Posterior reversible encephalopathy syndrome in critical COVID-19 patients: Report of 2 cases.

Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema. The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome. SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.

Síndrome de encefalopatía posterior reversible en pacientes críticos COVID-19: reporte de 2 casos / Posterior reversible encephalopathy syndrome in critical COVID-19 patients: Report of 2 cases

El síndrome de encefalopatía posterior reversible es un trastorno neurológico agudo caracterizado por una sintomatología variable e imágenes radiológicas características de edema vasogénico parietooccipital. Está asociado a condiciones clínicas como hipertensión arterial, infección/sepsis o fármacos citotóxicos/inmunosupresores, entre otros. Se caracteriza fisiopatológicamente por daño endotelial con rotura de la barrera hematoencefálica, hipoperfusión cerebral y edema vasogénico. Presentamos 2 casos de pacientes críticos COVID-19 que ingresaron por neumonía con necesidad de ventilación mecánica y que tras retirar la sedación desarrollaron clínica neurológica aguda y reversible consistente en epilepsia y encefalopatía, asociada a lesiones subcorticales hiperintensas en la resonancia magnética cerebral compatibles con síndrome de encefalopatía posterior reversible. El coronavirus SARS-CoV-2 activaría una respuesta inflamatoria que produciría daño en el endotelio cerebral. Este último podría ser desencadenado por la liberación de citocinas, así como por una lesión viral directa, dado que el endotelio expresa receptores ACE2. Esto podría explicar la posible asociación entre el síndrome de encefalopatía posterior reversible y la COVID-19.(AU)

Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema. The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome. SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.(AU)

[Posterior reversible encephalopathy syndrome in critical COVID-19 patients: Report of 2 cases]. / Síndrome de encefalopatía posterior reversible en pacientes críticos COVID-19: reporte de 2 casos.

Posterior reversible encephalopathy syndrome is an acute neurological disorder characterized by variable symptoms and radiological images characteristic of vasogenic parietal-occipital edema. It is associated with clinical conditions such as high blood pressure, infection/sepsis, or cytotoxic/immunosuppressive drugs, among others. It is characterized pathophysiologically by endothelial damage with breakdown of blood-brain barrier, cerebral hypoperfusion, and vasogenic edema.The cases are presented on 2 critical COVID-19 patients who were admitted to pneumonia requiring mechanical ventilation and who, after removing sedation, developed acute and reversible neurological symptoms consisting of epilepsy and encephalopathy, associated with hyperintense subcortical lesions on brain magnetic resonance imaging compatible with posterior reversible encephalopathy syndrome.SARS-CoV-2 coronavirus would activate an inflammatory response that would damage brain endothelium. It could be triggered by cytokine release, as well as by direct viral injury, given that endothelium expresses ACE2 receptors. It could explain the possible association between posterior reversible encephalopathy syndrome and COVID-19.