19 undergoing brain MRI for evaluation of coma or neurologic deficits were retrospectively identified. Eleven patients had punctate susceptibility-weighted imaging (SWI) lesions in the subcortical and deep white matter, eight patients had >10 SWI lesions, and four patients had lesions involving the corpus callosum. The distribution of SWI lesions was similar to that seen in patients with hypoxic respiratory failure, sepsis, and disseminated intravascular coagulation. Brain autopsy in one patient revealed that SWI lesions corresponded to widespread microvascular injury, characterized by perivascular and parenchymal petechial hemorrhages and microscopic ischemic lesions. Collectively, these radiologic and histopathologic findings add to growing evidence that patients with severe COVID-19 are at risk for multifocal microvascular hemorrhagic and ischemic lesions in the subcortical and deep white matter.


Subject(s)
Brain Injuries/diagnostic imaging , COVID-19/diagnostic imaging , Magnetic Resonance Imaging/methods , Microvessels/diagnostic imaging , Severity of Illness Index , Brain/blood supply , Brain/diagnostic imaging , Brain Injuries/etiology , COVID-19/complications , Humans , Intensive Care Units/trends , Male , Microvessels/injuries , Middle Aged , Retrospective Studies
4.
J Neuroradiol ; 48(3): 141-146, 2021 May.
Article in English | MEDLINE | ID: covidwho-978379

ABSTRACT

BACKGROUND AND PURPOSE: Cerebral complications related to COVID-19 were recently reported, and the underlying mechanisms of brain damage remain uncertain, probably multifactorial. Among various hypotheses suggested, a possible vasculitis was issued but never confirmed. Herein, we aimed to describe brain MRIs focused on the intracranial vessel wall in a population of COVID-19 patients with neurologic manifestations. MATERIALS AND METHODS: Between March 1 and May 31, 2020, 69 consecutive COVID-19 patients with neurologic manifestations underwent a brain MRI allowing the study of the intracranial vessel wall at Strasbourg University hospitals and were retrospectively included. During the same period, 25 consecutive patients, without suspicion of SARS-CoV-2 infection, underwent a brain MRI urgently, with the same imaging protocols. A vasculitis seemed likely when imaging demonstrated vessel wall thickening with homogeneous and concentric enhancement. RESULTS: Among the 69 COVID-19 patients included, 11 (16%) presented arterial vessel wall thickening with homogeneous and concentric enhancement, compatible with cerebral vasculitis. These neuroimaging findings were not found among the 25 patients without SARS-CoV-2 infection, and the difference was statistically significant (p = 0.03). Middle cerebral arteries, basilar artery, and posterior cerebral arteries were the most frequent vessels involved. For nine of them, imaging demonstrated ischemic or hemorrhagic complications. CONCLUSION: Cerebral vasculitis of medium-sized vessels seems to be one of the mechanisms at the origin of brain damage related to COVID-19.


Subject(s)
Brain/diagnostic imaging , COVID-19/complications , Vasculitis, Central Nervous System/etiology , Adult , Aged , Aged, 80 and over , COVID-19/diagnostic imaging , Female , Humans , Magnetic Resonance Angiography , Magnetic Resonance Imaging , Male , Middle Aged , Neuroimaging , Retrospective Studies , Vasculitis, Central Nervous System/diagnostic imaging , Young Adult
5.
Eur J Neurol ; 27(12): 2651-2657, 2020 12.
Article in English | MEDLINE | ID: covidwho-799153

ABSTRACT

AIM: The aim of this paper is to describe the clinical features of COVID-19-related encephalopathy and their metabolic correlates using brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) imaging. BACKGROUND AND PURPOSE: A variety of neurological manifestations have been reported in association with COVID-19. COVID-19-related encephalopathy has seldom been reported and studied. METHODS: We report four cases of COVID-19-related encephalopathy. The diagnosis was made in patients with confirmed COVID-19 who presented with new-onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) (FDG-PET/CT). RESULTS: The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID-19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG-PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy. CONCLUSIONS: Despite varied clinical presentations, all patients presented with a consistent FDG-PET pattern, which may reflect an immune mechanism.


Subject(s)
Brain Diseases/diagnostic imaging , COVID-19/complications , Aged , Brain Diseases/psychology , Brain Diseases/therapy , COVID-19/therapy , Cerebellar Diseases/diagnostic imaging , Cerebellar Diseases/etiology , Cognition Disorders/etiology , Cognition Disorders/psychology , Female , Fluorodeoxyglucose F18 , Frontal Lobe/diagnostic imaging , Humans , Immunotherapy , Magnetic Resonance Imaging , Male , Mental Disorders/etiology , Mental Disorders/psychology , Middle Aged , Myoclonus/diagnostic imaging , Myoclonus/etiology , Neuropsychological Tests , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Status Epilepticus/etiology , Treatment Outcome
6.
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
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