1
|
Azargoonjahromi A. Role of the SARS-CoV-2 Virus in Brain Cells. Viral Immunol 2024; 37:61-78. [PMID: 38315740 DOI: 10.1089/vim.2023.0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024] Open
Abstract
COVID-19, caused by the SARS-CoV-2 virus, can have neurological effects, including cognitive symptoms like brain fog and memory problems. Research on the neurological effects of COVID-19 is ongoing, and factors such as inflammation, disrupted blood flow, and damage to blood vessels may contribute to cognitive symptoms. Notably, some authors and existing evidence suggest that the SARS-CoV-2 virus can enter the central nervous system through different routes, including the olfactory nerve and the bloodstream. COVID-19 infection has been associated with neurological symptoms such as altered consciousness, headaches, dizziness, and mental disorders. The exact mechanisms and impact on memory formation and brain shrinkage are still being studied. This review will focus on pathways such as the olfactory nerve and blood-brain barrier disruption, and it will then highlight the interactions of the virus with different cell types in the brain, namely neurons, astrocytes, oligodendrocytes, and microglia.
Collapse
Affiliation(s)
- Ali Azargoonjahromi
- Researcher in Neuroscience, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
2
|
Ousseiran ZH, Fares Y, Chamoun WT. Neurological manifestations of COVID-19: a systematic review and detailed comprehension. Int J Neurosci 2023; 133:754-769. [PMID: 34433369 PMCID: PMC8506813 DOI: 10.1080/00207454.2021.1973000] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 07/25/2021] [Accepted: 08/16/2021] [Indexed: 12/13/2022]
Abstract
The current pandemic caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) is accompanied with a rapid increase of reports and papers detailing its neurological effects and symptoms. The virus infection causes respiratory illness named by the world health organization as corona virus 19 (COVID-19).This systematic review aims to study and summarize the different neurological manifestations of this virus. All articles published and indexed via Pubmed, Medline and Google Scholar databases between January 1st 2020 and February 28th 2021 that reported neurological symptoms of SARS-CoV-2 are reviewed following the Preferred Reporting Items for Systemic review and Meta-Analysis (PRISMA) guidelines.We included data from 113 articles: eight prospective studies, 25 retrospective studies and the rest were case reports/series. COVID-19 can present with central nervous system manifestations, such as headache, encephalitis and encephalopathy, peripheral nervous system manifestations, such as anosmia, ageusia and Guillian Barre syndrome, and skeletal muscle manifestations, such as myalgia and myasthenia gravis. Our systematic review showed that COVID-19 can be manifested by a wide spectrum of neurological symptoms reported either in the early stage or within the course of the disease. However, a detailed comprehension of these manifestations is required and more studies are needed in order to improve our scientific knowledge and to develop preventive and therapeutic measures to control this pandemic.
Collapse
Affiliation(s)
- Zeina Hassan Ousseiran
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Youssef Fares
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Wafaa Takash Chamoun
- Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| |
Collapse
|
3
|
Ziaee M, Saeedi M, Rohani M, Mehrpour M, Haghi Ashtiani B, Zamani B, Akhoundi FH, Salahi Khalaf M, Mirmoeeni S, Azari Jafari A, Shateri Z. Posterior reversible encephalopathy syndrome in SARS‐CoV‐2 infection: A case report and review of literature. Clin Case Rep 2023; 11:e7173. [PMID: 37020671 PMCID: PMC10067803 DOI: 10.1002/ccr3.7173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 04/05/2023] Open
Abstract
Consider PRES in SARS‐CoV‐2 infected patients who develop encephalopathy, seizures or impaired vision; especially if the disease is complicated by respiratory distress and need for mechanical ventilation. Consider PRES in SARS‐CoV‐2 infected patients who develop encephalopathy, seizures or impaired vision; especially if the disease is complicated by respiratory distress and need for mechanical ventilation.
Collapse
Affiliation(s)
- Mahsa Ziaee
- Department of NeurologyFiroozgar Hospital, Iran University of Medical SciencesTehranIran
| | - Maryam Saeedi
- Department of NeurologyShahroud University of Medical SciencesShahroudIran
| | - Mohammad Rohani
- Department of NeurologyHazrat Rasool Hospital, Iran University of Medical SciencesTehranIran
| | - Masoud Mehrpour
- Department of NeurologyShahid Beheshti Medical UniversityTehranIran
| | - Bahram Haghi Ashtiani
- Department of NeurologyFiroozgar Hospital, Iran University of Medical SciencesTehranIran
| | - Babak Zamani
- Department of NeurologyFiroozgar Hospital, Iran University of Medical SciencesTehranIran
| | - Fahimeh Haji Akhoundi
- Department of NeurologyFiroozgar Hospital, Iran University of Medical SciencesTehranIran
| | - Misagh Salahi Khalaf
- Student Research Committee, School of MedicineShahroud University of Medical SciencesShahroudIran
| | | | - Amirhossein Azari Jafari
- Student Research Committee, School of MedicineShahroud University of Medical SciencesShahroudIran
| | - Zahra Shateri
- Student Research Committee, School of MedicineShahroud University of Medical SciencesShahroudIran
| |
Collapse
|
4
|
Boyle T, Fernando SL, Drummond J, Fontes A, Parratt J. Phenotyping variants of tumefactive demyelinating lesions according to clinical and radiological features-A case series. Front Neurol 2023; 14:1092373. [PMID: 36816572 PMCID: PMC9935935 DOI: 10.3389/fneur.2023.1092373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Background Tumefactive demyelinating lesions (TDLs) are defined as lesions >2 cm on MRI of the brain. They are identified in a range of demyelinating diseases including massive demyelination due to Marburg's acute MS, Schilder's Disease, Balo's concentric sclerosis, and Tumefactive MS. Apart from the rare demyelinating variants which are often diagnosed histologically, there are no detailed data to phenotype TDLs. Methods We describe the clinical and radiological features of four similar patients with very large TDLs (>4 cm), that are not consistent with the rare demyelinating variants and may represent a distinct phenotype. Results All patients presented with hemiplegia and apraxia. The mean age at onset was 37 years with an equal sex distribution. All patients were diagnosed with Tumefactive demyelination based on MRI and CSF analysis, precluding the need for brain biopsy. All responded to potent immunotherapy (including high dose corticosteroids, plasma exchange, rituximab, and/or cyclophosphamide). The mean lag from diagnosis to treatment was 1 day. The median EDSS at presentation was six and recovery to a median EDSS of two occurred over 6 months. Conclusion We propose that Tumefactive lesions larger than 4 cm are termed "Giant demyelinating lesions" (GDLs) not only on the basis of size, but a rapid and fulminant demyelinating presentation leading to acute, severe neurological disability that is, nonetheless, responsive to immunotherapy. Further clinical studies are required to ratify this proposed phenotype, establish the immunological profile and best treatment for such patients.
Collapse
Affiliation(s)
- Thérèse Boyle
- Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia,Immunology Laboratory, Royal North Shore Hospital, St Leonards, NSW, Australia,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,*Correspondence: Thérèse Boyle ✉
| | - Suran L. Fernando
- Clinical Immunology and Allergy, Royal North Shore Hospital, St Leonards, NSW, Australia,Immunology Laboratory, Royal North Shore Hospital, St Leonards, NSW, Australia,Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - James Drummond
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neuroradiology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Ariadna Fontes
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
| | - John Parratt
- Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia,Department of Neurology, Royal North Shore Hospital, St Leonards, NSW, Australia
| |
Collapse
|
5
|
Kubo M, Kubo K, Kobayashi KI, Komiya N. Non-severe COVID-19 complicated by cytotoxic lesions of the corpus callosum (mild encephalitis/encephalopathy with a reversible splenial lesion): a case report and literature review. Int J Infect Dis 2022; 125:1-9. [PMID: 36122669 PMCID: PMC9477791 DOI: 10.1016/j.ijid.2022.09.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/07/2022] [Accepted: 09/07/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Coronavirus disease 2019- (COVID-19-) associated cytotoxic lesions of the corpus callosum (CLOCCs) have been reported as a rare neurological abnormality in severe cases. Here, a case of CLOCCs in the early stages of mild COVID-19 infection during the Omicron BA.1 epidemic is reported along with a literature review. CASE REPORT A Japanese woman with COVID-19 presented to the emergency department with altered consciousness and cerebellar symptoms a day after fever onset. Magnetic resonance imaging (MRI) revealed a lesion with restricted diffusion in the corpus callosum. She exhibited no complications of pneumonia, her neurological symptoms resolved after two days, and after 10 days, the brain lesion was not detected on MRI. LITERATURE REVIEW The PubMed database was searched for case reports that met the CLOCC definition proposed by Starkey et al. The search yielded 15 COVID-19-associated cases reported as CLOCCs and 13 cases described under former terms, including mild encephalitis/encephalopathy with a reversible splenial lesion. Adult cases with a documented course were accompanied by pneumonia or hypoxemia, whereas pediatric cases were mostly accompanied by a multisystem inflammatory syndrome. CONCLUSION COVID-19-associated CLOCCs can occur, even at an early, non-severe stage. Therefore, this condition may be underdiagnosed if MRI is not performed.
Collapse
Affiliation(s)
- Mayu Kubo
- Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Kenji Kubo
- Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, Japan,Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, Japan,Corresponding author
| | - Ken-ichiro Kobayashi
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, Japan
| | - Nobuhiro Komiya
- Department of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, Japan
| |
Collapse
|
6
|
Lima M, Aloizou AM, Siokas V, Bakirtzis C, Liampas I, Tsouris Z, Bogdanos DP, Baloyannis SJ, Dardiotis E. Coronaviruses and their relationship with multiple sclerosis: is the prevalence of multiple sclerosis going to increase after the Covid-19 pandemia? Rev Neurosci 2022; 33:703-720. [PMID: 35258237 DOI: 10.1515/revneuro-2021-0148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 01/24/2022] [Indexed: 12/11/2022]
Abstract
The purpose of this review is to examine whether there is a possible (etiological/triggering) relationship between infection with various Coronaviruses, including Severe Acute Respiratory Syndrome-related Coronavirus-2 (SARS-CoV-2), the virus responsible for the Coronavirus disease-19 (Covid-19) pandemia, and Multiple Sclerosis (MS), and whether an increase of the prevalence of MS after the current Covid-19 pandemia should be expected, examining new and preexisting data. Although the exact pathogenesis of MS remains unknown, environmental agents seem to greatly influence the onset of the disease, with viruses being the most popular candidate. Existing data support this possible etiological relationship between viruses and MS, and experimental studies show that Coronaviruses can actually induce an MS-like demyelinating disease in animal models. Findings in MS patients could also be compatible with this coronaviral MS hypothesis. More importantly, current data from the Covid-19 pandemia show that SARS-CoV-2 can trigger autoimmunity and possibly induce autoimmune diseases, in the Central Nervous System as well, strengthening the viral hypothesis of MS. If we accept that Coronaviruses can induce MS, it is reasonable to expect an increase in the prevalence of MS after the Covid-19 pandemia. This knowledge is of great importance in order to protect the aging groups that are more vulnerable against autoimmune diseases and MS specifically, and to establish proper vaccination and health policies.
Collapse
Affiliation(s)
- Maria Lima
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100, Larissa, Greece
| | - Athina-Maria Aloizou
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100, Larissa, Greece
| | - Vasileios Siokas
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100, Larissa, Greece
| | - Christos Bakirtzis
- B' Department of Neurology, Multiple Sclerosis Center, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100, Larissa, Greece
| | - Zisis Tsouris
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100, Larissa, Greece
| | - Dimitrios P Bogdanos
- Department of Rheumatology and clinical Immunology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 40500 Viopolis, Larissa, Greece
| | - Stavros J Baloyannis
- Research Institute for Alzheimer's disease, Aristotle University of Thessaloniki, 57200 Iraklio Lagkada, Thessaloniki, Greece.,1st Department of Neurology, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636, Thessaloniki, Greece
| | - Efthimios Dardiotis
- Department of Neurology, University General Hospital of Larissa, Faculty of Medicine, School of Health Sciences, University of Thessaly, 41100, Larissa, Greece
| |
Collapse
|
7
|
Ghosh R, Roy D, Ray A, Mandal A, Das S, Pal SK, Benito-León J. Non-Aneurysmal Subarachnoid Hemorrhage in COVID-19: A Case Report and Review of Literature. MEDICAL RESEARCH ARCHIVES 2022; 10. [PMID: 35187227 DOI: 10.18103/mra.v10i1.2673] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Hemorrhagic cerebrovascular events, either due to aneurysmal rupture or spontaneous subarachnoid hemorrhage (SAH), are not rare in COVID-19. Several mechanisms such as coagulopathy, cytokine storm, viral endotheliopathy, hypertension, and immune modulation might play a role in the pathogenesis of SAH in COVID-19. This study aimed to report the first case of spontaneous non-aneurysmal SAH associated with SARS-CoV-2 from India. We briefly discussed the possible pathogenetic mechanisms underlying this process and succinctly reviewed the relevant literature. CASE REPORT We herein report a case of a non-comorbid young woman infected with SARS-CoV-2 presenting with thunderclap headache and eventually non-aneurysmal SAH, who recovered with conservative management. CONCLUSION Headache, although a very common clinical feature of COVID-19 itself, must be investigated in detail to identify alternate causes that may be life-threatening. This case also incites further enquiry into the possible pathogenic mechanisms of neurovascular complications in COVID-19.
Collapse
Affiliation(s)
- Ritwik Ghosh
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Dipayan Roy
- Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Jodhpur, Rajasthan, India.,Indian Institute of Technology (IIT), Madras, Tamil Nadu, India.,School of Humanities, Indira Gandhi National Open University, New Delhi, India
| | - Adrija Ray
- Department of Medicine, RG Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Amrita Mandal
- Bankura Sammilani Medical College and Hospital, Bankura, West Bengal, India
| | - Shambaditya Das
- Department of Neuromedicine, Bangur Institute of Neurosciences (BIN), Kolkata, West Bengal, India
| | - Shyamal Kanti Pal
- Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India
| | - Julián Benito-León
- Department of Neurology, University Hospital "12 de Octubre", Madrid, Spain.,Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas (CIBERNED), Madrid, Spain.,Department of Medicine, Complutense University, Madrid, Spain
| |
Collapse
|
8
|
Huang JA, Chen WH, Liao NC, Wu CL, Fu YC, Chen PL. Acute delirium as an initial manifestation of COVID-19 patients with acute ischemic stroke: Report on two cases. J Formos Med Assoc 2022; 121:1605-1609. [PMID: 35221145 PMCID: PMC8841143 DOI: 10.1016/j.jfma.2022.01.025] [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: 09/06/2021] [Revised: 12/12/2021] [Accepted: 01/23/2022] [Indexed: 11/04/2022] Open
Abstract
Psychiatric and neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are common. Psychiatric symptoms are so common that they are easily misinterpreted as an affective disorder induced by SARSCoV-2 infection. However, psychiatric symptoms, such as acute delirium, though rarely seen, can be the initial manifestations of acute ischemic stroke (AIS). These psychiatric symptoms may confuse the diagnosis of acute stroke, which needs correct and timely management. We report two hospitalized cases with SARS-CoV-2 infection and elevated serum D-dimer levels having acute delirium as the initial manifestation of AIS. The diagnostic processes were challenging and time-consuming, so reperfusion therapy could not be given in the therapeutic time window. The diagnoses of AIS were finally made by brain magnetic resonance imaging which showed diffusion restriction at the right middle cerebral artery territory in both cases. Features of psychiatric complications and stroke in coronavirus disease 2019 (COVID-19) patients are reviewed. For the hospitalized COVID-19 patients with elevated levels of serum Ddimer and acute delirium, acute stroke with neuropsychiatric manifestations should beconsidered.
Collapse
|
9
|
Iftikhar S, Rehman AU, Ameer MZ, Nawaz A, Aemaz Ur Rehman M, Farooq H, Asmar A, Ebaad Ur Rehman M. The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review. Ann Med Surg (Lond) 2021; 72:103080. [PMID: 34840779 PMCID: PMC8605817 DOI: 10.1016/j.amsu.2021.103080] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 11/15/2021] [Accepted: 11/16/2021] [Indexed: 01/08/2023] Open
Abstract
The rise in Coronavirus disease 2019 (COVID-19) cases is revealing its unique neurological manifestations. In light of the emerging evidence, a possible association with Posterior Reversible Encephalopathy Syndrome (PRES) is being consistently reported. We conducted a systematic literature search on four databases namely Pubmed/MEDLINE, Cochrane, Google Scholar, and Science Direct. After rigorous screening as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 34 articles describing 56 cases were selected as a part of this review. The mean age of the patients was 56.6 ± 15.3 years. The most common clinical presentation of PRES was altered mental status (58.9%) followed by seizures (46.4%) and visual disturbances (23.2%) while hypertension and diabetes mellitus were the most commonly reported comorbidities. 91.1% of the cases reported Magnetic Resonance Imaging (MRI) or Computed Tomography (CT) findings suggestive of PRES in the brain. Symptomatic management was employed in most of the cases to control seizures and blood pressure, and 44 patients (78.5%) fully or partially recovered. The most likely underlying mechanism involves COVID-19 mediated cytokine storm syndrome that leads to endothelial damage and increased permeability of the cerebral vessels, thus causing the characteristic edema of PRES. High neuronal and glial cell expression of Angiotensin Converting Enzyme-2 (ACE-2) receptors also suggests the possibility of direct viral damage. Since timely diagnosis and treatment reports a good prognosis, it is vital for physicians and neurologists to be well-versed with this association.
Collapse
Affiliation(s)
- Sadaf Iftikhar
- Mayo Hospital, King Edward Medical University, Lahore, 54000, Pakistan
| | | | | | - Ahmad Nawaz
- King Edward Medical University, Lahore, 54000, Pakistan
| | | | - Hareem Farooq
- Mayo Hospital, King Edward Medical University, Lahore, 54000, Pakistan
| | - Abyaz Asmar
- Mayo Hospital, King Edward Medical University, Lahore, 54000, Pakistan
| | | |
Collapse
|
10
|
The relationship between COVID-19 infection and intracranial hemorrhage: A systematic review. BRAIN HEMORRHAGES 2021; 2:141-150. [PMID: 34786548 PMCID: PMC8582085 DOI: 10.1016/j.hest.2021.11.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 11/04/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION In addition to the deleterious effects Covid-19 has on the pulmonary and cardiovascular systems, COVID-19 can also result in damage to the nervous system. This review aims to explore current literature on the association between COVID-19 and intracranial hemorrhage (ICH). METHODS We conducted a systematic review of PubMed for literature published on COVID-19 and ICH. Ninety-four of 295 screened papers met inclusion criteria. RESULTS The literature addressed incidence and mortality of ICH associated with Covid-19. It also revealed cases of COVID-19 patients with subarachnoid hemorrhage, intraparenchymal hemorrhage, subdural hematomas, and hemorrhage secondary to cerebral venous thrombosis and ischemic stroke. ICH during COVID-19 infections was associated with increased morbidity and mortality. Risk factors for ICH appeared to be therapeutic anticoagulation, ECMO, and mechanical ventilation. Outcomes varied widely, depending on the severity of COVID-19 infection and neurologic injury. CONCLUSION Although treatment for severe Covid-19 infections is often aimed at addressing acute respiratory distress syndrome, vasculopathy, and coagulopathy, neurologic injury can also occur. Evidence-based treatments that improve COVID-19 mortality may also increase risk for developing ICH. Providers should be aware of potential neurologic sequelae of COVID-19, diagnostic methods to rule out other causes of ICH, and treatment regimens.
Collapse
|
11
|
Fällmar D, Rostami E, Kumlien E, Ashton NJ, Jackmann S, Pavel R, Blennow K, Hultström M, Lipcsey M, Frithiof R, Westman G, Zetterberg H, Wikström J, Virhammar J. The extent of neuroradiological findings in COVID-19 shows correlation with blood biomarkers, Glasgow coma scale score and days in intensive care. J Neuroradiol 2021; 49:421-427. [PMID: 34800562 PMCID: PMC8599173 DOI: 10.1016/j.neurad.2021.11.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/27/2021] [Accepted: 11/08/2021] [Indexed: 01/11/2023]
Abstract
BACKGROUND AND PURPOSE A wide range of neuroradiological findings has been reported in patients with coronavirus disease 2019 (COVID-19), ranging from subcortical white matter changes to infarcts, haemorrhages and focal contrast media enhancement. These have been descriptively but inconsistently reported and correlations with clinical findings and biomarkers have been difficult to extract from the literature. The purpose of this study was to quantify the extents of neuroradiological findings in a cohort of patients with COVID-19 and neurological symptoms, and to investigate correlations with clinical findings, duration of intensive care and biomarkers in blood. MATERIAL AND METHODS Patients with positive SARS-CoV-2 and at least one new-onset neurological symptom were included from April until July 2020. Nineteen patients were examined regarding clinical symptoms, biomarkers in blood and MRI of the brain. In order to quantify the MRI findings, a semi-quantitative neuroradiological severity scale was constructed a priori, and applied to the MR images by two specialists in neuroradiology. RESULTS AND CONCLUSIONS The score from the severity scale correlated significantly with blood biomarkers of CNS injury (glial fibrillary acidic protein, total-tau, ubiquitin carboxyl-terminal hydrolase L1) and inflammation (C-reactive protein), Glasgow Coma Scale score, and the number of days spent in intensive care. The underlying radiological assessments had inter-rater agreements of 90.5%/86% (for assessments with 2/3 alternatives). Total intraclass correlation was 0.80. Previously reported neuroradiological findings in COVID-19 have been diverse and heterogenous. In this study, the extent of findings in MRI examination of the brain, quantified using a structured report, shows correlation with relevant biomarkers.
Collapse
Affiliation(s)
- David Fällmar
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden.
| | - Elham Rostami
- Department of Neuroscience, Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Eva Kumlien
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Nicholas J Ashton
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden; Institute of Psychiatry, Psychology and Neuroscience, Maurice Wohl Institute Clinical Neuroscience Institute, King's College London, London, UK; NIHR Biomedical Research Centre for Mental Health and Biomedical Research Unit for Dementia at South London and Maudsley NHS Foundation, London, UK
| | - Sven Jackmann
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| | - Radu Pavel
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Michael Hultström
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Medical Cell Biology, Integrative Physiology, Uppsala University, Uppsala, Sweden
| | - Miklos Lipcsey
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden; Hedenstierna Laboratory, CIRRUS, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Robert Frithiof
- Department of Surgical Sciences, Anaesthesiology and Intensive Care, Uppsala University, Uppsala, Sweden
| | - Gabriel Westman
- Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden; Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK; UK Dementia Research Institute at UCL, London, UK
| | - Johan Wikström
- Department of Surgical Sciences, Radiology, Uppsala University, Uppsala, Sweden
| | - Johan Virhammar
- Department of Neuroscience, Neurology, Uppsala University, Uppsala, Sweden
| |
Collapse
|
12
|
Neurological Manifestations and Outcomes in a Retrospective Cohort of Mexican Inpatients with SARS-CoV-2 Pneumonia: Design of a Risk Profile. Healthcare (Basel) 2021; 9:healthcare9111501. [PMID: 34828547 PMCID: PMC8620259 DOI: 10.3390/healthcare9111501] [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: 09/21/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
We analyzed the neurological manifestations in Mexican patients hospitalized with pneumonia due to COVID-19 and investigated the association between demographic, clinical, and biochemical variables and outcomes, including death. A retrospective, analytical study was conducted using the electronic records of patients hospitalized between 1 April 2020 and 30 September 2020. Records of 1040 patients were analyzed: 31.25% died and 79.42% had neurological symptoms, including headache (80.62%), anosmia (32.20%), ageusia (31.96%), myopathy (28.08%), disorientation (14.89%), encephalopathy (12.22%), neuropathy (5.4%), stroke (1.3%), seizures (1.3%), cerebral hemorrhage (1.08%), encephalitis (0.84%), central venous thrombosis (0.36%), and subarachnoid hemorrhage (0.24%). Patients also had comorbidities, such as hypertension (42.30%), diabetes mellitus (38.74%), obesity (61.34%), chronic obstructive pulmonary disease (3.17%), and asthma (2.01%). Factors associated with neurological symptoms were dyspnea, chronic obstructive pulmonary disease, advanced respiratory support, prolonged hospitalization, and worsening fibrinogen levels. Factors associated with death were older age, advanced respiratory support, amine management, chronic obstructive pulmonary disease, intensive care unit management, dyspnea, disorientation, encephalopathy, hypertension, neuropathy, diabetes, male sex, three or more neurological symptoms, and obesity grade 3. In this study we designed a profile to help predict patients at higher risk of developing neurological complications and death following COVID-19 infection.
Collapse
|
13
|
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.
Collapse
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
| | | |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|
15
|
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]
|
16
|
Hixon AM, Thaker AA, Pelak VS. Persistent visual dysfunction following posterior reversible encephalopathy syndrome due to COVID-19: Case series and literature review. Eur J Neurol 2021; 28:3289-3302. [PMID: 34115917 PMCID: PMC8444757 DOI: 10.1111/ene.14965] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 05/25/2021] [Accepted: 06/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE The full spectrum of neurological sequelae in COVID-19 is beginning to emerge. SARS-CoV-2 has the potential to cause both direct and indirect brain vascular endothelial damage through infection and inflammation that may result in long-term neurological signs and symptoms. We sought to illuminate persistent neuro-ophthalmological deficits that may be seen following posterior reversible encephalopathy syndrome (PRES) due to COVID-19. METHODS We identified three individuals with PRES due to COVID-19 in our hospital system. One patient was identified on presentation to our neuro-ophthalmology clinic. The other patients were identified through internal records search. These cases were compared to published reports of PRES in COVID-19 identified through systematic literature search of PubMed/LitCOVID. RESULTS All three patients were hospitalized with severe COVID-19 and developed altered mental status with new onset seizures that led to the recognition of PRES through diagnostic imaging. During recovery, two patients had persistent visual dysfunction including visual field deficits. One patient also experienced hallucinatory palinopsia and visual hallucinations. Literature search identified 32 other cases of PRES in the context of COVID-19. Visual disturbances were described in 14 cases (40%), with only seven cases (50%) reporting full recovery by the time of publication. CONCLUSIONS As we learn about enduring neurological complications of COVID-19, it is possible that complications may be underrecognized and underreported. Understanding the range of complications can help in postcare evaluation and management changes in the critical care setting to potentially allow intervention before persistent deficits occur due to COVID-19.
Collapse
Affiliation(s)
- Alison M. Hixon
- Medical Scientist Training ProgramUniversity of Colorado School of MedicineAuroraCOUSA
| | - Ashesh A. Thaker
- Neuroradiology SectionDepartment of RadiologyUniversity of Colorado School of MedicineAuroraCOUSA
| | - Victoria S. Pelak
- Department of OphthalmologyUniversity of Colorado School of MedicineAuroraCOUSA
- Department of NeurologyUniversity of Colorado School of MedicineAuroraCOUSA
| |
Collapse
|
17
|
Lashkari A, Ranjbar R. A case-based systematic review on the SARS-COVID-2-associated cerebrovascular diseases and the possible virus routes of entry. J Neurovirol 2021; 27:691-701. [PMID: 34546547 PMCID: PMC8454012 DOI: 10.1007/s13365-021-01013-8] [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: 05/28/2021] [Revised: 08/13/2021] [Accepted: 08/20/2021] [Indexed: 12/12/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sparked a global pandemic that continues to affect various facets of human existence. Many sources reported virus-induced acute cerebrovascular disorders. Systematically, this paper reviews the case studies of COVID-19-related acute cerebrovascular diseases such as ischaemic stroke, intracerebral hemorrhage, and cerebral sinus thrombosis. We also spoke about how SARS-CoV-2 can infect the brain and trigger the aforementioned disorders. We stated that SARS-CoV-2 neuroinvasion and BBB dysfunction could cause the observed disorders; however, further research is required to specify the mechanisms and pathogenesis of the virus.
Collapse
Affiliation(s)
- Ali Lashkari
- Institute of Biochemistry and Biophysics (IBB), University of Tehran, Tehran, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
18
|
Iaconetta G, De Luca P, Scarpa A, Cassandro C, Cassandro E. Meningoencephalitis Associated with SARS-Coronavirus-2. TRANSLATIONAL MEDICINE AT UNISA 2021. [PMID: 34447712 PMCID: PMC8370532 DOI: 10.37825/2239-9747.1007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The aim of this work is to clarify the incidence of meningitis/encephalitis in SARS-CoV-2 patients. We conducted an initial search in PubMed using the Medical Subject Headings (MeSH) terms "meningitis," and "encephalitis,", and "COVID-19" to affirm the need for a review on the topic of the relationship between meningitis/encephalitis and SARS-CoV-2 infection. We included case series, case reports and review articles of COVID-19 patients with these neurological symptoms. Through PubMed database we identified 110 records. After removal of duplicates, we screened 70 record, and 43 were excluded because they focused on different SARS-CoV-2 neurological complications. For eligibility, we assessed 27 full-text articles which met inclusion criteria. Seven articles were excluded, and twenty studies were included in the narrative review, in which encephalitis and/or meningitis case reports/case series were reported. Neurological manifestations of COVID-19 are not rare, especially meningoencephalitis; the hypoxic/metabolic changes produced by the inflammatory response against the virus cytokine storm can lead to encephalopathy, and the presence of comorbidities and other neurological diseases, such as Alzheimer's disease, predispose to these metabolic changes. Further study are needed to investigate the biological mechanisms of neurological complications of COVID-19.
Collapse
Affiliation(s)
- G Iaconetta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - P De Luca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - A Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - C Cassandro
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - E Cassandro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| |
Collapse
|
19
|
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.
Collapse
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
| |
Collapse
|
20
|
Shabani Z. Demyelination as a result of an immune response in patients with COVID-19. Acta Neurol Belg 2021; 121:859-866. [PMID: 33934300 PMCID: PMC8088756 DOI: 10.1007/s13760-021-01691-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023]
Abstract
The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2), that already appeared as a global pandemic. Presentation of the disease often includes upper respiratory symptoms like dry cough, dyspnea, chest pain, and rhinorrhea that can develop to respiratory failure, needing intubation. Furthermore, the occurrence of acute and subacute neurological manifestations such as stroke, encephalitis, headache, and seizures are frequently stated in patients with COVID-19. One of the reported neurological complications of severe COVID-19 is the demolition of the myelin sheath. Indeed, the complex immunological dysfunction provides a substrate for the development of demyelination. Nevertheless, few published reports in the literature describe demyelination in subjects with COVID-19. In this short narrative review, we discuss probable pathological mechanisms that may trigger demyelination in patients with SARS-CoV-2 infection and summarize the clinical evidence, confirming SARS-CoV-2 condition as a risk factor for the destruction of myelin.
Collapse
Affiliation(s)
- Zahra Shabani
- Department of Neurosciences, Faculty of Advanced Medical Sciences, Tabriz University of Medical Sciences, Tabriz, Iran.
| |
Collapse
|
21
|
Khosravi B, Moradveisi B, Abedini M, Behzadi S, Karimi A. Stroke in a child with SARS-CoV-2 infection: A case report. eNeurologicalSci 2021; 23:100345. [PMID: 33937533 PMCID: PMC8079941 DOI: 10.1016/j.ensci.2021.100345] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 02/24/2021] [Accepted: 04/26/2021] [Indexed: 01/08/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Some patients with COVID-19 show widely neurological manifestations including stroke. We report a child who was hospitalized due to seizures and was later diagnosed with COVID-19. Acute infarction was seen in the right putamen, globus pallidus, and the posterior part of the insula. A small focal dilatation within M1 segment of the left middle cerebral artery (MCA) was also observed. According to the present case report, COVID-19 infection may contribute to the occurrence and development of ischemic stroke.
Collapse
Affiliation(s)
- Bkhtiar Khosravi
- Department of Neurology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Borhan Moradveisi
- Cancer and Immunology Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Masomeh Abedini
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Shirin Behzadi
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Awat Karimi
- Department of Pediatrics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| |
Collapse
|
22
|
Chong ZZ, Souayah N. SARS-CoV-2 Induced Neurological Manifestations Entangles Cytokine Storm That Implicates For Therapeutic Strategies. Curr Med Chem 2021; 29:2051-2074. [PMID: 33970839 DOI: 10.2174/0929867328666210506161543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/04/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022]
Abstract
The new coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can present with neurological symptoms and induce neurological complications. The involvement in both the central and peripheral nervous systems in COVID-19 patients has been associated with direct invasion of the virus and the induction of cytokine storm. This review discussed the pathways for the virus invasion into the nervous system and characterized the SARS-CoV-2 induced cytokine storm. In addition, the mechanisms underlying the immune responses and cytokine storm induction after SARS-CoV-2 infection were also discussed. Although some neurological symptoms are mild and disappear after recovery from infection, some severe neurological complications contribute to the mortality of COVID-19 patients. Therefore, the insight into the cause of SARS-CoV-2 induced cytokine storm in context with neurological complications will formulate the novel management of the disease and further identify new therapeutic targets for COVID-19.
Collapse
Affiliation(s)
- Zhao-Zhong Chong
- Institute of Materia Medica, Shandong Academy of Medical Sciences, Jinan, China
| | - Nizar Souayah
- Department of Neurology, Rutgers New Jersey Medical School, 90 Bergen Street Room Suite 8100, Newark, NJ 07101, United States
| |
Collapse
|
23
|
Posterior Reversible Leukoencephalopathy Syndrome in a Patient after Acute COVID-19 Infection. Case Rep Neurol Med 2021; 2021:5564802. [PMID: 33996162 PMCID: PMC8096577 DOI: 10.1155/2021/5564802] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/30/2021] [Accepted: 04/15/2021] [Indexed: 01/13/2023] Open
Abstract
The SARS-CoV-2 infection affects numerous organs, including the central nervous system. The neuroinvasive abilities and neuroinflammation may lead to short- and long-term neurological manifestations. Among neurological disorders associated with SARS-CoV-2 infection, posterior reversible encephalopathy syndrome (PRES) has been described in a few case-based observational studies during the acute phase of COVID-19 hospitalization. We present a case of a patient who developed seizures and PRES after recovering from an acute severe COVID-19 infection. A 90-year-old African American female with multiple comorbidities and a severe COVID-19 infection was discharged home in stable condition after two weeks of hospitalization. A week later, she developed new-onset generalized tonic-clonic seizures requiring readmission to the hospital. The patient's clinical course and brain imaging supported PRES. Her mentation returned to baseline with supportive care and anticonvulsant treatment. Follow-up brain MRI four months later demonstrated resolution of FLAIR signal abnormalities confirming PRES. SARS-CoV-2 insult on the cerebrovascular endothelial cells likely continued and despite the clinical recovery eventually resulted in PRES. We believe that this is the first case describing the presentation of PRES after recovery from severe acute COVID-19 infection.
Collapse
|
24
|
Ravindra VM, Grandhi R, Delic A, Hohmann S, Shippey E, Tirschwell D, Frontera JA, Yaghi S, Majersik JJ, Anadani M, de Havenon A. Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States. PLoS One 2021; 16:e0248728. [PMID: 33852591 PMCID: PMC8046225 DOI: 10.1371/journal.pone.0248728] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To examine the outcomes of adult patients with spontaneous intracranial and subarachnoid hemorrhage diagnosed with comorbid COVID-19 infection in a large, geographically diverse cohort. METHODS We performed a retrospective analysis using the Vizient Clinical Data Base. We separately compared two cohorts of patients with COVID-19 admitted April 1-October 31, 2020-patients with intracerebral hemorrhage (ICH) and those with subarachnoid hemorrhage (SAH)-with control patients with ICH or SAH who did not have COVID-19 admitted at the same hospitals in 2019. The primary outcome was in-hospital death. Favorable discharge and length of hospital and intensive-care stay were the secondary outcomes. We fit multivariate mixed-effects logistic regression models to our outcomes. RESULTS There were 559 ICH-COVID patients and 23,378 ICH controls from 194 hospitals. In the ICH-COVID cohort versus controls, there was a significantly higher proportion of Hispanic patients (24.5% vs. 8.9%), Black patients (23.3% vs. 20.9%), nonsmokers (11.5% vs. 3.2%), obesity (31.3% vs. 13.5%), and diabetes (43.4% vs. 28.5%), and patients had a longer hospital stay (21.6 vs. 10.5 days), a longer intensive-care stay (16.5 vs. 6.0 days), and a higher in-hospital death rate (46.5% vs. 18.0%). Patients with ICH-COVID had an adjusted odds ratio (aOR) of 2.43 [1.96-3.00] for the outcome of death and an aOR of 0.55 [0.44-0.68] for favorable discharge. There were 212 SAH-COVID patients and 5,029 controls from 119 hospitals. The hospital (26.9 vs. 13.4 days) and intensive-care (21.9 vs. 9.6 days) length of stays and in-hospital death rate (42.9% vs. 14.8%) were higher in the SAH-COVID cohort compared with controls. Patients with SAH-COVID had an aOR of 1.81 [1.26-2.59] for an outcome of death and an aOR of 0.54 [0.37-0.78] for favorable discharge. CONCLUSIONS Patients with spontaneous ICH or SAH and comorbid COVID infection were more likely to be a racial or ethnic minority, diabetic, and obese and to have higher rates of death and longer hospital length of stay when compared with controls.
Collapse
Affiliation(s)
- Vijay M. Ravindra
- Department of Neurosurgery, Naval Medical Center San Diego, San Diego, California, United States of America
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America
| | - Ramesh Grandhi
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America
| | - Alen Delic
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America
| | - Samuel Hohmann
- Research Analytics, Vizient Inc., Irving, Texas, United States of America
| | - Ernie Shippey
- Research Analytics, Vizient Inc., Irving, Texas, United States of America
| | - David Tirschwell
- Department of Neurology, University of Washington, Seattle, Washington, United States of America
| | - Jennifer A. Frontera
- Department of Neurology, NYU Langone Health, New York, New York, United States of America
| | - Shadi Yaghi
- Department of Neurology, NYU Langone Health, New York, New York, United States of America
- Department of Neurology, Brown University, Providence, Rhode Island, United States of America
| | - Jennifer J. Majersik
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America
| | - Mohammad Anadani
- Department of Neurology, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Adam de Havenon
- Department of Neurology, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, United States of America
| |
Collapse
|
25
|
Elkhaled W, Ben Abid F, Akhtar N, Abukamar MR, Ibrahim WH. A 23-Year-Old Man with SARS-CoV-2 Infection Who Presented with Auditory Hallucinations and Imaging Findings of Cytotoxic Lesions of the Corpus Callosum (CLOCC). AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e928798. [PMID: 33315854 PMCID: PMC7749447 DOI: 10.12659/ajcr.928798] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Patient: Male, 23-year-old Final Diagnosis: Cytokine release syndrome • disseminated intravascular coagulation • multiple organ failure Symptoms: Auditory hallucinations • fever • headache • restlessness • suicidal thoughts Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Neurology
Collapse
Affiliation(s)
- Walid Elkhaled
- Mental Health Services, Department of Psychiatry, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Ben Abid
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar.,Weill Cornell Medical College, Doha, Qatar
| | - Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed R Abukamar
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Wanis H Ibrahim
- Weill Cornell Medical College, Doha, Qatar.,Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| |
Collapse
|
26
|
Iaconetta G, De Luca P, Scarpa A, Cassandro C, Cassandro E. Meningoencephalitis Associated with SARS-Coronavirus-2. Transl Med UniSa 2020; 23:42-47. [PMID: 33457322 PMCID: PMC8370532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
The aim of this work is to clarify the incidence of meningitis/encephalitis in SARS-CoV-2 patients. We conducted an initial search in PubMed using the Medical Subject Headings (MeSH) terms "meningitis," and "encephalitis,", and "COVID-19" to affirm the need for a review on the topic of the relationship between meningitis/encephalitis and SARS-CoV-2 infection. We included case series, case reports and review articles of COVID-19 patients with these neurological symptoms. Through PubMed database we identified 110 records. After removal of duplicates, we screened 70 record, and 43 were excluded because they focused on different SARS-CoV-2 neurological complications. For eligibility, we assessed 27 full-text articles which met inclusion criteria. Seven articles were excluded, and twenty studies were included in the narrative review, in which encephalitis and/or meningitis case reports/case series were reported. Neurological manifestations of COVID-19 are not rare, especially meningoencephalitis; the hypoxic/metabolic changes produced by the inflammatory response against the virus cytokine storm can lead to encephalopathy, and the presence of comorbidities and other neurological diseases, such as Alzheimer's disease, predispose to these metabolic changes. Further study are needed to investigate the biological mechanisms of neurological complications of COVID-19.
Collapse
Affiliation(s)
- G Iaconetta
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - P De Luca
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - A Scarpa
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - C Cassandro
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - E Cassandro
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| |
Collapse
|