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1.
Eur J Neurol ; 28(10): 3289-3302, 2021 10.
Article in English | MEDLINE | ID: covidwho-1605352

ABSTRACT

BACKGROUND AND PURPOSE: The full spectrum of neurological sequelae in COVID-19 is beginning to emerge. SARS-CoV-2 has the potential to cause both direct and indirect brain vascular endothelial damage through infection and inflammation that may result in long-term neurological signs and symptoms. We sought to illuminate persistent neuro-ophthalmological deficits that may be seen following posterior reversible encephalopathy syndrome (PRES) due to COVID-19. METHODS: We identified three individuals with PRES due to COVID-19 in our hospital system. One patient was identified on presentation to our neuro-ophthalmology clinic. The other patients were identified through internal records search. These cases were compared to published reports of PRES in COVID-19 identified through systematic literature search of PubMed/LitCOVID. RESULTS: All three patients were hospitalized with severe COVID-19 and developed altered mental status with new onset seizures that led to the recognition of PRES through diagnostic imaging. During recovery, two patients had persistent visual dysfunction including visual field deficits. One patient also experienced hallucinatory palinopsia and visual hallucinations. Literature search identified 32 other cases of PRES in the context of COVID-19. Visual disturbances were described in 14 cases (40%), with only seven cases (50%) reporting full recovery by the time of publication. CONCLUSIONS: As we learn about enduring neurological complications of COVID-19, it is possible that complications may be underrecognized and underreported. Understanding the range of complications can help in postcare evaluation and management changes in the critical care setting to potentially allow intervention before persistent deficits occur due to COVID-19.


Subject(s)
COVID-19 , Posterior Leukoencephalopathy Syndrome , Critical Care , Humans , Posterior Leukoencephalopathy Syndrome/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , SARS-CoV-2 , Vision Disorders/etiology
2.
Case Rep Neurol Med ; 2021: 5564802, 2021.
Article in English | MEDLINE | ID: covidwho-1207518

ABSTRACT

The SARS-CoV-2 infection affects numerous organs, including the central nervous system. The neuroinvasive abilities and neuroinflammation may lead to short- and long-term neurological manifestations. Among neurological disorders associated with SARS-CoV-2 infection, posterior reversible encephalopathy syndrome (PRES) has been described in a few case-based observational studies during the acute phase of COVID-19 hospitalization. We present a case of a patient who developed seizures and PRES after recovering from an acute severe COVID-19 infection. A 90-year-old African American female with multiple comorbidities and a severe COVID-19 infection was discharged home in stable condition after two weeks of hospitalization. A week later, she developed new-onset generalized tonic-clonic seizures requiring readmission to the hospital. The patient's clinical course and brain imaging supported PRES. Her mentation returned to baseline with supportive care and anticonvulsant treatment. Follow-up brain MRI four months later demonstrated resolution of FLAIR signal abnormalities confirming PRES. SARS-CoV-2 insult on the cerebrovascular endothelial cells likely continued and despite the clinical recovery eventually resulted in PRES. We believe that this is the first case describing the presentation of PRES after recovery from severe acute COVID-19 infection.

3.
J Clin Neurosci ; 88: 108-112, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1174389

ABSTRACT

The novel human coronavirus disease (COVID-19) has been associated with vascular and thrombotic complications, some of which may result from endothelial dysfunction, including the posterior reversible encephalopathy syndrome (PRES). We report a case series of 8 patients with COVID-19 and PRES diagnosed at two academic medical centers between March and July of 2020. The clinical, laboratory and radiographic data, treatment, and short-term outcomes were retrospectively analyzed. The mean age was 57.9 ± 12 years, and 50% were women. Four patients had previous vascular comorbidities. All the patients suffered from severe pneumonia, requiring intensive care unit admission. Five patients were not hypertensive at presentation (all SBP < 127 mmHg). Neurologic symptoms included seizures in 7 patients; impaired consciousness in 5 patients; focal neurological signs in 3 patients; and visual disturbances in 1 patient. All patients underwent brain magnetic resonance imaging which indicated asymmetric T2 prolongation or diffusion changes (50%), extensive fronto-parieto-occipital involvement (25%), vascular irregularities (12.5%) and intracranial hemorrhage (25%). Four patients were treated with tocilizumab. Three patients were discharged without neurologic disability, 2 patients had persistent focal neurologic deficits and 2 expired. One patient's prognosis remains guarded. Together, these data support the relationship between PRES and endothelial dysfunction associated with severe COVID-19. In patients with severe COVID-19, PRES can be triggered by uncontrolled hypertension, or occur independently in the setting of systemic illness and certain medications. Like other infectious processes, critically ill patients with COVID-19 may be at greater risk of PRES because of impaired vasoreactivity or the use of novel agents like Tocilizumab.


Subject(s)
COVID-19/complications , Posterior Leukoencephalopathy Syndrome/etiology , Adult , Aged , Brain/diagnostic imaging , Comorbidity , Consciousness Disorders/etiology , Critical Care/statistics & numerical data , Critical Illness , Cytokine Release Syndrome/epidemiology , Cytokine Release Syndrome/etiology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Nervous System Diseases/epidemiology , Nervous System Diseases/etiology , Pneumonia/etiology , Pneumonia/therapy , Retrospective Studies , Seizures/etiology , Vision Disorders/etiology
4.
Cureus ; 13(2): e13475, 2021 Feb 21.
Article in English | MEDLINE | ID: covidwho-1143814

ABSTRACT

As the world has struggled to adapt to the coronavirus disease (COVID-19) pandemic, new evidence has emerged suggesting that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may manifest with a wide variety of neurologic symptoms. We present the case of a 70-year-old patient hospitalized for COVID-19 related pneumonia who was treated with off-label interleukin (IL)-6 inhibitor tocilizumab and eventually developed prolonged delirium. MRI findings were consistent with posterior reversible encephalopathy syndrome (PRES). PRES was felt to be from SARS-CoV-2 infection, tocilizumab, or a combination. The patient received symptomatic treatment without success. These findings are consistent with few other recent reports, which have chronicled PRES findings in patients with SARS-CoV-2 infections. However, this is only the second example of PRES in a COVID-19 patient treated with tocilizumab. While cases of PRES have been noted to occur with other infectious diseases, clinicians should be aware of the association with SARS-CoV-2 infection and tocilizumab therapy, particularly when considering tocilizumab treatment outside its approved indication. Future research efforts are needed to establish evidence-based guidelines for the management of these patients.

5.
Pediatr Infect Dis J ; 40(6): e240-e242, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1142732

ABSTRACT

Novel coronavirus disease 2019 is a viral infectious disease which commonly involve the lungs with primarily radiologic manifestations of atypical or organizing pneumonia. It can cause multisystemic involvement including central nervous system symptoms. One of these neurologic manifestations is posterior reversible encephalopathy syndrome (PRES). It is suggested that the increased levels of cytokines and inflammatory mediators in the course of the disease are responsible for cerebrovascular endothelial dysfunction and disruption of the blood-brain barrier. To the best of our knowledge, no pediatric PRES has been reported related to coronavirus disease 2019. Here, we present a pediatric PRES case associated with severe acute respiratory syndrome coronavirus 2 infection.


Subject(s)
COVID-19/complications , Posterior Leukoencephalopathy Syndrome/diagnostic imaging , Posterior Leukoencephalopathy Syndrome/virology , Blood-Brain Barrier , COVID-19/diagnostic imaging , COVID-19/immunology , COVID-19/virology , Child , Cytokines/immunology , Hospitalization , Humans , Lung/diagnostic imaging , Male , Posterior Leukoencephalopathy Syndrome/immunology , SARS-CoV-2/isolation & purification
6.
Cureus ; 13(1): e12794, 2021 Jan 19.
Article in English | MEDLINE | ID: covidwho-1050744

ABSTRACT

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic emerged in China in December 2019. Since then, there have been growing reports of coronavirus disease 2019 (COVID-19) cases with neurological involvement. We present a case of a 54-year-old woman who presented with confirmed SARS-CoV-2 pneumonia, complicated by a prolonged intensive care stay and posterior reversible encephalopathy syndrome (PRES). This resulted in persistent cortical blindness (Anton's syndrome). PRES has only rarely been reported in relation to SARS-CoV-2 infection and no patients have developed persistent cortical blindness. We summarise the clinical presentation of the patient and review the current literature.

7.
J Stroke Cerebrovasc Dis ; 29(12): 105357, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-796956

ABSTRACT

Encephalopathy in COVID-19 has been widely reported with several reports of posterior reversible encephalopathy syndrome (PRES) speculated to be due to an abrupt surge in blood pressure caused by coronavirus disease. Though peripartum posterior reversible encephalopathy syndrome is well recognized, its atypical variant with hemorrhage is uncommon. Peripartum atypical posterior reversible encephalopathy syndrome with COVID-19 requires early recognition and warrants dedicated inter-disciplinary management. We present a case of postpartum atypical posterior reversible encephalopathy syndrome with good maternal and fetal outcome. Our clinical and treatment approach with differential diagnosis are discussed in this hitherto unreported obstetric emergency with COVID-19.


Subject(s)
COVID-19/complications , Posterior Leukoencephalopathy Syndrome/etiology , Pregnancy Complications, Infectious , Adult , Antihypertensive Agents/therapeutic use , COVID-19/diagnosis , COVID-19/drug therapy , COVID-19/therapy , Emergencies , Female , Humans , Intermittent Pneumatic Compression Devices , Posterior Leukoencephalopathy Syndrome/diagnosis , Posterior Leukoencephalopathy Syndrome/therapy , Postpartum Period , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/therapy , Treatment Outcome
8.
SN Compr Clin Med ; 2(10): 1900-1902, 2020.
Article in English | MEDLINE | ID: covidwho-734894

ABSTRACT

Posterior reversible encephalopathy syndrome (PRES) is a clinical syndrome that can include headache, altered consciousness, visual disturbances, and seizures, usually related to autoregulatory cerebral failure and hypertension. The neuroimaging is essential to diagnosis, showing white matter vasogenic edema in posterior areas. We present a case of a 66-year-old woman with severe pneumonia by SARS-CoV-2 who developed a posterior reversible encephalopathy syndrome with a typical clinical and radiological presentation, after being treated with anti-interleukin treatment (anakinra and tocilizumab) following local guidelines. We report a case of posterior reversible encephalopathy syndrome in a patient with COVID-19 disease, possibly related to anti-IL-1 or anti-IL-6, suggesting that anti-interleukin treatments may cause this syndrome, at least in patients with predisposing conditions such as infections and hydroelectrolytic disorders.

9.
J Stroke Cerebrovasc Dis ; 29(11): 105212, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-688668

ABSTRACT

INTRODUCTION: Encephalopathy is a common complication of coronavirus disease 2019. Although the encephalopathy is idiopathic in many cases, there are several published reports of patients with posterior reversible encephalopathy syndrome in the setting of coronavirus disease 2019. OBJECTIVE: To describe the diverse presentations, risk factors, and outcomes of posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019. METHODS: We assessed patients with coronavirus disease 2019 and a diagnosis of posterior reversible encephalopathy syndrome at our institution from April 1 to June 24, 2020. We performed a literature search to capture all known published cases of posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019. RESULTS: There were 2 cases of posterior reversible encephalopathy syndrome in the setting of coronavirus 2019 at our institution during a 3-month period. One patient was treated with anakinra, an interleukin-1 inhibitor that may disrupt endothelial function. The second patient had an underlying human immunodeficiency virus infection. We found 13 total cases in our literature search, which reported modest blood pressure fluctuations and a range of risk factors for posterior reversible encephalopathy syndrome. One patient was treated with tocilizumab, an interleukin-6 inhibitor that may have effects on endothelial function. All patients had an improvement in their neurological symptoms. Interval imaging, when available, showed radiographic improvement of brain lesions. CONCLUSIONS: Risk factors for posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019 may include underlying infection or immunomodulatory agents with endothelial effects in conjunction with modest blood pressure fluctuations. We found that the neurological prognosis for posterior reversible encephalopathy syndrome in the setting of coronavirus disease 2019 infection is favorable. Recognition of posterior reversible encephalopathy syndrome in this patient population is critical for prognostication and initiation of treatment, which may include cessation of potential offending agents and tight blood pressure control.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Endothelium, Vascular/virology , Pneumonia, Viral/virology , Posterior Leukoencephalopathy Syndrome/virology , Blood Pressure , COVID-19 , Coinfection , Coronavirus Infections/diagnosis , Coronavirus Infections/immunology , Coronavirus Infections/physiopathology , Endothelium, Vascular/physiopathology , Female , HIV Infections/immunology , HIV Infections/physiopathology , HIV Infections/virology , Host-Pathogen Interactions , Humans , Immunosuppressive Agents/adverse effects , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/immunology , Pneumonia, Viral/physiopathology , Posterior Leukoencephalopathy Syndrome/diagnosis , Posterior Leukoencephalopathy Syndrome/immunology , Posterior Leukoencephalopathy Syndrome/physiopathology , Prognosis , Risk Factors , SARS-CoV-2
10.
J Neurol Sci ; 416: 117019, 2020 Sep 15.
Article in English | MEDLINE | ID: covidwho-643653

ABSTRACT

OBJECTIVE: To report four patients with coronavirus disease 2019 (COVID-19) who developed posterior reversible encephalopathy syndrome (PRES). METHODS: Patient data was abstracted from medical records at Weill Cornell Medical Center. RESULTS: Four patients with SARS-CoV-2 infection and PRES were identified. The patients' ages ranged from 64 to 74 years, and two were women. All four patients were admitted to the hospital with acute respiratory distress syndrome requiring intensive care unit admission and mechanical ventilation. PRES was diagnosed after persistent confusion, lethargy, new focal neurological deficits, or seizures were noted, with evidence of seizures on electroencephalogram for two of the patients. Imaging confirmed the presence of cerebral vasogenic edema. All four patients had elevated blood pressure and renal injury in the days preceding PRES diagnosis, as well as evidence of systemic inflammation and systemic hypercoagulability. Symptoms of PRES improved with blood pressure control. CONCLUSIONS: Our four cases demonstrate the occurrence of PRES in critically-ill patients with COVID-19. PRES should be considered in the differential for acute neurological deficits and seizures in this setting.


Subject(s)
COVID-19/complications , Posterior Leukoencephalopathy Syndrome/complications , Aged , Female , Humans , Male , Middle Aged , Retrospective Studies
11.
J Neurol ; 267(11): 3157-3160, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-612464

ABSTRACT

Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2.


Subject(s)
Coronavirus Infections/complications , Pneumonia, Viral/complications , Posterior Leukoencephalopathy Syndrome/virology , Betacoronavirus , COVID-19 , Coronavirus Infections/pathology , Female , Humans , Middle Aged , Pandemics , Pneumonia, Viral/pathology , Posterior Leukoencephalopathy Syndrome/pathology , SARS-CoV-2
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