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Posterior Reversible Encephalopathy Syndrome in Patients with Coronavirus Disease 2019: Two Cases and A Review of The Literature.
Anand, Pria; Lau, K H Vincent; Chung, David Y; Virmani, Deepti; Cervantes-Arslanian, Anna M; Mian, Asim Z; Takahashi, Courtney E.
  • Anand P; Department of Neurology, Boston University School of Medicine, Boston, MA USA. Electronic address: Pria.anand@bmc.org.
  • Lau KHV; Department of Neurology, Boston University School of Medicine, Boston, MA USA. Electronic address: Vincent.lau@bmc.org.
  • Chung DY; Department of Neurology, Boston University School of Medicine, Boston, MA USA. Electronic address: David.chung@bmc.org.
  • Virmani D; Department of Neurology, Boston University School of Medicine, Boston, MA USA. Electronic address: Deepti.virmani@bmc.org.
  • Cervantes-Arslanian AM; Department of Neurology, Boston University School of Medicine, Boston, MA USA. Electronic address: Anna.cervantes@bmc.org.
  • Mian AZ; Department of Radiology, Boston University School of Medicine, Boston, MA USA. Electronic address: Asim.mian@bmc.org.
  • Takahashi CE; Department of Neurology, Boston University School of Medicine, Boston, MA USA. Electronic address: Courtney.takahashi@bmc.org.
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.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Endothelium, Vascular / Coronavirus Infections / Posterior Leukoencephalopathy Syndrome / Betacoronavirus Type of study: Case report / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Middle aged Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Pneumonia, Viral / Endothelium, Vascular / Coronavirus Infections / Posterior Leukoencephalopathy Syndrome / Betacoronavirus Type of study: Case report / Diagnostic study / Observational study / Prognostic study Limits: Female / Humans / Middle aged Language: English Journal: J Stroke Cerebrovasc Dis Journal subject: Vascular Diseases / Brain Year: 2020 Document Type: Article