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Bauer L, Laksono BM, de Vrij FMS, Kushner SA, Harschnitz O, van Riel D. The neuroinvasiveness, neurotropism, and neurovirulence of SARS-CoV-2. Trends Neurosci 2022; 45:358-368. [PMID: 35279295 PMCID: PMC8890977 DOI: 10.1016/j.tins.2022.02.006] [Citation(s) in RCA: 95] [Impact Index Per Article: 47.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/26/2022]
Abstract
Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection is associated with a diverse spectrum of neurological complications during the acute and postacute stages. The pathogenesis of these complications is complex and dependent on many factors. For accurate and consistent interpretation of experimental data in this fast-growing field of research, it is essential to use terminology consistently. In this article, we outline the distinctions between neuroinvasiveness, neurotropism, and neurovirulence. Additionally, we discuss current knowledge of these distinct features underlying the pathogenesis of SARS-CoV-2-associated neurological complications. Lastly, we briefly discuss the advantages and limitations of different experimental models, and how these approaches can further be leveraged to advance the field.
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Affiliation(s)
- Lisa Bauer
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | | | | | - Steven A Kushner
- Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | | | - Debby van Riel
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands.
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Murthy VD, McLarty E, Woolard KD, Parker RL, Kortz G, King JN, Poppenga RH, Knipe MF, Dickinson PJ. Case Report: MRI, Clinical, and Pathological Correlates of Bromethalin Toxicosis in Three Dogs. Front Vet Sci 2022; 9:879007. [PMID: 35558887 PMCID: PMC9087846 DOI: 10.3389/fvets.2022.879007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Bromethalin toxicosis is an increasingly common clinical presentation in dogs that may be fatal depending on the extent of intoxication. Antemortem diagnosis of bromethalin toxicosis was achieved in three dogs by demonstration of the active metabolite desmethylbromethalin in fat or serum. Magnetic resonance imaging (MRI) findings were consistent with a diffuse leukoencephalopathy with restricted diffusion and prominent involvement of the corticospinal motor tracts on T2-weighted and diffusion-weighted sequences. Imaging findings were confirmed in one non-surviving dog at necropsy. Resolution of MRI abnormalities was demonstrated in one surviving dog that was consistent with the associated resolution of clinical signs. Initial findings in these dogs support further investigation of specific MRI patterns in cases of leukoencephalopathy to aid differential diagnosis. While antemortem detection of bromethalin and its metabolites confirms exposure, quantitation may be informative as a prognostic biomarker.
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Affiliation(s)
- Vishal D. Murthy
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Washington State University, Pullman, WA, United States
| | - Ehren McLarty
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Kevin D. Woolard
- Department of Pathology, Microbiology and Immunology, University of California, Davis, Davis, CA, United States
| | - Rell L. Parker
- Department of Small Animal Clinical Sciences, Virginia-Maryland Regional College of Veterinary Medicine, Virginia Polytechnic Institute and State University, Blacksburg, VA, United States
| | - Gregg Kortz
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Jamie N. King
- Department of Neurology, VCA Sacramento Veterinary Referral Center, Sacramento, CA, United States
| | - Robert H. Poppenga
- California Animal Health and Food Safety Laboratory System, University of California, Davis, Davis, CA, United States
| | - Marguerite F. Knipe
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
| | - Peter J. Dickinson
- Department of Surgical and Radiological Sciences, University of California, Davis, Davis, CA, United States
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Prodan CI, Batra A, Ungvari Z, Liotta EM. Stringent public health measures during COVID-19 across ischemic stroke care systems: the potential impact of patient perceptions on health care-seeking behaviors. GeroScience 2022; 44:1255-1262. [PMID: 35467316 PMCID: PMC9035971 DOI: 10.1007/s11357-022-00566-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
Decreases in acute stroke presentations have been reported during the coronavirus disease 2019 (COVID-19) pandemic surges. A recent study by Bojti et al. (GeroScience. 2021;43:2231–2248) sought to understand the relationship of public health mandates in Hungary as they were implemented with acute ischemic stroke admissions and interventions during two separate COVID-19 waves. We sought to perform a similar analysis of changes in ischemic stroke care at two distinct medical institutions in the USA. Two separate institutions and systems of ischemic stroke care were evaluated through a regional comprehensive stroke center telestroke service and a Veterans Affairs (VA) inpatient stroke and neurorehabilitation service. Telestroke consultations in a single system in Chicago, IL, were significantly decreased during the first COVID-19 wave during severely restricted public health mandates (z-score < − 2), and were less depressed during a subsequent wave with less severe restrictions (z-score approaching − 1), which resembles findings in Hungary as reported by Bojti et al. In contrast, inpatient admissions during the first and second COVID-19 waves to a VA stroke and neurorehabilitation service in Oklahoma City remained unchanged. The Chicago and Hungary patterns of stroke presentations suggest that public perceptions, as informed by regional health mandates, might influence healthcare-seeking behavior. However, the VA experience suggests that specific patient populations may react differently to given public health mandates. These observations highlight that changes in stroke presentation during the COVID-19 pandemic may vary regionally and by patient population as well as by the severity of public health mandates implemented. Further study of COVID-19-related public health policies on acute stroke populations is needed to capture the long-term impact of such policies. Learning from the real-time impact of pandemic surges and public health policy on presentation of acute medical conditions, such as ischemic stroke, may prove valuable for designing effective policies in the future.
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Affiliation(s)
- Calin I Prodan
- Department of Neurology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Veterans Affairs Medical Center, Oklahoma City, OK, USA
| | - Ayush Batra
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 1150, Chicago, IL, 60611, USA
| | - Zoltan Ungvari
- Vascular Cognitive Impairment and Neurodegeneration Program, Oklahoma Center for Geroscience and Healthy Brain Aging, Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,Department of Health Promotion Sciences, College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,The Peggy and Charles Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, 73104, USA.,International Training Program in Geroscience, Doctoral School of Basic and Translational Medicine/Department of Public Health, Semmelweis University, Budapest, Hungary
| | - Eric M Liotta
- Ken and Ruth Davee Department of Neurology, Northwestern University Feinberg School of Medicine, 625 N. Michigan Ave, Suite 1150, Chicago, IL, 60611, USA.
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Sharma R, Nalleballe K, Shah V, Haldal S, Spradley T, Hasan L, Mylavarapu K, Vyas K, Kumar M, Onteddu S, Gokden M, Kapoor N. Spectrum of Hemorrhagic Encephalitis in COVID-19 Patients: A Case Series and Review. Diagnostics (Basel) 2022; 12:924. [PMID: 35453972 PMCID: PMC9032293 DOI: 10.3390/diagnostics12040924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/22/2022] [Accepted: 03/29/2022] [Indexed: 01/27/2023] Open
Abstract
Severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is an ongoing pandemic that has affected over 400 million people worldwide and caused nearly 6 million deaths. Hemorrhagic encephalitis is an uncommon but serious complication of COVID-19. The etiology of this disease is multifactorial, including secondary to severe hypoxemia, systemic inflammation, direct viral invasion, hypercoagulability, etc. The clinical spectrum of COVID-19-related hemorrhagic encephalitis is also varied, ranging from leukoencephalopathy with microhemorrhage, acute necrotizing hemorrhagic encephalitis (ANHE) involving the cortex, basal ganglia, rarely brain stem and cervical spine, hemorrhagic posterior reversible encephalopathy syndrome (PRES) to superimposed co-infection with other organisms. We report a case series of three young patients with different presentations of hemorrhagic encephalitis after COVID-19 infection and a review of the literature. One patient had self-limiting ANHE in the setting of mild COVID-19 systemic illness. The second patient had self-limiting leukoencephalopathy with microhemorrhages in the setting of severe systemic diseases and ARDS, and clinically improved with the resolution of systemic illness. Both patients were healthy and did not have any premorbid conditions. The third patient with poorly controlled diabetes and hypertension had severe systemic illness with neurological involvement including multiple ischemic strokes, basal meningitis, hemorrhagic encephalitis with pathological evidence of cerebral mucormycosis, and Epstein-Barr virus coinfection, and improved after antifungal therapy.
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Affiliation(s)
- Rohan Sharma
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (R.S.); (K.N.); (S.H.); (S.O.)
| | - Krishna Nalleballe
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (R.S.); (K.N.); (S.H.); (S.O.)
| | - Vishank Shah
- Department of Neurology, John Hopkins University, Baltimore, MD 21205, USA;
| | - Shilpa Haldal
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (R.S.); (K.N.); (S.H.); (S.O.)
| | - Thomas Spradley
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (T.S.); (L.H.)
| | - Lana Hasan
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (T.S.); (L.H.)
| | | | - Keyur Vyas
- Department of Infectious Diseases, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Manoj Kumar
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Sanjeeva Onteddu
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (R.S.); (K.N.); (S.H.); (S.O.)
| | - Murat Gokden
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Nidhi Kapoor
- Department of Neurology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA; (R.S.); (K.N.); (S.H.); (S.O.)
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Neuropathology and virus in brain of SARS-CoV-2 infected non-human primates. Nat Commun 2022; 13:1745. [PMID: 35365631 PMCID: PMC8975902 DOI: 10.1038/s41467-022-29440-z] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/12/2022] [Indexed: 12/14/2022] Open
Abstract
Neurological manifestations are a significant complication of coronavirus disease (COVID-19), but underlying mechanisms aren’t well understood. The development of animal models that recapitulate the neuropathological findings of autopsied brain tissue from patients who died from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are critical for elucidating the neuropathogenesis of infection and disease. Here, we show neuroinflammation, microhemorrhages, brain hypoxia, and neuropathology that is consistent with hypoxic-ischemic injury in SARS-CoV-2 infected non-human primates (NHPs), including evidence of neuron degeneration and apoptosis. Importantly, this is seen among infected animals that do not develop severe respiratory disease, which may provide insight into neurological symptoms associated with “long COVID”. Sparse virus is detected in brain endothelial cells but does not associate with the severity of central nervous system (CNS) injury. We anticipate our findings will advance our current understanding of the neuropathogenesis of SARS-CoV-2 infection and demonstrate SARS-CoV-2 infected NHPs are a highly relevant animal model for investigating COVID-19 neuropathogenesis among human subjects. COVID-19 can result in neurological manifestations and animal models could provide insights into the mechanisms. Here, the authors describe neuroinflammation, microhemorrhages and brain hypoxia in SARS-CoV-2 infected non-human primates, including in animals that don’t develop severe respiratory disease.
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Kurinobu T, Araki J, Kamoshida K, Kunihiro Y, Miyake Y, Izumi S. Persistent disturbance of consciousness with bilateral globus pallidus and substantia nigra lesions in 2 patients with severe COVID-19 pneumonia. Radiol Case Rep 2022; 17:1330-1334. [PMID: 35222770 PMCID: PMC8857985 DOI: 10.1016/j.radcr.2022.01.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 02/07/2023] Open
Abstract
With an increasing number of cases of Coronavirus disease 2019 (COVID-19), various neurological complications have been reported; however, some of these have not been fully elucidated. We herein report on 2 cases in which lesions at the bilateral globus pallidus and substantia nigra were observed. The patients were a 27-year-old male and a 61-year-old female. They underwent ventilation management due to COVID-19 pneumonia with hypoxemia. However, even after the sedative had weakened, the state of consciousness disturbance was found to have continued. Brain magnetic resonance imaging was performed for both patients. From the bilateral globus pallidus to the substantia nigra of both, the fluid attenuated inversion recovery images and T2-weighted images indicated high intensity, while the diffusion-weighted image resulted in high intensity and low apparent diffusion coefficient. Regarding the 61-year-old female patient, head computed tomography also indicated low density at the bilateral globus pallidus. The patients did not show any improvement in their neurological findings while hospitalized. Although COVID-19 associated with bilateral globus pallidus and substantia nigra lesions are rare, the neurological prognosis may be poor. We believe that attention should be paid to these imaging findings at the onset of consciousness disturbance.
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Brandi N, Ciccarese F, Rimondi MR, Balacchi C, Modolon C, Sportoletti C, Renzulli M, Coppola F, Golfieri R. An Imaging Overview of COVID-19 ARDS in ICU Patients and Its Complications: A Pictorial Review. Diagnostics (Basel) 2022; 12:846. [PMID: 35453894 PMCID: PMC9032937 DOI: 10.3390/diagnostics12040846] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 01/08/2023] Open
Abstract
A significant proportion of patients with COVID-19 pneumonia could develop acute respiratory distress syndrome (ARDS), thus requiring mechanical ventilation, and resulting in a high rate of intensive care unit (ICU) admission. Several complications can arise during an ICU stay, from both COVID-19 infection and the respiratory supporting system, including barotraumas (pneumothorax and pneumomediastinum), superimposed pneumonia, coagulation disorders (pulmonary embolism, venous thromboembolism, hemorrhages and acute ischemic stroke), abdominal involvement (acute mesenteric ischemia, pancreatitis and acute kidney injury) and sarcopenia. Imaging plays a pivotal role in the detection and monitoring of ICU complications and is expanding even to prognosis prediction. The present pictorial review describes the clinicopathological and radiological findings of COVID-19 ARDS in ICU patients and discusses the imaging features of complications related to invasive ventilation support, as well as those of COVID-19 itself in this particularly fragile population. Radiologists need to be familiar with COVID-19's possible extra-pulmonary complications and, through reliable and constant monitoring, guide therapeutic decisions. Moreover, as more research is pursued and the pathophysiology of COVID-19 is increasingly understood, the role of imaging must evolve accordingly, expanding from the diagnosis and subsequent management of patients to prognosis prediction.
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Affiliation(s)
- Nicolò Brandi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Federica Ciccarese
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Maria Rita Rimondi
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Caterina Balacchi
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Cecilia Modolon
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Camilla Sportoletti
- Cardio-Thoracic Radiology Unit, University Hospital S.Orsola-Malpighi, 40138 Bologna, Italy; (M.R.R.); (C.M.); (C.S.)
| | - Matteo Renzulli
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
| | - Francesca Coppola
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
- Italian Society of Medical and Interventional Radiology, SIRM Foundation, Via della Signora 2, 20122 Milano, Italy
| | - Rita Golfieri
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, 40138 Bologna, Italy; (F.C.); (C.B.); (M.R.); (F.C.); (R.G.)
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Relationship between Lung and Brain Injury in COVID-19 Patients: A Hyperpolarized 129Xe-MRI-based 8-Month Follow-Up. Biomedicines 2022; 10:biomedicines10040781. [PMID: 35453531 PMCID: PMC9028000 DOI: 10.3390/biomedicines10040781] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 02/05/2023] Open
Abstract
Although the lungs are the primary organ involved, increasing evidence supports the neuroinvasive potential of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study investigates the potential relationship between coronavirus disease (COVID-19)-related deterioration of brain structure and the degree of damage to lung function. Nine COVID-19 patients were recruited in critical condition from Jin Yin-tan Hospital (Wuhan, China) who had been discharged between 4 February and 27 February 2020. The demographic, clinical, treatment, and laboratory data were extracted from the electronic medical records. All patients underwent chest CT imaging, 129Xe gas lung MRI, and 1H brain MRI. Four of the patients were followed up for 8 months. After nearly 12 months of recovery, we found no significant difference in lung ventilation defect percentage (VDP) between the COVID-19 group and the healthy group (3.8 ± 2.1% versus 3.7 ± 2.2%) using 129Xe MRI, and several lung-function-related parameters—such as gas–blood exchange time (T)—showed improvement (42.2 ms versus 32.5 ms). Combined with 1H brain MRI, we found that the change in gray matter volume (GMV) was strongly related to the degree of pulmonary function recovery—the greater the increase in GMV, the higher degree of pulmonary function damage.
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Hafiz R, Gandhi TK, Mishra S, Prasad A, Mahajan V, Di X, Natelson BH, Biswal BB. Higher Limbic and Basal Ganglia volumes in surviving COVID-negative patients and the relations to fatigue. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2022. [PMID: 34845462 DOI: 10.1101/2022.11.08.22281807v1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
BACKGROUND Among systemic abnormalities caused by the novel coronavirus, little is known about the critical attack on the central nervous system (CNS). Few studies have shown cerebrovascular pathologies that indicate CNS involvement in acute patients. However, replication studies are necessary to verify if these effects persist in COVID-19 survivors more conclusively. Furthermore, recent studies indicate fatigue is highly prevalent among 'long-COVID' patients. How morphometry in each group relate to work-related fatigue need to be investigated. METHOD COVID survivors were MRI scanned two weeks after hospital discharge. We hypothesized, these survivors will demonstrate altered gray matter volume (GMV) and experience higher fatigue levels when compared to healthy controls, leading to stronger correlation of GMV with fatigue. Voxel-based morphometry was performed on T1-weighted MRI images between 46 survivors and 30 controls. Unpaired two-sample t-test and multiple linear regression were performed to observe group differences and correlation of fatigue with GMV. RESULTS The COVID group experienced significantly higher fatigue levels and GMV of this group was significantly higher within the Limbic System and Basal Ganglia when compared to healthy controls. Moreover, while a significant positive correlation was observed across the whole group between GMV and self-reported fatigue, COVID subjects showed stronger effects within the Posterior Cingulate, Precuneus and Superior Parietal Lobule . CONCLUSION Brain regions with GMV alterations in our analysis align with both single case acute patient reports and current group level neuroimaging findings. We also newly report a stronger positive correlation of GMV with fatigue among COVID survivors within brain regions associated with fatigue, indicating a link between structural abnormality and brain function in this cohort.
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Affiliation(s)
- Rakibul Hafiz
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
| | - Tapan Kumar Gandhi
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Sapna Mishra
- Department of Electrical Engineering, Indian Institute of Technology (IIT), Block II, IIT Delhi Main Rd, IIT Campus, Hauz Khas, New Delhi, Delhi 110016, India
| | - Alok Prasad
- Internal Medicine, Irene Hospital & Senior Consultant Medicine, Metro Heart and Super-specialty Hospital, New Delhi, India
| | - Vidur Mahajan
- Centre for Advanced Research in Imaging, Neuroscience & Genomics, Mahajan Imaging, New Delhi, India
| | - Xin Di
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
| | - Benjamin H Natelson
- Director, Pain & Fatigue Study Center, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, 5 East 98th Street, 7th Floor, New York, NY 10029
| | - Bharat B Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology (NJIT), 323 Dr Martin Luther King Jr Blvd, Newark, NJ 07102, USA
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Kirtipal N, Kumar S, Dubey SK, Dwivedi VD, Gireesh Babu K, Malý P, Bharadwaj S. Understanding on the possible routes for SARS CoV-2 invasion via ACE2 in the host linked with multiple organs damage. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 99:105254. [PMID: 35217145 PMCID: PMC8863418 DOI: 10.1016/j.meegid.2022.105254] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 01/12/2022] [Accepted: 02/19/2022] [Indexed: 02/07/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), accountable for causing the coronavirus diseases 2019 (COVID-19), is already declared as a pandemic disease globally. Like previously reported SARS-CoV strain, the novel SARS-CoV-2 also initiates the viral pathogenesis via docking viral spike-protein with the membranal angiotensin-converting enzyme 2 (ACE2) - a receptor on variety of cells in the human body. Therefore, COVID-19 is broadly characterized as a disease that targets multiple organs, particularly causing acute complications via organ-specific pathogenesis accompanied by destruction of ACE2+ cells, including alveolus, cardiac microvasculature, endothelium, and glomerulus. Under such circumstances, the high expression of ACE2 in predisposing individuals associated with anomalous production of the renin-angiotensin system (RAS) may promote enhanced viral load in COVID-19, which comparatively triggers excessive apoptosis. Furthermore, multi-organ injuries were found linked to altered ACE2 expression and inequality between the ACE2/angiotensin-(1-7)/mitochondrial Ang system (MAS) and renin-angiotensin-system (RAS) in COVID-19 patients. However, the exact pathogenesis of multi-organ damage in COVID-19 is still obscure, but several perspectives have been postulated, involving altered ACE2 expression linked with direct/indirect damages by the virus-induced immune responses, such as cytokinin storm. Thus, insights into the invasion of a virus with respect to ACE2 expression site can be helpful to simulate or understand the possible complications in the targeted organ during viral infection. Hence, this review summarizes the multiple organs invasion by SARS CoV-2 linked with ACE2 expression and their consequences, which can be helpful in the management of the COVID-19 pathogenesis under life-threatening conditions.
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Affiliation(s)
- Nikhil Kirtipal
- School of Life Sciences, Gwangju Institute of Science and Technology (GIST), Gwangju, Republic of Korea
| | - Sanjay Kumar
- School of Biotechnology, Jawaharlal Nehru University, New Delhi, India; Centre for Bioinformatics, Computational and Systems Biology, Pathfinder Research and Training Foundation, Greater Noida, India
| | | | - Vivek Dhar Dwivedi
- Centre for Bioinformatics, Computational and Systems Biology, Pathfinder Research and Training Foundation, Greater Noida, India.
| | - K Gireesh Babu
- Department of Life Sciences, Parul Institute of Applied Sciences, Parul University, Limda, Vadodara, India.
| | - Petr Malý
- Laboratory of Ligand Engineering, Institute of Biotechnology of the Czech Academy of Sciences v.v.i., BIOCEV Research Center, Vestec, Czech Republic.
| | - Shiv Bharadwaj
- Laboratory of Ligand Engineering, Institute of Biotechnology of the Czech Academy of Sciences v.v.i., BIOCEV Research Center, Vestec, Czech Republic.
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61
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Ahmed M, Gaba WH, Khan FM, Mansoori RA, Adi AAK. COVID-Related Leukoencephalopathy: Unusual MRI Features and Comparability to Delayed Post Hypoxic Ischemic Encephalopathy. Radiol Case Rep 2022; 17:852-855. [PMID: 35013689 PMCID: PMC8734107 DOI: 10.1016/j.radcr.2021.11.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 11/21/2021] [Accepted: 11/21/2021] [Indexed: 10/25/2022] Open
Abstract
COVID-19 related leukoencephalopathy can be multifactorial given the systemic effects of the viral disease. We present couple of cases with typical clinico-imaging stigmata of COVID-19 resulting in severe respiratory insufficiency. MR brain imaging revealed confluent diffuse supratentorial white matter T2 hyperintensity with restricted diffusion during the sub-acute course of the disease. The MR imaging pattern of leukoencephalopathy was non-specific but more comparable to delayed post-hypoxic leukoencephalopathy (DPHL) as also previously reported in COVID-19. Interestingly, T2 imaging showed unusual but peculiar finding of "accentuated medullary veins" in the superficial zones. No dural venous sinus thrombosis or micro-hemorrhages were present to explain "dots and stripes" due to dilated medullary veins. The patho-mechanism of this findings is not clear but may possibly be related to demyelination as DPHL has shown to be a demyelinating process. We present a review of COVID-related leukoencephalopathy with discussion on hypoxia-induced demyelinating process with accentuated medullary veins as possible associated marker.
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Affiliation(s)
- Manzoor Ahmed
- Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Waqar Haider Gaba
- Department of Internal Medicine, Sheikh Khalifa Medical City, Karamah Street, Abu Dhabi, 51900, UAE
| | - Fahim M Khan
- Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Rabab Al Mansoori
- Department of Radiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Abd Al Kareem Adi
- Department of Internal Medicine, Sheikh Khalifa Medical City, Karamah Street, Abu Dhabi, 51900, UAE
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62
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Ependymal restricted diffusion and injury to the olfactory system on a ventriculoencephalitis associated with COVID-19. J Neurovirol 2022; 28:326-328. [PMID: 34982416 PMCID: PMC8725422 DOI: 10.1007/s13365-021-01033-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 11/30/2022]
Abstract
We describe the case of a 42-year-old female with COVID-19 and acute psychomotor agitation and without comorbidities. Brain MRI showed injury to the olfactory system associated with diffusion weighted imaging restriction in the ependymal surface of the lateral ventriculus suggesting ventriculoencephalitis.
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63
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Toro EF, Celant M, Zhang Q, Contarino C, Agarwal N, Linninger A, Müller LO. Cerebrospinal fluid dynamics coupled to the global circulation in holistic setting: Mathematical models, numerical methods and applications. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3532. [PMID: 34569188 PMCID: PMC9285081 DOI: 10.1002/cnm.3532] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 09/13/2021] [Indexed: 06/13/2023]
Abstract
This paper presents a mathematical model of the global, arterio-venous circulation in the entire human body, coupled to a refined description of the cerebrospinal fluid (CSF) dynamics in the craniospinal cavity. The present model represents a substantially revised version of the original Müller-Toro mathematical model. It includes one-dimensional (1D), non-linear systems of partial differential equations for 323 major blood vessels and 85 zero-dimensional, differential-algebraic systems for the remaining components. Highlights include the myogenic mechanism of cerebral blood regulation; refined vasculature for the inner ear, the brainstem and the cerebellum; and viscoelastic, rather than purely elastic, models for all blood vessels, arterial and venous. The derived 1D parabolic systems of partial differential equations for all major vessels are approximated by hyperbolic systems with stiff source terms following a relaxation approach. A major novelty of this paper is the coupling of the circulation, as described, to a refined description of the CSF dynamics in the craniospinal cavity, following Linninger et al. The numerical solution methodology employed to approximate the hyperbolic non-linear systems of partial differential equations with stiff source terms is based on the Arbitrary DERivative Riemann problem finite volume framework, supplemented with a well-balanced formulation, and a local time stepping procedure. The full model is validated through comparison of computational results against published data and bespoke MRI measurements. Then we present two medical applications: (i) transverse sinus stenoses and their relation to Idiopathic Intracranial Hypertension; and (ii) extra-cranial venous strictures and their impact in the inner ear circulation, and its implications for Ménière's disease.
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Affiliation(s)
| | - Morena Celant
- Department of MathematicsUniversity of TrentoTrentoItaly
| | - Qinghui Zhang
- Laboratory of Applied Mathematics, DICAMUniversity of TrentoTrentoItaly
| | | | | | - Andreas Linninger
- Department of BioengineeringUniversity of Illinois at ChicagoChicagoIllinoisUSA
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64
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Cavallieri F, Sellner J, Zedde M, Moro E. Neurologic complications of coronavirus and other respiratory viral infections. HANDBOOK OF CLINICAL NEUROLOGY 2022; 189:331-358. [PMID: 36031313 PMCID: PMC9418023 DOI: 10.1016/b978-0-323-91532-8.00004-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In humans, several respiratory viruses can have neurologic implications affecting both central and peripheral nervous system. Neurologic manifestations can be linked to viral neurotropism and/or indirect effects of the infection due to endothelitis with vascular damage and ischemia, hypercoagulation state with thrombosis and hemorrhages, systemic inflammatory response, autoimmune reactions, and other damages. Among these respiratory viruses, recent and huge attention has been given to the coronaviruses, especially the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic started in 2020. Besides the common respiratory symptoms and the lung tropism of SARS-CoV-2 (COVID-19), neurologic manifestations are not rare and often present in the severe forms of the infection. The most common acute and subacute symptoms and signs include headache, fatigue, myalgia, anosmia, ageusia, sleep disturbances, whereas clinical syndromes include mainly encephalopathy, ischemic stroke, seizures, and autoimmune peripheral neuropathies. Although the pathogenetic mechanisms of COVID-19 in the various acute neurologic manifestations are partially understood, little is known about long-term consequences of the infection. These consequences concern both the so-called long-COVID (characterized by the persistence of neurological manifestations after the resolution of the acute viral phase), and the onset of new neurological symptoms that may be linked to the previous infection.
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Affiliation(s)
- Francesco Cavallieri
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Marialuisa Zedde
- Neurology Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elena Moro
- Division of Neurology, CHU of Grenoble, Grenoble Alpes University, Grenoble Institute of Neurosciences, Grenoble, France,Correspondence to: Elena Moro, Service de neurologie, CHU de Grenoble (Hôpital Nord), Boulevard de la Chantourne, 38043 La Tronche, France. Tel: + 33-4-76-76-94-52, Fax: +33-4-76-76-56-31
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65
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Kremer S, Gerevini S, Ramos A, Lersy F, Yousry T, Vernooij MW, Anzalone N, Jäger HR. Neuroimaging in patients with COVID-19: a neuroradiology expert group consensus. Eur Radiol 2022; 32:3716-3725. [PMID: 35044509 PMCID: PMC8766353 DOI: 10.1007/s00330-021-08499-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023]
Abstract
Neurological and neuroradiological manifestations in patients with COVID-19 have been extensively reported. Available imaging data are, however, very heterogeneous. Hence, there is a growing need to standardise clinical indications for neuroimaging, MRI acquisition protocols, and necessity of follow-up examinations. A NeuroCovid working group with experts in the field of neuroimaging in COVID-19 has been constituted under the aegis of the Subspecialty Committee on Diagnostic Neuroradiology of the European Society of Neuroradiology (ESNR). The initial objectives of this NeuroCovid working group are to address the standardisation of the imaging in patients with neurological manifestations of COVID-19 and to give advice based on expert opinion with the aim of improving the quality of patient care and ensure high quality of any future clinical studies. KEY POINTS: • In patients with COVID-19 and neurological manifestations, neuroimaging should be performed in order to detect underlying causal pathology. • The basic MRI recommended protocol includes T2-weighted, FLAIR (preferably 3D), and diffusion-weighted images, as well as haemorrhage-sensitive sequence (preferably SWI), and at least for the initial investigation pre and post-contrast T1 weighted-images. • 3D FLAIR should be acquired after gadolinium administration in order to optimise the detection of leptomeningeal contrast enhancement.
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Affiliation(s)
- Stéphane Kremer
- Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, Strasbourg, France.
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France.
| | | | - Ana Ramos
- Sección de Neurorradiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - François Lersy
- Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, Strasbourg, France
| | - Tarek Yousry
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, Great Britain
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, Great Britain
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nicoletta Anzalone
- Department of Neuroradiology, IRCCS San Raffaele, Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, Great Britain
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, Great Britain
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66
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Latini F, Fahlström M, Fällmar D, Marklund N, Cunningham JL, Feresiadou A. Can diffusion tensor imaging (DTI) outperform standard magnetic resonance imaging (MRI) investigations in post-COVID-19 autoimmune encephalitis? Ups J Med Sci 2022; 127:8562. [PMID: 35722186 PMCID: PMC9169543 DOI: 10.48101/ujms.v127.8562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 04/07/2022] [Accepted: 04/07/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Neurological and psychiatric manifestations related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are widely recognised. Standard magnetic resonance imaging (MRI) investigations are normal in 40-80% of symptomatic patients, eventually delaying appropriate treatment when MRI is unrevealing any structural changes. The aim of this study is to investigate white matter abnormalities during an early stage of post-COVID-19 (coronavirus disease 2019) encephalitis while conventional MRI was normal. METHODS A patient with post-COVID-19 autoimmune encephalitis was investigated by serial MRIs and diffusion tensor imaging (DTI). Ten healthy control individuals (HC) were utilised as a control group for the DTI analysis. Major projection, commissural and association white matter pathways were reconstructed, and multiple diffusion parameters were analysed and then compared to the HC average using a z-test for serial examinations. RESULTS Eleven days after the onset of neurological symptoms, DTI revealed early white matter changes, compared with HC, when standard MRI was normal. On day 68, DTI showed multiple white matter lesions compared with HC, visible at this time also by the MRI images, indicating inflammatory changes in different association and projection white matter pathways. CONCLUSION We confirm a limitation in the sensitivity of conventional MRI at the acute setting of post-COVID-19 autoimmune encephalitis. A complementary DTI investigation could be a valuable diagnostic tool in early therapeutic decisions concerning COVID-19-related neurological symptoms.
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Affiliation(s)
- Francesco Latini
- Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Markus Fahlström
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - David Fällmar
- Radiology, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Niklas Marklund
- Neurosurgery, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Neurosurgery, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Janet L. Cunningham
- Psychiatry, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Amalia Feresiadou
- Neurology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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67
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Hamad MK, Takruri DH, Patro SN, Habib MB, Verma V. Corpus callosum hematoma, as a rare complication of COVID-19. Clin Case Rep 2021; 9:e05178. [PMID: 34938554 PMCID: PMC8659552 DOI: 10.1002/ccr3.5178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/20/2021] [Accepted: 11/23/2021] [Indexed: 11/11/2022] Open
Abstract
A 46-year-old gentleman had a complicated course of COVID-19 pneumonia. Despite the recovery of the respiratory status, he developed corpus callosum hematoma and critical illness neuropathy/myopathy. The clinical situation became more complicated by developing pulmonary embolism that required anticoagulation. Fortunately, the patient made a good recovery.
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Affiliation(s)
| | | | - Satya Narayana Patro
- Neuroradiology DepartmentUniversity of Arkansas for Medical SciencesLittle RockArkansasUSA
| | - Mhd Baraa Habib
- Internal Medicine DepartmentHamad Medical CorporationDohaQatar
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Hafiz R, Gandhi TK, Mishra S, Prasad A, Mahajan V, Di X, Natelson BH, Biswal BB. Higher Limbic and Basal Ganglia volumes in surviving COVID-negative patients and the relations to fatigue.. [PMID: 34845462 PMCID: PMC8629206 DOI: 10.1101/2021.11.23.21266761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background: Among systemic abnormalities caused by the novel coronavirus, little is known about the critical attack on the central nervous system (CNS). Few studies have shown cerebrovascular pathologies that indicate CNS involvement in acute patients. However, replication studies are necessary to verify if these effects persist in COVID-19 survivors more conclusively. Furthermore, recent studies indicate fatigue is highly prevalent among ‘long-COVID’ patients. How morphometry in each group relate to work-related fatigue need to be investigated. Method: COVID survivors were MRI scanned two weeks after hospital discharge. We hypothesized, these survivors will demonstrate altered gray matter volume (GMV) and experience higher fatigue levels when compared to healthy controls, leading to stronger correlation of GMV with fatigue. Voxel-based morphometry was performed on T1-weighted MRI images between 46 survivors and 30 controls. Unpaired two-sample t-test and multiple linear regression were performed to observe group differences and correlation of fatigue with GMV. Results: The COVID group experienced significantly higher fatigue levels and GMV of this group was significantly higher within the Limbic System and Basal Ganglia when compared to healthy controls. Moreover, while a significant positive correlation was observed across the whole group between GMV and self-reported fatigue, COVID subjects showed stronger effects within the Posterior Cingulate, Precuneus and Superior Parietal Lobule. Conclusion: Brain regions with GMV alterations in our analysis align with both single case acute patient reports and current group level neuroimaging findings. We also newly report a stronger positive correlation of GMV with fatigue among COVID survivors within brain regions associated with fatigue, indicating a link between structural abnormality and brain function in this cohort.
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69
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Wan D, Du T, Hong W, Chen L, Que H, Lu S, Peng X. Neurological complications and infection mechanism of SARS-COV-2. Signal Transduct Target Ther 2021; 6:406. [PMID: 34815399 PMCID: PMC8609271 DOI: 10.1038/s41392-021-00818-7] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/27/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Currently, SARS-CoV-2 has caused a global pandemic and threatened many lives. Although SARS-CoV-2 mainly causes respiratory diseases, growing data indicate that SARS-CoV-2 can also invade the central nervous system (CNS) and peripheral nervous system (PNS) causing multiple neurological diseases, such as encephalitis, encephalopathy, Guillain-Barré syndrome, meningitis, and skeletal muscular symptoms. Despite the increasing incidences of clinical neurological complications of SARS-CoV-2, the precise neuroinvasion mechanisms of SARS-CoV-2 have not been fully established. In this review, we primarily describe the clinical neurological complications associated with SARS-CoV-2 and discuss the potential mechanisms through which SARS-CoV-2 invades the brain based on the current evidence. Finally, we summarize the experimental models were used to study SARS-CoV-2 neuroinvasion. These data form the basis for studies on the significance of SARS-CoV-2 infection in the brain.
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Affiliation(s)
- Dandan Wan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Tingfu Du
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China
| | - Weiqi Hong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Li Chen
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Haiying Que
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Shuaiyao Lu
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
| | - Xiaozhong Peng
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
- State Key Laboratory of Medical Molecular Biology, Department of Molecular, Biology and Biochemistry, Institute of Basic Medical Sciences, Medical Primate Research Center, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
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70
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Varadarajan V, Shabani M, Ambale Venkatesh B, Lima JAC. Role of Imaging in Diagnosis and Management of COVID-19: A Multiorgan Multimodality Imaging Review. Front Med (Lausanne) 2021; 8:765975. [PMID: 34820400 PMCID: PMC8606587 DOI: 10.3389/fmed.2021.765975] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/04/2021] [Indexed: 01/08/2023] Open
Abstract
In this pandemic of Coronavirus disease 2019 (COVID-19), a vast proportion of healthcare resources, including imaging tools, have been dedicated to the management of affected patients; yet, the frequent reports of unknown presentations and complications of disease over time have been changing the usual standard of care and resource allocation in health centers. As of now, we have witnessed multisystemic symptoms requiring the collaboration of different clinical teams in COVID-19 patients' care. Compared to previous viral pandemics, imaging modalities are now playing an essential role in the diagnosis and management of patients. This widespread utility of imaging modalities calls for a deeper understanding of potential radiologic findings in this disease and identifying the most compatible imaging protocol with safety precautions. Although initially used for respiratory tract evaluation, imaging modalities have also been used for cardiovascular, neurologic, and gastrointestinal evaluation of patients with COVID-19. In this narrative review article, we provide multimodality and multisystemic review of imaging techniques and features that can aid in the diagnosis and management of COVID-19 patients.
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Affiliation(s)
| | | | | | - Joao A. C. Lima
- Department of Cardiology, Johns Hopkins School of Medicine, Baltimore, MD, United States
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71
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Wenzel J, Lampe J, Müller-Fielitz H, Schuster R, Zille M, Müller K, Krohn M, Körbelin J, Zhang L, Özorhan Ü, Neve V, Wagner JUG, Bojkova D, Shumliakivska M, Jiang Y, Fähnrich A, Ott F, Sencio V, Robil C, Pfefferle S, Sauve F, Coêlho CFF, Franz J, Spiecker F, Lembrich B, Binder S, Feller N, König P, Busch H, Collin L, Villaseñor R, Jöhren O, Altmeppen HC, Pasparakis M, Dimmeler S, Cinatl J, Püschel K, Zelic M, Ofengeim D, Stadelmann C, Trottein F, Nogueiras R, Hilgenfeld R, Glatzel M, Prevot V, Schwaninger M. The SARS-CoV-2 main protease M pro causes microvascular brain pathology by cleaving NEMO in brain endothelial cells. Nat Neurosci 2021. [PMID: 34675436 DOI: 10.1038/s41593-02100926-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
Coronavirus disease 2019 (COVID-19) can damage cerebral small vessels and cause neurological symptoms. Here we describe structural changes in cerebral small vessels of patients with COVID-19 and elucidate potential mechanisms underlying the vascular pathology. In brains of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected individuals and animal models, we found an increased number of empty basement membrane tubes, so-called string vessels representing remnants of lost capillaries. We obtained evidence that brain endothelial cells are infected and that the main protease of SARS-CoV-2 (Mpro) cleaves NEMO, the essential modulator of nuclear factor-κB. By ablating NEMO, Mpro induces the death of human brain endothelial cells and the occurrence of string vessels in mice. Deletion of receptor-interacting protein kinase (RIPK) 3, a mediator of regulated cell death, blocks the vessel rarefaction and disruption of the blood-brain barrier due to NEMO ablation. Importantly, a pharmacological inhibitor of RIPK signaling prevented the Mpro-induced microvascular pathology. Our data suggest RIPK as a potential therapeutic target to treat the neuropathology of COVID-19.
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Affiliation(s)
- Jan Wenzel
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
| | - Josephine Lampe
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
| | - Helge Müller-Fielitz
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Raphael Schuster
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Marietta Zille
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
| | - Kristin Müller
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Markus Krohn
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
| | - Jakob Körbelin
- Department of Oncology, Hematology & Bone Marrow Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Linlin Zhang
- Institute of Molecular Medicine, University of Lübeck, Lübeck, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Ümit Özorhan
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
| | - Vanessa Neve
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Julian U G Wagner
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
- Institute for Cardiovascular Regeneration, Cardiopulmonary Institute (CPI), University Frankfurt, Frankfurt, Germany
| | - Denisa Bojkova
- Institute of Medical Virology, University Frankfurt, Frankfurt, Germany
| | - Mariana Shumliakivska
- Institute for Cardiovascular Regeneration, Cardiopulmonary Institute (CPI), University Frankfurt, Frankfurt, Germany
| | - Yun Jiang
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Anke Fähnrich
- Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Fabian Ott
- Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Valentin Sencio
- Centre d'Infection et d'Immunité de Lille, Inserm U1019, CNRS UMR 9017, University of Lille, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Cyril Robil
- Centre d'Infection et d'Immunité de Lille, Inserm U1019, CNRS UMR 9017, University of Lille, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Susanne Pfefferle
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Florent Sauve
- Univ. Lille, Inserm, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition, UMR-S 1172, DISTALZ, EGID, Lille, France
| | - Caio Fernando Ferreira Coêlho
- Univ. Lille, Inserm, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition, UMR-S 1172, DISTALZ, EGID, Lille, France
| | - Jonas Franz
- Institute of Neuropathology, University Medical Center, Göttingen, Germany
- Campus Institute for Dynamics of Biological Networks, University of Göttingen, Göttingen, Germany
- Max Planck Institute for Experimental Medicine, Göttingen, Germany
| | - Frauke Spiecker
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Beate Lembrich
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Sonja Binder
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Nina Feller
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
| | - Peter König
- Airway Research Center North, Member of the German Center for Lung Research (DZL), Lübeck, Germany
- Institute of Anatomy, University of Lübeck, Lübeck, Germany
| | - Hauke Busch
- Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Institute for Cardiogenetics, University of Lübeck, Lübeck, Germany
| | - Ludovic Collin
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Basel, Switzerland
| | - Roberto Villaseñor
- Roche Pharma Research and Early Development (pRED), Roche Innovation Center, Basel, Switzerland
| | - Olaf Jöhren
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany
| | - Hermann C Altmeppen
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - Stefanie Dimmeler
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany
- Institute for Cardiovascular Regeneration, Cardiopulmonary Institute (CPI), University Frankfurt, Frankfurt, Germany
| | - Jindrich Cinatl
- Institute of Medical Virology, University Frankfurt, Frankfurt, Germany
| | - Klaus Püschel
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matija Zelic
- Rare and Neurologic Diseases Research, Sanofi, Framingham, MA, USA
| | - Dimitry Ofengeim
- Rare and Neurologic Diseases Research, Sanofi, Framingham, MA, USA
| | | | - François Trottein
- Centre d'Infection et d'Immunité de Lille, Inserm U1019, CNRS UMR 9017, University of Lille, CHU Lille, Institut Pasteur de Lille, Lille, France
| | - Ruben Nogueiras
- Department of Physiology, CIMUS, University of Santiago de Compostela-Instituto de Investigación Sanitaria, Santiago de Compostela, Spain
| | - Rolf Hilgenfeld
- Institute of Molecular Medicine, University of Lübeck, Lübeck, Germany
- German Center for Infection Research (DZIF), partner site Hamburg-Lübeck-Borstel-Riems, Lübeck, Germany
| | - Markus Glatzel
- Institute of Neuropathology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vincent Prevot
- Univ. Lille, Inserm, CHU Lille, Laboratory of Development and Plasticity of the Neuroendocrine Brain, Lille Neuroscience & Cognition, UMR-S 1172, DISTALZ, EGID, Lille, France
| | - Markus Schwaninger
- Institute for Experimental and Clinical Pharmacology and Toxicology, Center of Brain, Behavior and Metabolism (CBBM), University of Lübeck, Lübeck, Germany.
- DZHK (German Research Centre for Cardiovascular Research), Hamburg-Lübeck-Kiel and Frankfurt, Germany.
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Kim PH, Kim M, Suh CH, Chung SR, Park JE, Kim SC, Choi YJ, Lee JH, Kim HS, Baek JH, Choi CG, Kim SJ. Neuroimaging Findings in Patients with COVID-19: A Systematic Review and Meta-Analysis. Korean J Radiol 2021; 22:1875-1885. [PMID: 34269530 PMCID: PMC8546134 DOI: 10.3348/kjr.2021.0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 03/31/2021] [Accepted: 04/21/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Central nervous system involvement in coronavirus disease 2019 (COVID-19) has been increasingly reported. We performed a systematic review and meta-analysis to evaluate the incidence of radiologically demonstrated neurologic complications and detailed neuroimaging findings associated with COVID-19. MATERIALS AND METHODS A systematic literature search of MEDLINE/PubMed and EMBASE databases was performed up to September 17, 2020, and studies evaluating neuroimaging findings of COVID-19 using brain CT or MRI were included. Several cohort-based outcomes, including the proportion of patients with abnormal neuroimaging findings related to COVID-19 were evaluated. The proportion of patients showing specific neuroimaging findings was also assessed. Subgroup analyses were also conducted focusing on critically ill COVID-19 patients and results from studies that used MRI as the only imaging modality. RESULTS A total of 1394 COVID-19 patients who underwent neuroimaging from 17 studies were included; among them, 3.4% of the patients demonstrated COVID-19-related neuroimaging findings. Olfactory bulb abnormalities were the most commonly observed (23.1%). The predominant cerebral neuroimaging finding was white matter abnormality (17.6%), followed by acute/subacute ischemic infarction (16.0%), and encephalopathy (13.0%). Significantly more critically ill patients had COVID-19-related neuroimaging findings than other patients (9.1% vs. 1.6%; p = 0.029). The type of imaging modality used did not significantly affect the proportion of COVID-19-related neuroimaging findings. CONCLUSION Abnormal neuroimaging findings were occasionally observed in COVID-19 patients. Olfactory bulb abnormalities were the most commonly observed finding. Critically ill patients showed abnormal neuroimaging findings more frequently than the other patient groups. White matter abnormalities, ischemic infarctions, and encephalopathies were the common cerebral neuroimaging findings.
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Affiliation(s)
- Pyeong Hwa Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Minjae Kim
- Department of Radiology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chong Hyun Suh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
| | - Sae Rom Chung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Soo Chin Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Young Jun Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jeong Hyun Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Mogensen MA, Wangaryattawanich P, Hartman J, Filippi CG, Hippe DS, Cross NM. Special report of the RSNA COVID-19 task force: systematic review of outcomes associated with COVID-19 neuroimaging findings in hospitalized patients. Br J Radiol 2021; 94:20210149. [PMID: 33914618 PMCID: PMC8553187 DOI: 10.1259/bjr.20210149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE We reviewed the literature to describe outcomes associated with abnormal neuroimaging findings among adult COVID-19 patients. METHODS We performed a systematic literature review using PubMed and Embase databases. We included all studies reporting abnormal neuroimaging findings among hospitalized patients with confirmed COVID-19 and outcomes. Data elements including patient demographics, neuroimaging findings, acuity of neurological symptoms and/or imaging findings relative to COVID-19 onset (acute, subacute, chronic), and patient outcomes were recorded and summarized. RESULTS After review of 775 unique articles, a total of 39 studies comprising 884 COVID-19 patients ≥ 18 years of age with abnormal neuroimaging findings and reported outcomes were included in our analysis. Ischemic stroke was the most common neuroimaging finding reported (49.3%, 436/884) among patients with mortality outcomes data. Patients with intracranial hemorrhage (ICH) had the highest all-cause mortality (49.7%, 71/143), followed by patients with imaging features consistent with leukoencephalopathy (38.5%, 5/13), and ischemic stroke (30%, 131/436). There was no mortality reported among COVID-19 patients with acute disseminated encephalomyelitis without necrosis (0%, 0/8) and leptomeningeal enhancement alone (0%, 0/12). Stroke was a common acute or subacute neuroimaging finding, while leukoencephalopathy was a common chronic finding. CONCLUSION Among hospitalized COVID-19 patients with abnormal neuroimaging findings, those with ICH had the highest all-cause mortality; however, high mortality rates were also seen among COVID-19 patients with ischemic stroke in the acute/subacute period and leukoencephalopathy in the chronic period. ADVANCES IN KNOWLEDGE Specific abnormal neuroimaging findings may portend differential mortality outcomes, providing a potential prognostic marker for hospitalized COVID-19 patients.
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Affiliation(s)
- Monique A Mogensen
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | | | - Jason Hartman
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Christopher G Filippi
- Department of Radiology, Tufts University School of Medicine, Boston, MA, United States
| | - Daniel S Hippe
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
| | - Nathan M Cross
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, United States
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74
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Yeahia R, Schefflein J, Chiarolanzio P, Rozenstein A, Gomes W, Ali S, Mehta H, Al-Mufti F, McClelland A, Gulko E. Brain MRI findings in COVID-19 patients with PRES: A systematic review. Clin Imaging 2021; 81:107-113. [PMID: 34700172 PMCID: PMC8519663 DOI: 10.1016/j.clinimag.2021.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/21/2021] [Accepted: 10/05/2021] [Indexed: 12/27/2022]
Abstract
Background Numerous case reports and case series have described brain Magnetic Resonance Imaging (MRI) findings in Coronavirus disease 2019 (COVID-19) patients with concurrent posterior reversible encephalopathy syndrome (PRES). Purpose We aim to compile and analyze brain MRI findings in patients with COVID-19 disease and PRES. Methods PubMed and Embase were searched on April 5th, 2021 using the terms “COVID-19”, “PRES”, “SARS-CoV-2” for peer-reviewed publications describing brain MRI findings in patients 21 years of age or older with evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and PRES. Results Twenty manuscripts were included in the analysis, which included descriptions of 30 patients. The average age was 57 years old. Twenty-four patients (80%) required mechanical ventilation. On brain MRI examinations, 15 (50%) and 7 (23%) of patients exhibited superimposed foci of hemorrhage and restricted diffusion respectively. Conclusions PRES is a potential neurological complication of COVID-19 related disease. COVID-19 patients with PRES may exhibit similar to mildly greater rates of superimposed hemorrhage compared to non-COVID-19 PRES patients.
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Affiliation(s)
- Rubaya Yeahia
- New York Medical College, Valhalla, New York, United States of America
| | - Javin Schefflein
- Division of Neuroradiology, Department of Radiology, Westchester Medical Center, Valhalla, New York, United States of America
| | - Patrick Chiarolanzio
- Department of Radiology, New York Medical College, Valhalla, New York, United States of America
| | - Anna Rozenstein
- Division of Cardiothoracic Radiology, Department of Radiology, Westchester Medical Center, Valhalla, New York, United States of America
| | - William Gomes
- Division of Neuroradiology, Department of Radiology, Westchester Medical Center, Valhalla, New York, United States of America
| | - Sana Ali
- Division of Neuroradiology, Department of Radiology, Westchester Medical Center, Valhalla, New York, United States of America
| | - Hasit Mehta
- Division of Neuroradiology, Department of Radiology, Westchester Medical Center, Valhalla, New York, United States of America
| | - Fawaz Al-Mufti
- Department of Neurology, Westchester Medical Center, Valhalla, New York, United States of America
| | - Andrew McClelland
- Division of Neuroradiology, Department of Radiology, Montefiore Medical Center, Bronx, New York, United States of America
| | - Edwin Gulko
- Division of Neuroradiology, Department of Radiology, Westchester Medical Center, Valhalla, New York, United States of America.
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75
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Lang M, Chang YS, Mehan WA, Rincon SP, Buch K. Long-term neuroimaging follow-up of COVID-19-related leukoencephalopathy. Neuroradiology 2021; 63:2153-2156. [PMID: 34664111 PMCID: PMC8523011 DOI: 10.1007/s00234-021-02829-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/08/2021] [Indexed: 11/27/2022]
Abstract
More than a year after the start of the COVID-19 pandemic, long-term neurological manifestations of COVID-19 are increasingly being reported. The long-term sequelae of COVID-19-related leukoencephalopathy, however, remain unclear. Here, we present long-term neuroimaging follow-up in two cases of COVID-19-related leukoencephalopathy. The two cases demonstrate the utility of brain MRI for evaluating neurologic symptoms in critically ill patients with COVID-19, for diagnosis of underlying neural injury and prognostication of future recovery. The presence of leukoencephalopathy may result in chronic neurologic manifestations and may represent a poor prognosticator of neurologic recovery. The presence of leukoencephalomalacia on follow-up neuroimaging is potentially an indicator of irreversible white matter damage, which may be associated with more severe chronic deficits.
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Affiliation(s)
- Min Lang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Yuh-Shin Chang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - William A Mehan
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Sandra P Rincon
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Karen Buch
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
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76
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Ramos AD, Koyfman F, Byrns K, Wu A, Yasen J, Elreda L, Boddu S, Pishanidar S, Allen B, Juthani RG. Characterization of Hemorrhagic and Ischemic Stroke in a Diverse Cohort of COVID-19 Patients. Neurohospitalist 2021; 11:295-302. [PMID: 34567389 PMCID: PMC8442153 DOI: 10.1177/1941874421990545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND AND PURPOSE COVID-19 is a known risk factor for stroke. There is limited data on the influence of demographics, risk factors, and hematologic function on outcomes in COVID-19 stroke patients. METHODS All patients with acute ischemic or hemorrhagic stroke tested for COVID-19 and treated from March 13 through May 19, 2020 were retrospectively analyzed. COVID+ patients were compared to COVID- patients and a historical cohort from 2019. RESULTS 84 patients with radiographic acute stroke from the 2020 study period and 152 patients in the historical cohort were included. Stroke incidence in COVID+ patients was 1.5%, with a significant decline in total stroke presentations during this period compared to 2019. 37 patients were COVID+ and 47 patients were COVID-. 32% of COVID+ stroke patients were Hispanic compared to 15% and 18% in the COVID- and 2019 cohorts respectively (p = 0.069 and 0.07). COVID+ stroke patients were younger, had higher rates of hemorrhagic conversion (p = 0.034), higher initial NIHSS (p < 0.001), increased cryptogenic stroke mechanism (p = 0.02), and higher mortality independent of COVID-19 severity. COVID+ patients had higher rates of thrombocytopenia (p = 0.02), and were less likely to be on antiplatelet therapy (p = 0.025). In multivariable analysis, only COVID-19 status independently predicted mortality. CONCLUSIONS COVID status, independent of severity, was significantly associated with higher mortality in stroke patients. COVID+ stroke patients were younger and less likely to be on antiplatelets, with higher rates of thrombocytopenia, suggesting a possible role for antiplatelet use in this population.
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Affiliation(s)
| | - Feliks Koyfman
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Kory Byrns
- Department of Radiology, New York-Presbyterian Queens Flushing, New York, NY, USA
| | - Alan Wu
- Division of Biostatistics and Epidemiology, Department of Population
Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Jay Yasen
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Lauren Elreda
- Division of Hematology/Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Srikanth Boddu
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, USA
| | - Sammy Pishanidar
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Baxter Allen
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Rupa G. Juthani
- Department of Neurosurgery, Weill Cornell Medicine, New York, NY, USA
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77
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The Spectrum of Neuroimaging Findings on CT and MRI in Adults With COVID-19. AJR Am J Roentgenol 2021; 217:959-974. [DOI: 10.2214/ajr.20.24839] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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78
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Benson JC, Hunt CH, Klaas JP, Kallmes DF. Intracranial microhemorrhages in the setting of COVID-19: what we know so far. Neuroradiol J 2021; 34:435-439. [PMID: 33765876 PMCID: PMC8559007 DOI: 10.1177/19714009211004144] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Diffuse intracranial susceptibility abnormalities have recently been described among patients with coronavirus disease 2019 (COVID-19), although prior studies have consisted of case reports and/or series. This brief literature review seeks to compile and catalogue the available data to elucidate characteristic features of such findings. MATERIALS AND METHODS Scientific articles and studies on intracranial microhemorrhages in the setting of COVID-19 were searched on PubMed, Google Scholar, and the Cochrane Library. Included studies described intracranial microbleed(s) on magnetic resonance imaging in patients with COVID-19. If multiple patients were described, only patients with intracranial microhemorrhage on magnetic resonance imaging were included for analysis. Patient demographics, severity of illness (e.g. intensive care unit admission and/or intubation), time from diagnosis of COVID-19 to magnetic resonance imaging, and location(s) of any observed microhemorrhages were noted. RESULTS A total of 39 patients with suspected intracranial microhemorrhages have been described in prior studies. The average age of patients was 64.7 years; 21.9% were women. The average time between COVID-19 diagnosis and magnetic resonance imaging was 31.7 days. All patients in the cohort were admitted to critical care and were either intubated or treated with extracorporeal membrane oxygenation during their clinical course. Microhemorrhages were most commonly located in the subcortical/juxtacortical white matter and corpus callosum. CONCLUSIONS Intracranial microbleeds are a well-documented finding in patients with severe COVID-19, and are most commonly callosal and subcortical/juxtacortical in location.
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Affiliation(s)
- John C Benson
- Department of Radiology, Mayo Clinic, Rochester, USA
| | | | - James P Klaas
- Department of Neurology, Mayo Clinic, Rochester, USA
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79
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Migdady I, Shoskes A, Hasan LZ, Hassett C, George P, Newey C, Cho SM, Rae-Grant A, Uchino K. Timing of Acute Stroke in COVID-19-A Health System Registry Study. Neurohospitalist 2021; 11:285-294. [PMID: 34567388 PMCID: PMC8442157 DOI: 10.1177/1941874420985983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE The association between SARS-CoV-2 infection and stroke remains unknown. We aimed to compare the characteristics of stroke patients who were hospitalized with Coronavirus Disease 2019 (COVID-19) based on the timing of stroke diagnosis. METHODS We performed a retrospective analysis of adult patients in a health system registry of COVID-19 who were hospitalized and had imaging-confirmed acute stroke during hospitalization. Baseline characteristics and hospital outcomes were collected and analyzed. RESULTS Out of 882 COVID-19 patients who were hospitalized between March 9 to May 17, 2020, 14 patients (2% of all COVID-19 patients and 21% of those who underwent imaging) presented with stroke or developed stroke during hospitalization. Eleven had acute ischemic stroke (AIS) and 3 had acute hemorrhagic stroke. Six patients (43%) presented to the hospital with acute stroke symptoms and were found to have SARS-CoV-2. Compared to patients who presented with AIS, more patients with AIS during hospitalization were male, of older age, had pneumonia and acute respiratory distress syndrome, were severely ill, and had high inflammatory and thrombotic markers (including C reactive protein, D dimer, ferritin, and fibrinogen). Among all patients, hospital mortality was high (50%) and the majority of patients who were discharged had poor neurological outcome. CONCLUSIONS A distinction should be made between patients who present with acute stroke with concurrent SARS-CoV-2 infection and those who develop stroke as a complication of severe COVID-19. It is likely that a subset of stroke patients will incidentally test positive for the virus given the widespread pandemic.
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Affiliation(s)
- Ibrahim Migdady
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
- Division of Neurocritical Care, Department of Neurology,
Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Aaron Shoskes
- Department of Neurology, Cleveland Clinic, Cleveland, OH, USA
| | - Leen Z. Hasan
- Department of Medicine, University of Connecticut, Farmington, CT,
USA
- Department of Infectious Diseases, Cleveland Clinic, Cleveland, OH, USA
| | - Catherine Hassett
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Pravin George
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Christopher Newey
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Sung-Min Cho
- Departments of Neurology, Neurological Intensive Care,
Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander Rae-Grant
- Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Ken Uchino
- Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA
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Sabino JV, Gonçales ESL, Reis F. COVID-19-associated leukoencephalopathy and brain microhemorrhages. Rev Soc Bras Med Trop 2021; 54:e0469. [PMID: 34586292 PMCID: PMC8463029 DOI: 10.1590/0037-8682-0469-2021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- João Vitor Sabino
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Radiologia, Campinas, SP, Brasil
| | - Eduardo Sellan Lopes Gonçales
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brasil
| | - Fabiano Reis
- Universidade Estadual de Campinas, Faculdade de Ciências Médicas, Departamento de Clínica Médica, Campinas, SP, Brasil
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81
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Bondira IP, Lambert-Cheatham NA, Sakuru RC, Polinger-Hyman DJ, Pipitone BD, Arnold KE, Nagia L, Kaufman DI. Inability to Read After Prolonged COVID-19 Hospitalization: MRI With Clinical Correlation. J Neuroophthalmol 2021; 41:e277-e278. [PMID: 34415278 PMCID: PMC8366530 DOI: 10.1097/wno.0000000000001121] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Inna P Bondira
- Department of Neurology and Ophthalmology (IB, NL-C, RCS, LN, DK), Michigan State University, East Lansing, Michigan; Department of Radiology (DP-H, BP), Michigan State University, East Lansing, Michigan; and Ferris State University (KA), Michigan College of Optometry, Big Rapids, Michigan
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82
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Podduturi V, Blessing MM, Joseph DM, Ross JL, Sandberg GD. A Case Series of Acute Hemorrhagic Leukoencephalitis. Am J Forensic Med Pathol 2021; 42:263-266. [PMID: 33394682 DOI: 10.1097/paf.0000000000000642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Acute hemorrhagic leukoencephalitis (AHL) is an acute, hemorrhagic demyelinating disease thought to be caused by an immune-mediated process. Acute hemorrhagic leukoencephalitis is both diagnostically challenging and fatal in the majority of cases. We present two cases of AHL unexpectedly diagnosed at autopsy. These cases demonstrate the often nonspecific and challenging nature of AHL clinical presentation, review neuropathological mimics, and emphasize the importance of considering this diagnosis in the forensic setting.
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Affiliation(s)
- Varsha Podduturi
- From the Department of Pathology, Harris County Institute of Forensic Sciences
| | - Melissa M Blessing
- From the Department of Pathology, Harris County Institute of Forensic Sciences
| | - David M Joseph
- Pathology and Genomic Medicine Department, Houston Methodist Hospital, Houston, TX
| | - Jennifer L Ross
- From the Department of Pathology, Harris County Institute of Forensic Sciences
| | - Glenn D Sandberg
- From the Department of Pathology, Harris County Institute of Forensic Sciences
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83
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Rivera-Sotelo N, Vargas-Del-Angel RG, Ternovoy SK, Roldan-Valadez E. Global research trends in COVID-19 with MRI and PET/CT: a scoping review with bibliometric and network analyses. Clin Transl Imaging 2021; 9:625-639. [PMID: 34414137 PMCID: PMC8364406 DOI: 10.1007/s40336-021-00460-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Accepted: 08/04/2021] [Indexed: 02/05/2023]
Abstract
Objective To identify and evaluate the indexed studies that allow us to understand the implications of imaging studies in MRI and PET/CT related to COVID-19 research. Methods Scoping review. Articles in PubMed, Scopus, and Web of Science (WoS) were scanned from 2019 to 2021 with COVID-19, MRI, and PET-CT as keywords. EndNote software and manual checking removed the duplicated references. Our assessment includes citation, bibliometric, keyword network, and statistical analyses using descriptive statistics and correlations. Highlighted variables were publication year, country, journals, and authorship. Results Only 326 papers were included. The most cited article reached 669 cites; this number represented 21.71% of 3081 citations. The top-15 cited authors received 1787 citations, which represented 58% of the total cites. These authors had affiliations from ten countries (Belgium, China, France, Italy, Japan, Spain, Sweden, Turkey, United Kingdom (UK), and the USA). The top-30 journals were cited 2762 times, representing 89.65% of the total cites. Only five journals were cited more than 100 times; Int J Infect Dis had the most significant number of citations (674). Some of the unexpected keywords were encephalitis, stroke, microbleeds, myocarditis. Conclusion COVID-19 pandemic is still spreading worldwide, and the knowledge about its different facets continues advancing. MRI and PET/CT are being used in more than 50% of the selected studies; research trends span seven categories, no only the diagnostic but others like socio-economic impact and pathogenesis Developed countries had an advantage by having hospitals with more resources, including MRI and PET/CT facilities in the same institution to supplement basic assessment in patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s40336-021-00460-x.
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Affiliation(s)
- Nathaly Rivera-Sotelo
- Directorate of Research, Hospital General de Mexico "Dr Eduardo Liceaga", 06720 Mexico City, Mexico
| | | | - Sergey K Ternovoy
- Department of Radiology, A.L. Myasnikov Research Institute of Clinical Cardiology of National Medical Research Center, Moscow, Russia.,Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia
| | - Ernesto Roldan-Valadez
- Directorate of Research, Hospital General de Mexico "Dr Eduardo Liceaga", 06720 Mexico City, Mexico.,Department of Radiology, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119992 Moscow, Russia
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84
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Association of CNS demyelination and COVID-19 infection: an updated systematic review. J Neurol 2021; 269:541-576. [PMID: 34386902 PMCID: PMC8359762 DOI: 10.1007/s00415-021-10752-x] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/05/2021] [Accepted: 08/05/2021] [Indexed: 12/27/2022]
Abstract
Background Since the declaration of COVID-19 pandemic, several case reports of demyelination of both peripheral and central nervous systems have been published. The association between CNS demyelination and viral infection has long been documented, and this link was recently reported following SARS-CoV-2 infection as well. Objectives In this systematic review, we aim to investigate the existing literature on CNS demyelination associated with SARS-CoV-2, and the proposed pathophysiological mechanisms. Methods We conducted a systematic review of articles in PubMed, SCOPUS, EMBASE, Cochrane, Google Scholar and Ovid databases, from 1 January 2020 until June 15, 2021. The following keywords were used: “COVID-19”, “SARS-CoV-2”, “demyelination”, “demyelinating disease”, “multiple sclerosis”, “neuromyelitis optica”, and “transverse myelitis”. Results A total of 60 articles were included in the final analysis of this systematic review and included 102 patients: 52 (51%) men and 50 (49%) women, with a median age of 46.5 years. The demyelination mimicked a variety of conditions with a picture of encephalitis/encephalomyelitis being the most common. At the same time other patterns were less frequently reported such as MS, NMOSD and even MOGAD. Longitudinally extensive transverse myelitis (LETM) was the most frequently reported pattern of spinal cord involvement. Conclusion A growing body of literature has shown an association between SARS‐CoV‐2 infection and the development of different types of CNS demyelination. Although causality cannot readily be inferred, this review may suggest a probable causal relationship, through a para-infectious or post-infectious immune-mediated etiology in COVID-19 patients. This relationship needs to be clarified in future research.
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85
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Witvoet EH, Jiang FY, Laumans W, de Bruijn SFTM. COVID-19-related diffuse leukoencephalopathy with microbleeds and persistent coma: a case report with good clinical outcome. BMJ Case Rep 2021; 14:14/8/e242504. [PMID: 34380677 PMCID: PMC8359524 DOI: 10.1136/bcr-2021-242504] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A 60-year-old patient presented with respiratory distress, after recently being tested COVID-19 positive and was mechanically ventilated for 15 days. After cessation of sedation, he remained in deep comatose state, without any reaction on pain stimuli (Glasgow Coma Score 3). MRI of the brain showed diffuse leukoencephalopathy and multiple (>50) microbleeds. Diffuse COVID-19-associated leukoencephalopathy with microhaemorrhages is associated with a poor prognosis. However, 3 months later, our patient showed a remarkable recovery and was able to walk independently. This case report shows COVID-related leukoencephalopathy and intracerebral microbleeds, even with persistent comatose state, may have a favourable clinical outcome and prolonged treatment should be considered in individual cases.
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Affiliation(s)
| | - Feng Yan Jiang
- Department of Radiology, Haga Hospital, Den Haag, The Netherlands
| | - Willemijn Laumans
- Department of Intensive Care Medicine, Haga Hospital, Den Haag, The Netherlands
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86
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Review of COVID-19, part 2: Musculoskeletal and neuroimaging manifestations including vascular involvement of the aorta and extremities. Clin Imaging 2021; 79:300-313. [PMID: 34388683 PMCID: PMC8349444 DOI: 10.1016/j.clinimag.2021.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/30/2021] [Accepted: 08/05/2021] [Indexed: 12/12/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has affected almost every country in the world resulting in severe morbidity, mortality and economic hardship, altering the landscape of healthcare forever. Its devastating and most frequent thoracic and cardiac manifestations have been well reported since the start of the pandemic. Its extra-thoracic manifestations are myriad and understanding them is critical in diagnosis and disease management. The role of radiology is growing in the second wave and second year of the pandemic as the multiorgan manifestations of COVID-19 continue to unfold. Musculoskeletal, neurologic and vascular disease processes account for a significant number of COVID-19 complications and understanding their frequency, clinical sequelae and imaging manifestations is vital in guiding management and improving overall survival. The authors aim to provide a comprehensive overview of the pathophysiology of the virus along with a detailed and systematic imaging review of the extra-thoracic manifestation of COVID-19. In Part I, abdominal manifestations of COVID-19 in adults and multisystem inflammatory syndrome in children will be reviewed. In Part II, manifestations of COVID-19 in the musculoskeletal, central nervous and vascular systems will be reviewed.
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87
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Sullivan BN, Fischer T. Age-Associated Neurological Complications of COVID-19: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:653694. [PMID: 34408638 PMCID: PMC8366271 DOI: 10.3389/fnagi.2021.653694] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
The outbreak of the novel and highly infectious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in hundreds of millions of infections and millions of deaths globally. Infected individuals that progress to coronavirus disease-19 (COVID-19) experience upper and lower respiratory complications that range in severity and may lead to wide-spread inflammation and generalized hypoxia or hypoxemia that impacts multiple organ systems, including the central and peripheral nervous systems. Since the SARS-CoV-2 outbreak, multiple reports continue to emerge that detail neurological symptoms, ranging from relatively mild (e.g., impaired taste and/or smell) to severe (e.g., stroke), suggesting SARS-CoV-2 may be neurotropic and/or contribute to nervous system injury through direct and/or indirect mechanisms. To gain insight into the types of neurological complications associated with SARS-CoV-2 infection and their possible relationship with age, sex, COVID-19 severity, and comorbidities, we performed a systematic review of case reports and series published in 2020 - April 4, 2021 of infected patients with neurological manifestations. Meta-analyses were conducted using individual patient data from reports where these data could be extracted. Here, we report neurological injury occurs across the lifespan in the context of infection, with and without known comorbidities, and with all disease severities, including asymptomatic patients. Older individuals, however, are more susceptible to developing life-threatening COVID-19 and cerebrovascular disease (CVD), such as stroke. A mild but inverse correlation with age was seen with CNS inflammatory diseases, such as encephalitis, as well as taste and/or smell disorders. When reported, increased age was also associated with comorbid cardiovascular risk factors, including hypertension, diabetes mellitus, and lipid disorders, but not with obesity. Obesity did correlate with development of critical COVID-19. Discussion into potential pathophysiological mechanisms by which neurological symptoms arise and long-term consequences of infection to the nervous system is also provided.
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Affiliation(s)
- Brianne N. Sullivan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
- Neuroscience Program, Tulane Brain Institute, School of Science and Engineering, Tulane University, New Orleans, LA, United States
| | - Tracy Fischer
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, United States
- Tulane Brain Institute, Tulane University School of Medicine, New Orleans, LA, United States
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88
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Nath A. Neurologic Manifestations of Severe Acute Respiratory Syndrome Coronavirus 2 Infection. Continuum (Minneap Minn) 2021; 27:1051-1065. [PMID: 34623104 PMCID: PMC9527260 DOI: 10.1212/con.0000000000000992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW This article describes the spectrum of neurologic complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, their underlying pathology and pathogenic mechanisms, gaps in knowledge, and current therapeutic strategies. RECENT FINDINGS COVID-19 is the clinical syndrome caused by the novel coronavirus SARS-CoV-2. It can affect the entire neuraxis, and presentations in the acute phase are variable, although anosmia is a common manifestation. Encephalopathy is common in patients who are hospitalized and is often associated with multiorgan involvement. Immune-mediated encephalitis is probably underrecognized; however, viral encephalitis is rare. Other manifestations include stroke, seizures, myelitis, and peripheral neuropathies, including Guillain-Barré syndrome, which sometimes has atypical manifestations. Treatment is symptomatic, and immunotherapies have been used successfully in some patients. Long-term complications include dysautonomia, exercise intolerance, malaise, sleep disturbances, cognitive impairment, and mood disorders. SUMMARY Neurologic manifestations of COVID-19 may occur in the acute setting and may be independent of respiratory manifestations. Immune-mediated syndromes and cerebrovascular complications are common. Large populations of patients are expected to have long-term neurologic complications of COVID-19, many of which may emerge only after recovery from the acute illness.
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89
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90
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Ahmed IAH, Aker L, Sharafeldin M, Own A, Abdelhady M, Vattoth S. COVID-19 related leukoencephalopathy with bilateral reticular formation involvement. BJR Case Rep 2021; 7:20210054. [PMID: 35047207 PMCID: PMC8749398 DOI: 10.1259/bjrcr.20210054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/22/2022] Open
Abstract
We are presenting the imaging findings of COVID-19-related leukoencephalopathy associated with bilateral reticular formation diffusion restriction in brain magnetic resonance imaging. To the best of our knowledge, this is the first reported case of bilateral reticular formation affection in a COVID-19 patient.
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Affiliation(s)
| | - Loai Aker
- Diagnostic Radiology Resident, Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar
| | - Mamdouh Sharafeldin
- Neuroradiology Consultant, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Own
- Neuroradiology Consultant, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Abdelhady
- Associate consultant neuroradiology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Surjith Vattoth
- Associate Professor of Radiology, Neuroradiology Section, University of Arkansas for Medical Sciences (UAMS), Little Rock, AR, USA
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91
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Bahranifard B, Mehdizadeh S, Hamidi A, Khosravi A, Emami R, Mirzaei K, Nemati R, Nemati F, Assadi M, Gholamrezanezhad A. A review of neuroradiological abnormalities in patients with coronavirus disease 2019 (COVID-19). Neuroradiol J 2021; 35:3-24. [PMID: 34224248 PMCID: PMC8819585 DOI: 10.1177/19714009211029177] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to
various neurological manifestations. There is an urgent need for a summary
of neuroimaging findings to accelerate diagnosis and treatment plans. We
reviewed prospective and retrospective studies to classify neurological
abnormalities observed in patients with the SARS-CoV-2 infection. Methods The relevant studies published in Scopus, PubMed and Clarivate Analytics
databases were analysed. The search was performed for full-text articles
published from 23 January 2020 to 23 February 2021. Results In 23 studies the number of patients with SARS-CoV-2 infection was 20,850 and
the number of patients with neurological manifestations was 1996 (9.5%). The
total number of patients with neuroradiological abnormalities was 602
(2.8%). SARS-CoV-2 has led to various neuroimaging abnormalities which can
be categorised by neuroanatomical localisation of lesions and their main
probable underlying pathogenesis. Cranial nerve and spinal root
abnormalities were cranial neuritis and polyradiculitis. Parenchymal
abnormalities fell into four groups of: (a) thrombosis disorders, namely
ischaemic stroke and sinus venous thrombosis; (b) endothelial dysfunction
and damage disorders manifested as various types of intracranial haemorrhage
and posterior reversible encephalopathy syndrome; (c) hypoxia/hypoperfusion
disorders of leukoencephalopathy and watershed infarction; and (d)
inflammatory disorders encompassing demyelinating disorders, encephalitis,
vasculitis-like disorders, vasculopathy and cytotoxic lesions of the corpus
callosum. Leptomeninges disorders included meningitis. Ischaemic stroke was
the most frequent abnormality in these studies. Conclusion The review study suggests that an anatomical approach to the classification
of heterogeneous neuroimaging findings in patients with SARS-CoV-2 and
neurological manifestations would lend itself well for use by practitioners
in diagnosis and treatment planning.
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Affiliation(s)
- Bahar Bahranifard
- Department of Neurology, Bushehr University of Medical Sciences, Iran
| | | | - Ali Hamidi
- Department of Medical Library and Information Science, Bushehr University of Medical Sciences, Iran
| | - Alireza Khosravi
- Department of Neurology, Zahedan University of Medical Sciences, Iran
| | - Ramin Emami
- Department of Neurology, Abhar Medical Clinic, Iran
| | - Kamran Mirzaei
- Department of Community Medicine, Bushehr University of Medical Sciences, Iran
| | - Reza Nemati
- Department of Neurology, Bushehr University of Medical Sciences, Iran
| | - Fatemeh Nemati
- Department of English Language and Literature, Persian Gulf University, Iran
| | - Majid Assadi
- Department of Molecular Imaging and Radionuclide Therapy (MIRT), The Persian Gulf Nuclear Medicine Research Center, Iran
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92
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Ahmad Z, Goswami S, Paneerselvam A, Kabilan K, Chowdhury H, Roy A, Guleria R, Soni KD, Baruah U, Das CJ. Imaging of Coronavirus Disease 2019 Infection From Head to Toe: A Primer for the Radiologist. Curr Probl Diagn Radiol 2021; 50:842-855. [PMID: 34330569 PMCID: PMC8256677 DOI: 10.1067/j.cpradiol.2021.06.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 01/08/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) disease has rapidly spread around the world after initial identification in Wuhan, China, in December 2019. Most common presentation is mild or asymptomatic disease, followed by pneumonia, and rarely- multiorgan failure and Acute Respiratory Distress Syndrome (ARDS). Knowledge about the pathophysiology, imaging and treatment of this novel virus is rapidly evolving due to ongoing worldwide research. Most common imaging modalities utilized during this pandemic are chest radiography and HRCT with findings of bilateral peripheral, mid and lower zone GGO and/or consolidation, vascular enlargement and crazy paving. HRCT is also useful for prognostication and follow-up of severely ill COVID-19 patients. Portable radiography allows follow-up of ICU patients & obviates the need of shifting critically ill patients and disinfection of CT room. As the pandemic has progressed, numerous neurologic manifestations have been described in COVID-19 including stroke, white matter hyperintensities and demyelination on MRI. Varying abdominal presentations have been described, which on imaging either show evidence of COVID-19 pneumonia in lung bases or show abdominal findings including bowel thickening and vascular thrombosis. Numerous thrombo-embolic and cardiovascular complications have also been described in COVID-19 including arterial and venous thrombosis, pulmonary embolism and myocarditis. It is imperative for radiologists to be aware of all the varied faces of this disease on imaging, as they may well be the first physician to suspect the disease. This article aims to review the multimodality imaging manifestations of COVID-19 disease in various organ systems from head to toe.
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Affiliation(s)
- Zohra Ahmad
- Department of Radiodiagnosis, Gauhati Medical College, Guwahati, Assam, India
| | - Sneha Goswami
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kaviraj Kabilan
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Himanshu Chowdhury
- Consultant Radiologist, Dept of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, Maharashtra, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | | | - Kapil Dev Soni
- Critical & Intensive care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Udismita Baruah
- Department of Anesthesiology, VMMC and Safdarjung Hospital, New Delhi, India
| | - Chandan J Das
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
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93
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Bhandari R, Khanna G, Kaushik D, Kuhad A. Divulging the Intricacies of Crosstalk Between NF-Kb and Nrf2-Keap1 Pathway in Neurological Complications of COVID-19. Mol Neurobiol 2021; 58:3347-3361. [PMID: 33683626 PMCID: PMC7938034 DOI: 10.1007/s12035-021-02344-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 02/25/2021] [Indexed: 01/06/2023]
Abstract
The severity of COVID-19 infection is surging day by day. With the cases increasing daily, it is becoming more and more essential to understand the pathogenic mechanisms underlying the severity of the disease. It is now well known that the infection manifests itself primarily as respiratory, but the involvement of the other organ systems has now been documented in many studies. SARS-CoV-2 can invade the nervous system by a multitude of proposed mechanisms that have been discussed in this review. NF-κB and Nrf2 are transcription factors that regulate genes responsible for inflammatory and anti-oxidant response respectively. Specific focus in this review has been given to NF-κB and Nrf2 pathways that are involved in the cytokine storm and oxidative stress that are the hallmarks of COVID-19. As the immune injury is an important mechanism of neuro-invasion and neuroinflammation, there is the possible involvement of these two pathways in the neurological complications. The crosstalk mechanisms of these signaling pathways have also been discussed. Immuno-modulators both synthetic and natural are promising candidates in catering to the pathologies targeted in the aforementioned pathways.
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Affiliation(s)
- Ranjana Bhandari
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Panjab University, Chandigarh, 160 014, India.
| | - Garima Khanna
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Panjab University, Chandigarh, 160 014, India
| | - Dhriti Kaushik
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Panjab University, Chandigarh, 160 014, India
| | - Anurag Kuhad
- Pharmacology Research Laboratory, University Institute of Pharmaceutical Sciences, UGC-Centre of Advanced Study, Panjab University, Chandigarh, 160 014, India.
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94
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021. [DOI: 10.4329/wjr.v13.i6.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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95
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Sideris GA, Nikolakea M, Karanikola AE, Konstantinopoulou S, Giannis D, Modahl L. Imaging in the COVID-19 era: Lessons learned during a pandemic. World J Radiol 2021; 13:192-222. [PMID: 34249239 PMCID: PMC8245753 DOI: 10.4329/wjr.v13.i6.192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/02/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023] Open
Abstract
The first year of the coronavirus disease 2019 (COVID-19) pandemic has been a year of unprecedented changes, scientific breakthroughs, and controversies. The radiology community has not been spared from the challenges imposed on global healthcare systems. Radiology has played a crucial part in tackling this pandemic, either by demonstrating the manifestations of the virus and guiding patient management, or by safely handling the patients and mitigating transmission within the hospital. Major modifications involving all aspects of daily radiology practice have occurred as a result of the pandemic, including workflow alterations, volume reductions, and strict infection control strategies. Despite the ongoing challenges, considerable knowledge has been gained that will guide future innovations. The aim of this review is to provide the latest evidence on the role of imaging in the diagnosis of the multifaceted manifestations of COVID-19, and to discuss the implications of the pandemic on radiology departments globally, including infection control strategies and delays in cancer screening. Lastly, the promising contribution of artificial intelligence in the COVID-19 pandemic is explored.
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Affiliation(s)
- Georgios Antonios Sideris
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | - Melina Nikolakea
- Radiology Working Group, Society of Junior Doctors, Athens 11527, Greece
| | | | - Sofia Konstantinopoulou
- Division of Pulmonary Medicine, Department of Pediatrics, Sheikh Khalifa Medical City, Abu Dhabi W13-01, United Arab Emirates
| | - Dimitrios Giannis
- Institute of Health Innovations and Outcomes Research, The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY 11030, United States
| | - Lucy Modahl
- Department of Radiology, University of Massachusetts Medical School, Baystate Medical Center, Springfield, MA 01199, United States
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96
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Vahedi A, Apap Mangion S, Silber E, Sibtain N, Chandra J. COVID-19 leukoencephalopathy with subacute magnetic resonance imaging findings of vasculitis and demyelination. J Neurovirol 2021; 27:656-661. [PMID: 34101087 PMCID: PMC8186364 DOI: 10.1007/s13365-021-00990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/04/2021] [Accepted: 05/16/2021] [Indexed: 12/04/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly results in a respiratory illness in symptomatic patients; however, those critically ill can develop a leukoencephalopathy. We describe two patients who had novel subacute MRI findings in the context of coronavirus disease 2019 (COVID-19) leukoencephalopathy, which we hypothesize could implicate a potent small-vessel vasculitis, ischemic demyelination and the presence of prolonged ischemia. Recent evidence of the direct neuroinvasiness of SARS-CoV-2 leading to ischemia and vascular damage supports this hypothesis.
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Affiliation(s)
- Ali Vahedi
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sean Apap Mangion
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Naomi Sibtain
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Julie Chandra
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
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97
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Manca R, De Marco M, Ince PG, Venneri A. Heterogeneity in Regional Damage Detected by Neuroimaging and Neuropathological Studies in Older Adults With COVID-19: A Cognitive-Neuroscience Systematic Review to Inform the Long-Term Impact of the Virus on Neurocognitive Trajectories. Front Aging Neurosci 2021; 13:646908. [PMID: 34149394 PMCID: PMC8209297 DOI: 10.3389/fnagi.2021.646908] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/28/2021] [Indexed: 12/14/2022] Open
Abstract
Background: Other than its direct impact on cardiopulmonary health, Coronavirus Disease 2019 (COVID-19) infection affects additional body systems, especially in older adults. Several studies have reported acute neurological symptoms that present at onset or develop during hospitalisation, with associated neural injuries. Whilst the acute neurological phase is widely documented, the long-term consequences of COVID-19 infection on neurocognitive functioning remain unknown. Although an evidence-based framework describing the disease chronic phase is premature, it is important to lay the foundations for future data-driven models. This systematic review aimed at summarising the literature on neuroimaging and neuropathological findings in older over-60 patients with COVID-19 following a cognitive neuroscientific perspective, to clarify the most vulnerable brain areas and speculate on the possible cognitive consequences. Methods: PubMed and Web of Science databases were searched to identify relevant manuscripts published between 1st March 2020 and 31th December 2020. Outputs were screened and selected by two assessors. Relevant studies not detected by literature search were added manually. Results: Ninety studies, mainly single cases and case series, were included. Several neuroimaging and neuropathological findings in older patients with COVID-19 emerged from these studies, with cerebrovascular damage having a prominent role. Abnormalities (hyperintensities, hypoperfusion, inflammation, and cellular damage) were reported in most brain areas. The most consistent cross-aetiology findings were in white matter, brainstem and fronto-temporal areas. Viral DNA was detected mainly in olfactory, orbitofrontal and brainstem areas. Conclusion: Studies on COVID-19 related neural damage are rich and diverse, but limited to description of hospitalised patients with fatal outcome (i.e., in neuropathological studies) or severe symptoms (i.e., in neuroimaging studies). The damage seen in this population indicates acute and largely irreversible dysfunction to neural regions involved in major functional networks that support normal cognitive and behavioural functioning. It is still unknown whether the long-term impact of the virus will be limited to chronic evolution of acute events, whether sub-clinical pathological processes will be exacerbated or whether novel mechanisms will emerge. Based on current literature, future theoretical frameworks describing the long-term impact of COVID-19 infection on mental abilities will have to factor in major trends of aetiological and topographic heterogeneity.
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Affiliation(s)
- Riccardo Manca
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Matteo De Marco
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Paul G. Ince
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
| | - Annalena Venneri
- Department of Neuroscience, University of Sheffield, Sheffield, United Kingdom
- Department of Life Sciences, Brunel University London, Uxbridge, United Kingdom
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98
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de Erausquin GA, Snyder H, Carrillo M, Hosseini AA, Brugha TS, Seshadri S. The chronic neuropsychiatric sequelae of COVID-19: The need for a prospective study of viral impact on brain functioning. Alzheimers Dement 2021; 17:1056-1065. [PMID: 33399270 PMCID: PMC10431934 DOI: 10.1002/alz.12255] [Citation(s) in RCA: 116] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 11/04/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION The increasing evidence of SARS-CoV-2 impact on the central nervous system (CNS) raises key questions on its impact for risk of later life cognitive decline, Alzheimer's disease (AD), and other dementia. METHODS The Alzheimer's Association and representatives from more than 30 countries-with technical guidance from the World Health Organization-have formed an international consortium to study the short-and long-term consequences of SARS-CoV-2 on the CNS-including the underlying biology that may contribute to AD and other dementias. This consortium will link teams from around the world covering more than 22 million COVID-19 cases to enroll two groups of individuals including people with disease, to be evaluated for follow-up evaluations at 6, 9, and 18 months, and people who are already enrolled in existing international research studies to add additional measures and markers of their underlying biology. CONCLUSIONS The increasing evidence and understanding of SARS-CoV-2's impact on the CNS raises key questions on the impact for risk of later life cognitive decline, AD, and other dementia. This program of studies aims to better understand the long-term consequences that may impact the brain, cognition, and functioning-including the underlying biology that may contribute to AD and other dementias.
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Affiliation(s)
- Gabriel A. de Erausquin
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UTHSA, San Antonio, Texas, USA
| | | | | | - Akram A. Hosseini
- Neurology Department, Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
| | - Traolach S. Brugha
- Social and Epidemiological Psychiatry Research Group, Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sudha Seshadri
- The Glenn Biggs Institute for Alzheimer’s and Neurodegenerative Diseases, UTHSA, San Antonio, Texas, USA
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LaRovere KL, Riggs BJ, Poussaint TY, Young CC, Newhams MM, Maamari M, Walker TC, Singh AR, Dapul H, Hobbs CV, McLaughlin GE, Son MBF, Maddux AB, Clouser KN, Rowan CM, McGuire JK, Fitzgerald JC, Gertz SJ, Shein SL, Munoz AC, Thomas NJ, Irby K, Levy ER, Staat MA, Tenforde MW, Feldstein LR, Halasa NB, Giuliano JS, Hall MW, Kong M, Carroll CL, Schuster JE, Doymaz S, Loftis LL, Tarquinio KM, Babbitt CJ, Nofziger RA, Kleinman LC, Keenaghan MA, Cvijanovich NZ, Spinella PC, Hume JR, Wellnitz K, Mack EH, Michelson KN, Flori HR, Patel MM, Randolph AG. Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA Neurol 2021; 78:536-547. [PMID: 33666649 DOI: 10.1001/jamaneurol.2021.0504] [Citation(s) in RCA: 256] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. Objective To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. Setting, Design, and Participants Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. Exposures Severe acute respiratory syndrome coronavirus 2. Main Outcomes and Measures Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. Results Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. Conclusions and Relevance In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.
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Affiliation(s)
- Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Becky J Riggs
- Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tina Y Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Cameron C Young
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Margaret M Newhams
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Mia Maamari
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern, Children's Health Medical Center Dallas
| | - Tracie C Walker
- Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill
| | - Aalok R Singh
- Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla
| | - Heda Dapul
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Charlotte V Hobbs
- Division of Infectious Diseases, Department of Pediatrics, Department of Microbiology, University of Mississippi Medical Center, Jackson
| | - Gwenn E McLaughlin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Beth F Son
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Aline B Maddux
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Katharine N Clouser
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey
| | - Courtney M Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis
| | - John K McGuire
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle
| | - Julie C Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Shira J Gertz
- Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Steven L Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Alvaro Coronado Munoz
- Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston
| | - Neal J Thomas
- Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey
| | - Katherine Irby
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock
| | - Emily R Levy
- Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mary A Staat
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark W Tenforde
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leora R Feldstein
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John S Giuliano
- Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | | | - Jennifer E Schuster
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Sule Doymaz
- Division of Pediatric Critical Care, Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn
| | - Laura L Loftis
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston
| | - Keiko M Tarquinio
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Ryan A Nofziger
- Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio
| | - Lawrence C Kleinman
- Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael A Keenaghan
- Pediatric Critical Care, New York City Health and Hospitals, Kings County Hospital, Brooklyn, New York
| | - Natalie Z Cvijanovich
- Division of Critical Care Medicine, University of California, San Francisco, Benioff Children's Hospital, Oakland
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Janet R Hume
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Elizabeth H Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Kelly N Michelson
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor
| | - Manish M Patel
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adrienne G Randolph
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts
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Extrathoracic manifestations of COVID-19 in adults and presentation of the disease in children. RADIOLOGIA 2021; 63:370-383. [PMID: 34246427 PMCID: PMC8133527 DOI: 10.1016/j.rxeng.2021.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/17/2021] [Indexed: 12/21/2022]
Abstract
In March 2020, the World Health Organization declared a global pandemic of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); epidemic conditions continue in nearly all countries today. Although the symptoms and imaging manifestations of COVID-19 predominantly involve the respiratory system, it is fundamental to know the manifestations of the disease and its possible complications in other organs to help in diagnosis and orient the prognosis. To improve the diagnostic process without increasing the risk of contagion unnecessarily, it is crucial to know when extrathoracic imaging tests are indicated and which tests are best in each situation. This paper aims to provide answers to these questions. To this end, we describe and illustrate the extrathoracic imaging manifestations of COVID-19 in adults as well as the entire spectrum of imaging findings in children.
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