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Ollila H, Pihlajamaa J, Martola J, Kuusela L, Blennow K, Zetterberg H, Salmela V, Hokkanen L, Tiainen M, Hästbacka J. Brain magnetic resonance imaging findings six months after critical COVID-19: A prospective cohort study. J Crit Care 2024; 80:154502. [PMID: 38113746 DOI: 10.1016/j.jcrc.2023.154502] [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] [Received: 03/08/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND COVID-19 patients suffered from neurological symptoms in the acute phase. Whether this led to long-term consequences was unknown. We studied long-term brain MRI findings in ICU-treated COVID-19 patients and compared them with findings in groups with less severe acute disease. MATERIALS AND METHODS In this prospective cohort study, 69 ICU-treated, 46 ward-treated, and 46 home-isolated patients, as well as 53 non-COVID-19 controls, underwent brain MRI six months after acute COVID-19. Plasma neurofilament light chain (NfL), a biomarker of neuroaxonal injury, was measured simultaneously. RESULTS Ischaemic infarctions existed in 5.8% of ICU-treated patients. Cerebral microbleeds (CMBs) existed in 27 (39.1%) ICU-treated, 13 (28.3%) ward-treated, 8 (17.4%) home-isolated COVID-19 patients, and 12 (22.6%) non-COVID controls. Patients with CMBs were older (p < 0.001), had a higher level of plasma NfL (p = 0.003), and higher supplementary oxygen days (p < 0.001). In multivariable analysis, age (OR 1.06, 95% CI 1.02-1.09) and supplementary oxygen days (OR 1.07, 95% CI 1.02-1.13) were associated with CMBs. The ICU group showed prevalent distribution of CMBs in deep regions. CONCLUSION Age and supplementary oxygen days were independently associated with CMBs; COVID-19 status showed no association. Accumulation of risk factors in the ICU group may explain the higher prevalence of CMBs. TRIAL REGISTRATION ClinicalTrials.govNCT04864938, registered February 9, 2021.
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Affiliation(s)
- Henriikka Ollila
- Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Janne Pihlajamaa
- HUS Medical Imaging Centre, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Juha Martola
- HUS Medical Imaging Centre, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Linda Kuusela
- HUS Medical Imaging Centre, Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaj Blennow
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden; Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and 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, Queen Square, London, UK; UK Dementia Research Institute at UCL, London, UK; Hong Kong Center for Neurodegenerative Diseases, Clear Water Bay, Hong Kong, China; UW Department of Medicine, School of Medicine and Public Health, Madison, WI, USA
| | - Viljami Salmela
- Department of Psychology and Logopaedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Laura Hokkanen
- Department of Psychology and Logopaedics, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Marjaana Tiainen
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Hästbacka
- Department of Perioperative, Intensive Care and Pain Medicine, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Ali YM, Carnell GW, Fumagalli S, Mercurio D, Seminara S, Lynch NJ, Khatri P, Arachchilage CH, Mascheroni L, Kaminski C, George CL, Stewart H, Yabuki M, Demopulos G, Heeney JL, Schwaeble W. Inhibition of the Lectin Pathway of Complement Activation Reduces Acute Respiratory Distress Syndrome Severity in a Mouse Model of SARS-CoV-2 Infection. J Infect Dis 2024; 229:680-690. [PMID: 37878754 PMCID: PMC10938221 DOI: 10.1093/infdis/jiad462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 10/09/2023] [Accepted: 10/20/2023] [Indexed: 10/27/2023] Open
Abstract
Most patients with COVID-19 in the intensive care unit develop an acute respiratory distress syndrome characterized by severe hypoxemia, decreased lung compliance, and high vascular permeability. Activation of the complement system is a hallmark of moderate and severe COVID-19, with abundant deposition of complement proteins in inflamed tissue and on the endothelium during COVID-19. Using a transgenic mouse model of SARS-CoV-2 infection, we assessed the therapeutic utility of an inhibitory antibody (HG4) targeting MASP-2, a key enzyme in the lectin pathway. Treatment of infected mice with HG4 reduced the disease severity score and improved survival vs mice that received an isotype control antibody. Administration of HG4 significantly reduced the lung injury score, including alveolar inflammatory cell infiltration, alveolar edema, and alveolar hemorrhage. The ameliorating effect of MASP-2 inhibition on the severity of COVID-19 pathology is reflected by a significant reduction in the proinflammatory activation of brain microglia in HG4-treated mice.
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Affiliation(s)
- Youssif M Ali
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
- Department of Microbiology and Immunology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - George W Carnell
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
| | - Stefano Fumagalli
- Department of Acute Brain and Cardiovascular Injury, Laboratory of Stroke and Vascular Dysfunctions, Mario Negri IRCCS, via Mario Negri 2, 20156 Milano, Italy
| | - Domenico Mercurio
- Department of Acute Brain and Cardiovascular Injury, Laboratory of Stroke and Vascular Dysfunctions, Mario Negri IRCCS, via Mario Negri 2, 20156 Milano, Italy
| | - Serena Seminara
- Department of Acute Brain and Cardiovascular Injury, Laboratory of Stroke and Vascular Dysfunctions, Mario Negri IRCCS, via Mario Negri 2, 20156 Milano, Italy
| | - Nicholas J Lynch
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
| | - Priyanka Khatri
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
| | - Chanuka H Arachchilage
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
| | - Luca Mascheroni
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, UK
| | - Clemens Kaminski
- Department of Chemical Engineering and Biotechnology, University of Cambridge, Cambridge CB3 0AS, UK
| | - Charlotte L George
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
| | - Hazel Stewart
- Department of Pathology, University of Cambridge, Cambridge CB2 1QP, UK
| | | | | | - Jonathan L Heeney
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
| | - Wilhelm Schwaeble
- Department of Veterinary Medicine, School of Biological Sciences, University of Cambridge, Cambridge CB3 0ES, UK
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3
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Widemon RS, Huang S, Capaccione KM, Mitchell RP, Salvatore MM, Lignelli A, Nguyen P. The impact of the COVID-19 pandemic on neuroimaging volume in New York City. Neuroradiol J 2022; 35:713-717. [PMID: 35503042 DOI: 10.1177/19714009221096828] [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 COVID-19 pandemic acutely disrupted all facets of healthcare, with future implications that are expected to resonate for many years. We investigated the effect of the pandemic on neuroimaging volume, hypothesizing that all representative studies would experience a reduction in volume, with those typically performed in the inpatient setting (noncontrast enhanced CT head and CTA head/neck) taking longer to recover to pre-pandemic volumes compared to studies typically performed in the outpatient setting (MR brain with and without and MR lumbar spine without). MATERIALS AND METHODS We retrospectively queried our institution's radiology reporting system to collect weekly data for 1 year following the World Health Organization declaration of a pandemic (11 March 2020-9 March 2021) and compared them to imaging volumes from the previous year (11 March 2019-9 March 2020). We subsequently analyzed quarterly data (e.g., first quarter comparison: 3/11/2020-6/9/2020 was compared to 3/11/2019-6/9/2019). RESULTS All studies experienced decreased volume during the first quarter of the year following onset of the COVID-19 pandemic, with noncontrast enhanced CT head failing to recover to pre-pandemic volumes. CTA head/neck actually surpassed pre-pandemic volume by the second quarter of the year. MRI brain w/wo and MRI lumbar spine without recovered to baseline volume by the second quarter. CONCLUSION Noncontrast enhanced CT head did not recover pre-pandemic imaging volume. CTA head/neck volume initially decreased, however volume increased above pre-pandemic levels during the second quarter; this finding may be attributable to a prothrombotic state in COVID-19 patients.
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Affiliation(s)
- Reginald Scott Widemon
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Sophia Huang
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Kathleen M Capaccione
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Ryan P Mitchell
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Mary M Salvatore
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Angela Lignelli
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
| | - Pamela Nguyen
- Department of Radiology, 21611Columbia University Irving Medical Center, New York, NY, USA
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Hwang ST, Ballout AA, Sonti AN, Kapyur A, Kirsch C, Singh N, Markowitz N, Leung TM, Chong DJ, Temes R, Pacia SV, Kuzniecky RI, Najjar S. EEG Abnormalities and Their Radiographic Correlates in a COVID-19 Inpatient Cohort. Neurol Clin Pract 2022; 12:52-59. [PMID: 36157621 PMCID: PMC9491502 DOI: 10.1212/cpj.0000000000001136] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 08/18/2021] [Indexed: 02/03/2023]
Abstract
Background and Objectives To identify the prevalence of EEG abnormalities in patients with coronavirus disease 2019 (COVID-19) with neurologic changes, their associated neuroimaging abnormalities, and rates of mortality. Methods A retrospective case series of 192 adult COVID-19-positive inpatients with EEG performed between March and June 2020 at 4 hospitals: 161 undergoing continuous, 24 routine, and 7 reduced montage EEG. Study indication, epilepsy history, intubation status, administration of sedatives or antiseizure medications (ASMs), metabolic abnormalities, neuroimaging pathology associated with epileptiform abnormalities, and in-hospital mortality were analyzed. Results EEG indications included encephalopathy (54.7%), seizure (18.2%), coma (17.2%), focal deficit (5.2%), and abnormal movements (4.6%). Epileptiform abnormalities occurred in 39.6% of patients: focal intermittent epileptiform discharges in 25.0%, lateralized periodic discharges in 6.3%, and generalized periodic discharges in 19.3%. Seizures were recorded in 8 patients, 3 with status epilepticus. ASM administration, epilepsy history, and older age were associated with epileptiform abnormalities. Only 26.3% of patients presented with any epileptiform abnormality, 37.5% with electrographic seizures, and 25.7% patients with clinical seizures had known epilepsy. Background findings included generalized slowing (88.5%), focal slowing (15.6%), burst suppression (3.6%), attenuation (3.1%), and normal EEG (3.1%). Neuroimaging pathology was identified in 67.1% of patients with epileptiform abnormalities, over two-thirds acute. In-hospital mortality was 39.5% for patients with epileptiform abnormalities and 36.2% for those without. Risk factors for mortality were coma and ventilator support at time of EEG. Discussion This article highlights the range of EEG abnormalities frequently associated with acute neuroimaging abnormalities in COVID-19. Mortality rates were high, particularly for patients in coma requiring mechanical ventilation. These findings may guide the prognosis and management of patients with COVID-19 and neurologic changes.
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Affiliation(s)
- Sean T Hwang
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Ahmad A Ballout
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Anup N Sonti
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Amitha Kapyur
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Claudia Kirsch
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Neeraj Singh
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Noah Markowitz
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Tung Ming Leung
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Derek J Chong
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Richard Temes
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Steven V Pacia
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Ruben I Kuzniecky
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
| | - Souhel Najjar
- Department of Neurology (STH, AAB, NS, DJC, SVP, RIK, SN), Zucker School of Medicine; Zucker School of Medicine (ANS, AK); Department of Neuroradiology (CK), Zucker School of Medicine, Hempstead; Feinstein Institutes for Medical Research (NM, TML), Manhasset; and Department of Neurosurgery (RT), Zucker School of Medicine, Hempstead, NY
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Iqbal Y, Alabdulla M, Latoo J, Kumar R, Albrahim S, Wadoo O, M Haddad P. Mania and hypomania associated with COVID-19: a series of 15 cases seen by the consultation-liaison psychiatry service in Qatar. Qatar Med J 2021; 2021:65. [PMID: 34888201 PMCID: PMC8631349 DOI: 10.5339/qmj.2021.65] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: A range of neuropsychiatric diagnoses have been reported in association with coronavirus disease 2019 (COVID-19). However, only sporadic cases of mania or hypomania have been reported in patients with COVID-19. This study aimed to report clinical characteristics of 15 consecutive cases of COVID-19-associated mania or hypomania seen in three general hospitals in Qatar in the early months of the pandemic in 2020. Methods: This study is a retrospective case-note review of 15 cases of COVID-19-associated mania or hypomania (confirmed by polymerase chain reaction test), seen as inpatient consultations out of the first 100 consecutive patients managed by consultation-liaison psychiatric teams in Qatar between 2 March 2020 and 7 July 2020. Results: The mean age of the 15 patients was 40 years. Twelve patients had mania, and three had hypomania. Regarding the physical severity of COVID-19, 10 patients were asymptomatic, two had upper respiratory tract symptoms alone and three had pneumonia. None of the patients were intubated. Potential risk factors for mania/hypomania included pandemic-related psychosocial stress before admission (n = 9), past history of mania/bipolar disorder (n = 6) or psychosis (n = 2), raised inflammatory markers (n = 7) and steroid use (n = 3). None had a history of recent substance misuse. Other than one patient with advanced cancer, none had comorbidity regarded as likely to have caused mania or hypomania. Three patients had mild white matter ischaemic changes on brain imaging. Standard pharmacological treatment for mania (i.e. antipsychotic medication supplemented by prn benzodiazepines) was effective. Ten patients were discharged home from the COVID-19 facility where they presented, but five required transfer to Qatar's psychiatric hospital for further treatment of mania. Conclusion: The association of mania or hypomania with COVID-19 may be spurious (e.g. representing an initial presentation of bipolar disorder) or causal. The reported cases illustrate a range of potential aetiological mechanisms by which COVID-19 could cause mania or hypomania. Cohort studies are necessary to determine the incidence, aetiology and prognosis of COVID-19-associated mania/hypomania.
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Affiliation(s)
- Yousaf Iqbal
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Majid Alabdulla
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Javed Latoo
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Rajeev Kumar
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail: .,College of Medicine, Qatar University, Qatar
| | - Sultan Albrahim
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
| | - Ovais Wadoo
- Psychiatry Hospital, Hamad Medical Corporation, Doha, Qatar E-mail:
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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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7
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Xydakis MS, Albers MW, Holbrook EH, Lyon DM, Shih RY, Frasnelli JA, Pagenstecher A, Kupke A, Enquist LW, Perlman S. Post-viral effects of COVID-19 in the olfactory system and their implications. Lancet Neurol 2021; 20:753-761. [PMID: 34339626 PMCID: PMC8324113 DOI: 10.1016/s1474-4422(21)00182-4] [Citation(s) in RCA: 107] [Impact Index Per Article: 35.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/17/2021] [Accepted: 06/02/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND The mechanisms by which any upper respiratory virus, including SARS-CoV-2, impairs chemosensory function are not known. COVID-19 is frequently associated with olfactory dysfunction after viral infection, which provides a research opportunity to evaluate the natural course of this neurological finding. Clinical trials and prospective and histological studies of new-onset post-viral olfactory dysfunction have been limited by small sample sizes and a paucity of advanced neuroimaging data and neuropathological samples. Although data from neuropathological specimens are now available, neuroimaging of the olfactory system during the acute phase of infection is still rare due to infection control concerns and critical illness and represents a substantial gap in knowledge. RECENT DEVELOPMENTS The active replication of SARS-CoV-2 within the brain parenchyma (ie, in neurons and glia) has not been proven. Nevertheless, post-viral olfactory dysfunction can be viewed as a focal neurological deficit in patients with COVID-19. Evidence is also sparse for a direct causal relation between SARS-CoV-2 infection and abnormal brain findings at autopsy, and for trans-synaptic spread of the virus from the olfactory epithelium to the olfactory bulb. Taken together, clinical, radiological, histological, ultrastructural, and molecular data implicate inflammation, with or without infection, in either the olfactory epithelium, the olfactory bulb, or both. This inflammation leads to persistent olfactory deficits in a subset of people who have recovered from COVID-19. Neuroimaging has revealed localised inflammation in intracranial olfactory structures. To date, histopathological, ultrastructural, and molecular evidence does not suggest that SARS-CoV-2 is an obligate neuropathogen. WHERE NEXT?: The prevalence of CNS and olfactory bulb pathosis in patients with COVID-19 is not known. We postulate that, in people who have recovered from COVID-19, a chronic, recrudescent, or permanent olfactory deficit could be prognostic for an increased likelihood of neurological sequelae or neurodegenerative disorders in the long term. An inflammatory stimulus from the nasal olfactory epithelium to the olfactory bulbs and connected brain regions might accelerate pathological processes and symptomatic progression of neurodegenerative disease. Persistent olfactory impairment with or without perceptual distortions (ie, parosmias or phantosmias) after SARS-CoV-2 infection could, therefore, serve as a marker to identify people with an increased long-term risk of neurological disease.
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Affiliation(s)
- Michael S Xydakis
- Human Performance Wing, Air Force Research Lab, US Department of Defense, Wright-Patterson Air Force Base, Dayton, OH, USA.
| | - Mark W Albers
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Eric H Holbrook
- Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, USA
| | - Dina M Lyon
- Human Performance Wing, Air Force Research Lab, US Department of Defense, Wright-Patterson Air Force Base, Dayton, OH, USA
| | - Robert Y Shih
- Division of Neuroradiology, Walter Reed National Military Medical Center, US Department of Defense, Bethesda, MD, USA
| | - Johannes A Frasnelli
- Department of Anatomy, Université du Québec à Trois-Rivières, Trois-Rivières, QC, Canada
| | - Axel Pagenstecher
- Department of Neuropathology, Philipps University of Marburg, Marburg, Germany
| | - Alexandra Kupke
- Marburg Virology Institute, Philipps University of Marburg, Marburg, Germany
| | - Lynn W Enquist
- Princeton Neuroscience Institute, Princeton University, Princeton, NJ, USA
| | - Stanley Perlman
- Department of Microbiology and Immunology, University of Iowa, Iowa City, IA, USA
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8
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Mohan N, Fayyaz MA, del Rio C, Khurana NKRS, Vaidya SS, Salazar E, Joyce J, Ali AA. Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:68. [PMID: 34093004 PMCID: PMC8170868 DOI: 10.1186/s41983-021-00322-3] [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: 01/11/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. OBJECTIVE To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2.To identify neuro-invasive pathways of COVID infection. METHODS Relevant studies were identified through four databases-the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords-"COVID-19," "SARS-CoV2," "neurological manifestations," "neuroimaging," "CT," and "MRI." Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. RESULTS Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. CONCLUSION The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.
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Affiliation(s)
- Nikita Mohan
- Jawaharlal Nehru Medical College, Belagavi, Karnataka India
| | | | - Christopher del Rio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico
| | | | | | - Esteban Salazar
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico
| | - John Joyce
- M.S Ramaiah Medical College, Bangalore, Karnataka India
| | - Amrat Ayaz Ali
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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Capaccione KM, Yang H, West E, Patel H, Ma H, Patel S, Fruauff A, Loeb G, Maddocks A, Borowski A, Lala S, Nguyen P, Lignelli A, D'souza B, Desperito E, Ruzal-Shapiro C, Salvatore MM. Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review. Acad Radiol 2021; 28:595-607. [PMID: 33583712 PMCID: PMC7859715 DOI: 10.1016/j.acra.2021.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 01/12/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND COVID-19 commonly presents with upper respiratory symptoms; however, studies have shown that SARS-CoV-2 infection affects multiple organ systems. Here, we review the pathophysiology and imaging characteristics of SARS-CoV-2 infection in organ systems throughout the body and explore commonalities. OBJECTIVE Familiarity with the underlying pathophysiology and imaging characteristics is essential for the radiologist to recognize these findings in patients with COVID-19 infection. Though pulmonary findings are the most prevalent presentation, COVID-19 may have multiple manifestations and recognition of the extrapulmonary manifestations is especially important because of the potential serious and long-term effects of COVID-19 on multiple organ systems.
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Affiliation(s)
- K M Capaccione
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032.
| | - H Yang
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E West
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - H Ma
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Patel
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Fruauff
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - G Loeb
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Maddocks
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Borowski
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - S Lala
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - P Nguyen
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - A Lignelli
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - B D'souza
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - E Desperito
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - C Ruzal-Shapiro
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
| | - M M Salvatore
- Department of Radiology, Columbia University Irving Medical Center, 622 W 168th Street, New York, NY 10032
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10
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Lehmann HC, Schoser B, Wunderlich G, Berlit P, Fink GR. [Neuromuscular complications of SARS-CoV-2 infections-Part 1: peripheral nerves]. DER NERVENARZT 2021; 92:540-547. [PMID: 33770191 PMCID: PMC7994351 DOI: 10.1007/s00115-021-01094-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
In recent months various disorders and diseases of the peripheral nerves (including cranial nerves) and the musculature have been described in association with the pulmonary disease coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the first part of our review the current knowledge about a potential association of a SARS-CoV‑2 infection with dysfunction and diseases of cranial and peripheral nerves is discussed. Anosmia, ageusia, motor cranial nerve involvement and Guillain-Barré syndrome (GBS) were described in a temporal association with a SARS-CoV‑2 infection. Several studies could show that anosmia and ageusia were frequent symptoms of a SARS-CoV‑2 infection. In contrast the failure of other cranial nerves has so far only been sporadically described. A number of case reports and case series indicate a causal association between a SARS-CoV‑2 infection and GBS but epidemiological evidence is still lacking.
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Affiliation(s)
- Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Benedikt Schoser
- LMU Klinikum, Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Gilbert Wunderlich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Köln, Köln, Deutschland
| | - Peter Berlit
- Deutsche Gesellschaft für Neurologie (DGN), Reinhardtstr. 27C, 10117, Berlin, Deutschland
| | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Institut für Neurowissenschaften (INM-3), Forschungszentrum Jülich, Jülich, Deutschland
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11
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Chowdhary A, Subedi R, Tandon M, Wen S, Patel J, Kataria S, Peterson S, Gwinn R, Elkhooly M, Prasad A, Nirwan L, Adcock A, Sriwastava S. Relevance and Clinical Significance of Magnetic Resonance Imaging of Neurological Manifestations in COVID-19: A Systematic Review of Case Reports and Case Series. Brain Sci 2020; 10:E1017. [PMID: 33371260 PMCID: PMC7766893 DOI: 10.3390/brainsci10121017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 02/06/2023] Open
Abstract
We performed a systematic literature review of neuroimaging, predominantly focusing on magnetic resonance imaging (MRI) findings associated with neurological manifestations of coronavirus disease-2019 (COVID-19). We screened articles from PubMed, Google Scholar and Scopus, looking for reports that would potentially have neuroimaging findings in patients with COVID-19. Data analysis was performed with patient-based data based on the availability of clinical characteristics and outcomes for each individual patient from the studies. Chi square and Wilcoxon rank-sum tests were used to report COVID-19 severity and outcomes based on neurological imaging indicators and pathophysiology. A total of 171 patients with COVID-19 having neurological complications, from 134 studies, were identified in our review. The most common neuroimaging finding was ischemic stroke (62, 36.2%) cases, followed by CNS inflammatory disorder (44, 25.7%), and hemorrhagic stroke (41, 24.0%). Around 51% of all the fatal COVID-19 cases had an ischemic stroke. Among patients with ischemic stroke, the mean age of those who suffered from COVID-19 infection was 57.5 years (SD = 15.4) whereas it was 50.7 years (SD = 15.1) among those without stroke/other diagnosis. Fatality was more common in patients with ischemic stroke compared to those with other diagnosis (40% vs. 22%, p = 0.011). The most frequently published neuroimaging findings in patients with COVID-19 were ischemic stroke, CNS inflammatory disorder, and hemorrhagic disorder. In those studies, ischemic stroke was associated with fatality, and was more frequently seen in older patients. Based on our findings, early usage of MRI in COVID-19 patients may be recommended.
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Affiliation(s)
- Anisa Chowdhary
- Institute of Nuclear Medicine and Allied Sciences, New Delhi 110054, India;
| | - Roshan Subedi
- Institute of Medicine, Kathmandu P.O.BOX 1524, Nepal;
| | | | - Sijin Wen
- Department of Biostatistics, West Virginia University, Morgantown, WV 26506, USA;
| | - Jenil Patel
- Department of Epidemiology, Fay W. Boozman, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR 72205, USA;
| | - Saurabh Kataria
- Department of Neurology, University of Missouri Healthcare, Columbia, MO 65212, USA;
| | - Sarah Peterson
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (S.P.); (R.G.)
| | - Ronald Gwinn
- School of Medicine, West Virginia University, Morgantown, WV 26506, USA; (S.P.); (R.G.)
| | - Mahmoud Elkhooly
- Department of Neuropsychiatry, Minia University, Minia 61519, Egypt;
| | - Apoorv Prasad
- Department of Neurology, Berkeley Medical Center, West Virginia University, Morgantown, WV 26506, USA;
| | - Lalit Nirwan
- Meditrina Institute of Medical Sciences, Nagpur, Maharashtra 440012, India;
| | - Amelia Adcock
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA;
| | - Shitiz Sriwastava
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26506, USA;
- Department of Neurology, Wayne State University, Detroit, MI 48201, USA
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12
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Hwang ST, Ballout AA, Mirza U, Sonti AN, Husain A, Kirsch C, Kuzniecky R, Najjar S. Acute Seizures Occurring in Association With SARS-CoV-2. Front Neurol 2020; 11:576329. [PMID: 33224090 PMCID: PMC7674622 DOI: 10.3389/fneur.2020.576329] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 09/29/2020] [Indexed: 12/13/2022] Open
Abstract
Seizures are an infrequent and serious neurological complication of SARS-CoV-2 infection, with limited data describing the etiology and the clinical context in which these occur or the associated electrographic and imaging findings. This series details four cases of seizures occurring in patients with COVID-19 with distinct time points, underlying pathology, and proposed physiological mechanisms. An enhanced understanding of seizure manifestations in COVID-19 and their clinical course may allow for earlier detection and improved patient management.
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Affiliation(s)
- Sean T Hwang
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Ahmad A Ballout
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Usman Mirza
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Anup N Sonti
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Arif Husain
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Claudia Kirsch
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Ruben Kuzniecky
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
| | - Souhel Najjar
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, North Shore University Hospital, Manhasset, NY, United States
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