Hypoechogenicity of brainstem raphe in long-COVID syndrome-less common but independently associated with depressive symptoms: a cross-sectional study.

OBJECTIVE: Long coronavirus disease (Long-COVID) syndrome is a hitherto poorly understood phenomenon with a broad spectrum of symptoms, including depression and anxiety. Depressive symptoms have been associated with brainstem raphe (BR) alterations in transcranial sonography (TCS) that might reflect dysfunction of the serotonergic system. The primary aim was to investigate the connection of BR alterations with depressive and anxiety symptoms in patients with Long-COVID syndrome. METHODS: In a cross-sectional study design, we included outpatients fulfilling the criteria of Long-COVID syndrome. All patients were examined by TCS in the axial plane with focus on BR signal alterations. The Hospital Anxiety and Depression Scale (HADS) was used to test for symptoms of anxiety and depression. RESULTS: We included n = 70 patients with Long-COVID syndrome, of which 28.6% (n = 20) exhibited a reduced echogenicity of BR in the TCS examination. Patients with hypoechogenic BR had higher subscores for anxiety and depression compared to normoechogenic patients (HADS depression: median 8 versus 5.5, p = 0.006; HADS anxiety: median 9 versus 6.5, p = 0.006). After adjustment for reasonable confounders, only the odds ratio (OR) for relevant depressive symptoms was higher among Long-COVID patients with hypoechogenic raphe (adjusted OR 3.884, 95% CI 1.244-12.123). DISCUSSION: Hypoechogenic BR alterations are independently associated with depressive symptoms in Long-COVID patients but are not highly frequent. Future studies should investigate whether the hypoechogenicity of the BR is a direct consequence or whether it reflects a priori a higher susceptibility to depressive symptoms after COVID-19, thus enabling to identify COVID-19 patients at higher risk of developing Long-COVID depressive symptoms.

Usefulness of Computed Tomographic Perfusion Imaging for Appropriate Diagnosis of Acute Cerebral Vessel Occlusion in Case of Anatomic Variations of the Circle of Willis.

Mechanical thrombectomy (MT) is an effective treatment in patients with acute ischemic stroke (AIS) due to emergent large-vessel occlusion in the anterior circulation. Occlusion of the anterior cerebral artery (ACA) affects up to 15% of these patients. Here we report a case of an elderly patient with an successful MT of an embolic A2-segment occlussion with the anatomic variation of a triplication. Triplication of ACA is a rare anatomical variation, and the occlusion could have been easily overlooked in case of not performing the CT-perfusion (CTP) sequences. As anatomical variations of the circle of Willis are present in most subjects, CTA alone might be limited in the acute setting, particularly for young residents performing the first view on call. This case highlights the importance of including CTP in the initial CT-diagnostic algorithm in AIS patients who are basically eligible for recanalization therapies, irrespective of inconspicuous initial findings in CTA.