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McClelland AC, Benitez SJ, Burns J. COVID-19 Neuroimaging Update: Pathophysiology, Acute Findings, and Post-Acute Developments. Semin Ultrasound CT MR 2024:S0887-2171(24)00026-X. [PMID: 38518814 DOI: 10.1053/j.sult.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2024]
Abstract
COVID-19 has prominent effects on the nervous system with important manifestations on neuroimaging. In this review, we discuss the neuroimaging appearance of acute COVID-19 that became evident during the early stages of the pandemic. We highlight the underlying pathophysiology mediating nervous system effects and neuroimaging appearances including systemic inflammatory response such as cytokine storm, coagulopathy, and para/post-infections immune mediated phenomena. We also discuss the nervous system manifestations of COVID-19 and the role of imaging as the pandemic has evolved over time, including related to the development of vaccines and the emergence of post-acute sequalae such as long COVID.
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Affiliation(s)
| | - Steven J Benitez
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
| | - Judah Burns
- Department of Radiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY
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Reyes CZ, Villar M, Cheponis K, Yacoub HA. Focal Cerebral Vasculitis due to SARS-CoV-2 Infection With a Robust Response to Intravenous Steroids. Neurologist 2024; 29:106-108. [PMID: 37611403 DOI: 10.1097/nrl.0000000000000525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
INTRODUCTION Severe and less common neurological manifestations of SARS-CoV-2 infection include acute ischemic stroke, intracerebral hemorrhage, central venous sinus thrombosis, and vasculitis. In this report, we present a case of a 42-year-old man with acute ischemic stroke due to SARS-CoV-2 infection-associated central nervous system vasculitis that improved with steroid therapy. CASE REPORT A 42-year-old man with SARS-CoV-2 infection presented with non-fluent aphasia and right-sided hemiparesis. Computed tomography angiography revealed an occlusion of the proximal left middle cerebral artery (MCA), with acute infarcts in the left posterior parietal, lentiform nucleus, and cortical frontal cortex on magnetic resonance imaging (MRI). Patient developed pulmonary emboli and was discharged on apixaban and atorvastatin. Four weeks later, the patient presented with recurring symptoms and was found to have worsening left MCA stenosis. MRI and MR angiography revealed a penumbra within the left MCA territory and pruning of the distal branches with severe stenosis. Laboratory workup for autoimmune causes of vasculitis was unrevealing. High-dose intravenous steroid treatment was initiated. Subsequent MRI and MR angiography revealed improved flow in the left cerebral vasculature and no novel ischemic infarcts. CONCLUSION Central nervous system vasculitis is a rare manifestation of SARS-CoV-2 infection. This case suggests that high-dose intravenous steroids may have a therapeutic role in this patient population. Steroid use, in combination with vasopressor support to augment cerebral blood flow, may prevent further stroke burden.
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Affiliation(s)
- Cleo Zarina Reyes
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA
| | - Manny Villar
- University of South Florida Morsani College of Medicine, Tampa, FL
| | - Kathryn Cheponis
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA
| | - Hussam A Yacoub
- Department of Neurology, Lehigh Valley Health Network, Allentown, PA
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3
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Afsahi AM, Norbash AM, Syed SF, Sedaghat M, Afsahi G, Shahidi R, Tajabadi Z, Bagherzadeh-Fard M, Karami S, Yarahmadi P, Shirdel S, Asgarzadeh A, Baradaran M, Khalaj F, Sadeghsalehi H, Fotouhi M, Habibi MA, Jang H, Alavi A, Sedaghat S. Brain MRI findings in neurologically symptomatic COVID-19 patients: a systematic review and meta-analysis. J Neurol 2023; 270:5131-5154. [PMID: 37535100 DOI: 10.1007/s00415-023-11914-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/24/2023] [Accepted: 07/28/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has been associated with nervous system involvement, with more than one-third of COVID-19 patients experiencing neurological manifestations. Utilizing a systematic review, this study aims to summarize brain MRI findings in COVID-19 patients presenting with neurological symptoms. METHODS Systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) checklist. The electronic databases of PubMed/MEDLINE, Embase, Scopus, and Web of Science were systematically searched for literature addressing brain MRI findings in COVID-19 patients with neurological symptoms. RESULTS 25 publications containing a total number of 3118 COVID-19 patients with neurological symptoms who underwent MRI were included. The most common MRI findings and the respective pooled incidences in decreasing order were acute/subacute infarct (22%), olfactory bulb abnormalities (22%), white matter abnormalities (20%), cerebral microbleeds (17%), grey matter abnormalities (12%), leptomeningeal enhancement (10%), ADEM (Acute Disseminated Encephalomyelitis) or ADEM-like lesions (10%), non-traumatic ICH (10%), cranial neuropathy (8%), cortical gray matter signal changes compatible with encephalitis (8%), basal ganglia abnormalities (5%), PRES (Posterior Reversible Encephalopathy Syndrome) (3%), hypoxic-ischemic lesions (4%), venous thrombosis (2%), and cytotoxic lesions of the corpus callosum (2%). CONCLUSION The present study revealed that a considerable proportion of patients with COVID-19 might harbor neurological abnormalities detectable by MRI. Among various findings, the most common MRI alterations are acute/subacute infarction, olfactory bulb abnormalities, white matter abnormalities, and cerebral microbleeds.
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Affiliation(s)
| | | | - Shahla F Syed
- Department of Radiology, Weill Cornell Medicine, New York, NY, USA
| | - Maya Sedaghat
- Department for Radiology and Neuroradiology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Ghazaleh Afsahi
- Department of Biotechnology Research, Blue California Ingredients, Rancho Santa Margarita, CA, USA
| | - Ramin Shahidi
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Zohreh Tajabadi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Pourya Yarahmadi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shabnam Shirdel
- Department of Psychology, Faculty of Education and Psychology, University of Tabriz, Tabriz, Iran
| | - Ali Asgarzadeh
- Students Research Committee, School of Medicine, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mansoureh Baradaran
- Department of Radiology, Imam Ali Hospital, North Khorasan University of Medical Science, Bojnurd, Iran
| | - Fattaneh Khalaj
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Sadeghsalehi
- Department of Artificial Intelligence in Medical Sciences, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Maryam Fotouhi
- Quantitative MR Imaging and Spectroscopy Group (QMISG), Research Centre for Molecular and Cellular Imaging (RCMCI), Advanced Medical Technologies and Equipment Institute (AMTEI), Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | | | - Hyungseok Jang
- Department of Radiology, University of California, San Diego, CA, USA
| | - Abass Alavi
- Department of Diagnostic Radiology and Nuclear Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sam Sedaghat
- Department of Radiology, University of California, San Diego, CA, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
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4
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Boparai MS, Musheyev B, Hou W, Mehler MF, Duong TQ. Brain MRI findings in severe COVID-19 patients: a meta-analysis. Front Neurol 2023; 14:1258352. [PMID: 37900601 PMCID: PMC10602808 DOI: 10.3389/fneur.2023.1258352] [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: 07/13/2023] [Accepted: 09/27/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Neurocognitive symptoms and dysfunction of various severities have become increasingly recognized as potential consequences of SARS-CoV-2 infection. Although there are numerous observational and subjective survey-reporting studies of neurological symptoms, by contrast, those studies describing imaging abnormalities are fewer in number. Methods This study conducted a metanalysis of 32 studies to determine the incidence of the common neurological abnormalities using magnetic resonance imaging (MRI) in patients with COVID-19. Results We also present the common clinical findings associated with MRI abnormalities. We report the incidence of any MRI abnormality to be 55% in COVID-19 patients with perfusion abnormalities (53%) and SWI abnormalities (44%) being the most commonly reported injuries. Cognitive impairment, ICU admission and/or mechanical ventilation status, older age, and hospitalization or longer length of hospital stay were the most common clinical findings associated with brain injury in COVID-19 patients. Discussion Overall, the presentation of brain injury in this study was diverse with no substantial pattern of injury emerging, yet most injuries appear to be of vascular origin. Moreover, analysis of the association between MRI abnormalities and clinical findings suggests that there are likely many mechanisms, both direct and indirect, by which brain injury occurs in COVID-19 patients.
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Affiliation(s)
- Montek S. Boparai
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States
| | - Benjamin Musheyev
- Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States
| | - Wei Hou
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States
| | - Mark F. Mehler
- Department of Neurology, Montefiore Health System and Albert Einstein College of Medicine, Bronx, NY, United States
| | - Tim Q. Duong
- Department of Radiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, NY, United States
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Corrêa DG, Pacheco FT, da Cruz LCH, Nunes RH, Maia ACM, de Souza Godoy LF, Bisolo L, da Silva NA, Soldatelli MD, de Siqueira Campos CM, Vedolin LM, do Amaral LLF, da Rocha AJ. Intracranial vessel wall magnetic resonance imaging features of infectious vasculitis. Clin Imaging 2023; 98:26-35. [PMID: 36996597 DOI: 10.1016/j.clinimag.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/19/2023] [Accepted: 03/21/2023] [Indexed: 03/31/2023]
Abstract
Vasculitis is a complication of several infectious diseases affecting the central nervous system, which may result in ischemic and/or hemorrhagic stroke, transient ischemic attack, and aneurysm formation. The infectious agent may directly infect the endothelium, causing vasculitis, or indirectly affect the vessel wall through an immunological mechanism. The clinical manifestations of these complications usually overlap with those of non-infectious vascular diseases, making diagnosis challenging. Intracranial vessel wall magnetic resonance imaging (VWI) enables the evaluation of the vessel wall and the diseases that affect it, providing diagnostic data beyond luminal changes and enabling the identification of inflammatory changes in cerebral vasculitis. This technique demonstrates concentric vessel wall thickening and gadolinium enhancement, associated or not with adjacent brain parenchymal enhancement, in patients with vasculitis of any origin. It permits the detection of early alterations, even before a stenosis occurs. In this article, we review the intracranial vessel wall imaging features of infectious vasculitis of bacterial, viral, and fungal etiologies.
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Affiliation(s)
- Diogo Goulart Corrêa
- Department of Radiology, Clínica de Diagnóstico por Imagem (CDPI)/DASA, Rio de Janeiro, RJ, Brazil; Department of Radiology, Federal Fluminense University, Niterói, RJ, Brazil.
| | - Felipe Torres Pacheco
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | | | - Renato Hoffmann Nunes
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
| | - Antônio Carlos Martins Maia
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, Fleury, São Paulo, SP, Brazil
| | | | - Louise Bisolo
- Department of Radiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Nivaldo Adolfo da Silva
- Department of Radiology, DASA, São Paulo, SP, Brazil; Department of Radiology, University of Campinas, Campinas, SP, Brazil
| | | | | | - Leonardo Modesti Vedolin
- Department of Radiology, DASA, São Paulo, SP, Brazil; Department of Radiology, Hospital de Clínicas de Porta Alegre, Porto Alegre, RS, Brazil
| | | | - Antônio José da Rocha
- Department of Neuroradiology, Irmandade da Santa Casa de Misericórdia de São Paulo, São Paulo, SP, Brazil; Department of Radiology, DASA, São Paulo, SP, Brazil
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6
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Holroyd KB, Conway SE. Central Nervous System Neuroimmunologic Complications of COVID-19. Semin Neurol 2023. [PMID: 37080234 DOI: 10.1055/s-0043-1767713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
Autoimmune disorders of the central nervous system following COVID-19 infection include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune encephalitis, acute disseminated encephalomyelitis, and other less common neuroimmunologic disorders. In general, these disorders are rare and likely represent postinfectious phenomena rather than direct consequences of the SARS-CoV-2 virus itself. The impact of COVID-19 infection on patients with preexisting neuroinflammatory disorders depends on both the disorder and disease-modifying therapy use. Patients with MS do not have an increased risk for severe COVID-19, though patients on anti-CD20 therapies may have worse clinical outcomes and attenuated humoral response to vaccination. Data are limited for other neuroinflammatory disorders, but known risk factors such as older age and medical comorbidities likely play a role. Prophylaxis and treatment for COVID-19 should be considered in patients with preexisting neuroinflammatory disorders at high risk for developing severe COVID-19.
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Affiliation(s)
- Kathryn B Holroyd
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sarah E Conway
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts
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Farooqui AA, Farooqui T, Sun GY, Lin TN, Teh DBL, Ong WY. COVID-19, Blood Lipid Changes, and Thrombosis. Biomedicines 2023; 11:biomedicines11041181. [PMID: 37189799 DOI: 10.3390/biomedicines11041181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/12/2023] [Accepted: 04/13/2023] [Indexed: 05/17/2023] Open
Abstract
Although there is increasing evidence that oxidative stress and inflammation induced by COVID-19 may contribute to increased risk and severity of thromboses, the underlying mechanism(s) remain to be understood. The purpose of this review is to highlight the role of blood lipids in association with thrombosis events observed in COVID-19 patients. Among different types of phospholipases A2 that target cell membrane phospholipids, there is increasing focus on the inflammatory secretory phospholipase A2 IIA (sPLA2-IIA), which is associated with the severity of COVID-19. Analysis indicates increased sPLA2-IIA levels together with eicosanoids in the sera of COVID patients. sPLA2 could metabolise phospholipids in platelets, erythrocytes, and endothelial cells to produce arachidonic acid (ARA) and lysophospholipids. Arachidonic acid in platelets is metabolised to prostaglandin H2 and thromboxane A2, known for their pro-coagulation and vasoconstrictive properties. Lysophospholipids, such as lysophosphatidylcholine, could be metabolised by autotaxin (ATX) and further converted to lysophosphatidic acid (LPA). Increased ATX has been found in the serum of patients with COVID-19, and LPA has recently been found to induce NETosis, a clotting mechanism triggered by the release of extracellular fibres from neutrophils and a key feature of the COVID-19 hypercoagulable state. PLA2 could also catalyse the formation of platelet activating factor (PAF) from membrane ether phospholipids. Many of the above lipid mediators are increased in the blood of patients with COVID-19. Together, findings from analyses of blood lipids in COVID-19 patients suggest an important role for metabolites of sPLA2-IIA in COVID-19-associated coagulopathy (CAC).
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Affiliation(s)
- Akhlaq A Farooqui
- Department of Molecular and Cellular Biochemistry, Ohio State University, Columbus, OH 43210, USA
| | - Tahira Farooqui
- Department of Molecular and Cellular Biochemistry, Ohio State University, Columbus, OH 43210, USA
| | - Grace Y Sun
- Department of Biochemistry, University of Missouri, Columbia, MO 65211, USA
| | - Teng-Nan Lin
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11929, Taiwan
| | - Daniel B L Teh
- Department of Ophthalmology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119260, Singapore
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119260, Singapore
- Neurobiology Research Programme, Life Sciences Institute, National University of Singapore, Singapore 119260, Singapore
| | - Wei-Yi Ong
- Department of Anatomy, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119260, Singapore
- Neurobiology Research Programme, Life Sciences Institute, National University of Singapore, Singapore 119260, Singapore
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8
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Kim J, Young GS. Neuroimaging of COVID-19. Semin Neurol 2023; 43:205-218. [PMID: 37379850 DOI: 10.1055/s-0043-1767771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
We review the wide variety of common neuroimaging manifestations related to coronavirus disease 2019 (COVID-19) and COVID therapies, grouping the entities by likely pathophysiology, recognizing that the etiology of many entities remains uncertain. Direct viral invasion likely contributes to olfactory bulb abnormalities. COVID meningoencephalitis may represent direct viral infection and/or autoimmune inflammation. Para-infectious inflammation and inflammatory demyelination at the time of infection are likely primary contributors to acute necrotizing encephalopathy, cytotoxic lesion of the corpus callosum, and diffuse white matter abnormality. Later postinfectious inflammation and demyelination may manifest as acute demyelinating encephalomyelitis, Guillain-Barré syndrome, or transverse myelitis. The hallmark vascular inflammation and coagulopathy of COVID-19 may produce acute ischemic infarction, microinfarction contributing to white matter abnormality, space-occupying hemorrhage or microhemorrhage, venous thrombosis, and posterior reversible encephalopathy syndrome. Adverse effects of therapies including zinc, chloroquine/hydroxychloroquine, antivirals, and vaccines, and current evidence regarding "long COVID" is briefly reviewed. Finally, we present a case of bacterial and fungal superinfection related to immune dysregulation from COVID.
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Affiliation(s)
- Jisoo Kim
- Division of Neuroradiology, Department of Radiology, Harvard Medical School & Brigham and Women's Hospital, Boston, Massachusetts
| | - Geoffrey S Young
- Division of Neuroradiology, Department of Radiology, Harvard Medical School & Brigham and Women's Hospital, Boston, Massachusetts
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Md Noh MSF, Abdul Rashid AM, Mohd Zain NR. The Spectrum of Vessel Wall Imaging (VWI) Findings in COVID-19-Associated Neurological Syndromes: A Review. Cureus 2023; 15:e37296. [PMID: 37168192 PMCID: PMC10166570 DOI: 10.7759/cureus.37296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2023] [Indexed: 05/13/2023] Open
Abstract
Since the start of the pandemic, there have been extensive studies from all over the world reporting on coronavirus disease 2019 (COVID-19)-associated neurological syndromes. Although initially thought of as primarily a respiratory pathogen, it became increasingly clear that the virus does have other systemic manifestations, including on the neurological system. Since then, the discovery of the many neuroimaging features of COVID-19-associated neurological syndromes have puzzled researchers and physicians in terms of interpretation, and how best to manage these findings to benefit patients. We sought to review the neuroimaging findings of COVID-19-associated neurological syndromes, particularly the vessel wall imaging (VWI) features, in the hope of finding a common feature that would better guide physicians in terms of further management of this group of patients. We will also look into the potential pitfalls of interpreting the VWI findings in these patients.
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Affiliation(s)
- Mohamad Syafeeq Faeez Md Noh
- Department of Radiology, Universiti Putra Malaysia Teaching Hospital, Serdang, MYS
- Department of Radiology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
| | - Anna Misyail Abdul Rashid
- Department of Neurology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, MYS
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Okrzeja J, Garkowski A, Kubas B, Moniuszko-Malinowska A. Imaging and neuropathological findings in patients with Post COVID-19 Neurological Syndrome-A review. Front Neurol 2023; 14:1136348. [PMID: 36846139 PMCID: PMC9947471 DOI: 10.3389/fneur.2023.1136348] [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: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Post COVID-19 syndrome is determined as signs and symptoms that appear during or after an infection consistent with SARS-CoV-2 disease, persist for more than 12 weeks and are not explained by an alternative diagnosis. This review presents the neuropathological findings and imaging findings in Post COVID-19 Neurological Syndrome: the focal point is on the manifestations of involvement evident on brain and spine imaging.
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Affiliation(s)
- Jakub Okrzeja
- Medical University of Białystok, Białystok, Poland,*Correspondence: Jakub Okrzeja ✉
| | - Adam Garkowski
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Bożena Kubas
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
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Alqahtani MS, Abbas M, Alshahrani MY, Alabdullh K, Alqarni A, Alqahtani FF, Jambi LK, Alkhayat A. Effects of COVID-19 on Synaptic and Neuronal Degeneration. Brain Sci 2023; 13:brainsci13010131. [PMID: 36672112 PMCID: PMC9856402 DOI: 10.3390/brainsci13010131] [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: 11/29/2022] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023] Open
Abstract
Neurons are the basic building blocks of the human body's neurological system. Atrophy is defined by the disintegration of the connections between cells that enable them to communicate. Peripheral neuropathy and demyelinating disorders, as well as cerebrovascular illnesses and central nervous system (CNS) inflammatory diseases, have all been linked to brain damage, including Parkinson's disease (PD). It turns out that these diseases have a direct impact on brain atrophy. However, it may take some time after the onset of one of these diseases for this atrophy to be clearly diagnosed. With the emergence of the Coronavirus disease 2019 (COVID-19) pandemic, there were several clinical observations of COVID-19 patients. Among those observations is that the virus can cause any of the diseases that can lead to brain atrophy. Here we shed light on the research that tracked the relationship of these diseases to the COVID-19 virus. The importance of this review is that it is the first to link the relationship between the Coronavirus and diseases that cause brain atrophy. It also indicates the indirect role of the virus in dystrophy.
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Affiliation(s)
- Mohammed S. Alqahtani
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
- BioImaging Unit, Space Research Centre, University of Leicester, Michael Atiyah Building, Leicester LE1 7RH, UK
| | - Mohamed Abbas
- Electrical Engineering Department, College of Engineering, King Khalid University, Abha 61421, Saudi Arabia
- Electronics and Communications Department, College of Engineering, Delta University for Science and Technology, Gamasa 35712, Egypt
- Correspondence:
| | - Mohammad Y. Alshahrani
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Khulud Alabdullh
- Radiology Department, King Abdullah Hospital Bisha, Bisha 61922, Saudi Arabia
| | - Amjad Alqarni
- Radiological Sciences Department, College of Applied Medical Sciences, King Khalid University, Abha 61421, Saudi Arabia
| | - Fawaz F. Alqahtani
- Department of Radiological Sciences, College of Applied Medical Sciences, Najran University, Najran 55461, Saudi Arabia
| | - Layal K. Jambi
- Radiological Sciences Department, College of Applied Medical Sciences, King Saud University, P.O. Box 10219, Riyadh 11433, Saudi Arabia
| | - Adnan Alkhayat
- Department of Hematopathology, King Fahad Central Hospital, Gizan 82666, Saudi Arabia
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12
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Araújo ST, Araújo CT, Silva E Castro R, de Oliveira Brügger LM, Souza E Silva NG, de Miranda DM, Simões E Silva AC. Imaging Markers of Neurologic Damage in COVID-19: A Systematic Review. Curr Med Chem 2023; 30:1086-1106. [PMID: 35786328 DOI: 10.2174/0929867329666220701124945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 04/12/2022] [Accepted: 04/21/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection commonly leads to neurologic manifestations. In the present review, we aimed to investigate potential neuroimaging markers of early diagnosis and prognosis of neurologic manifestations in COVID-19. METHODS Our study was registered in the Prospective Register of Systematic Reviews (PROSPERO) under the protocol CDR42021265443. Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we selected 51 studies for whole-manuscript analysis. RESULTS Magnetic resonance imaging (MRI) was the most common imaging method. The pattern, sites of lesion, signs, and symptoms of neurologic injury varied. Such manifestations possibly resulted from a direct viral infection or, most likely, from indirect mechanisms including coagulation disturbances, hypoxemia, and immunological responses. CONCLUSION The heterogeneity of the studies precludes any generalization of the findings. Brain MRI is the most informative imaging exam. Population studies, including the entire spectrum of COVID-19 are missing. There is still a need for future population studies evaluating neurologic manifestations of all COVID-19 severities acutely and chronically.
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Affiliation(s)
- Sara Tavares Araújo
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Clara Tavares Araújo
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Rafael Silva E Castro
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | - Lara Machado de Oliveira Brügger
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil
| | | | - Debora Marques de Miranda
- Laboratory of Translational Medicine, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil.,Department of Pediatrics, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
| | - Ana Cristina Simões E Silva
- Interdisciplinary Laboratory of Medical Investigation, Faculty of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.,Department of Pediatrics, Faculty of Medicine, UFMG, Belo Horizonte, MG, Brazil
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13
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Isolated Central Nervous System Vasculitides in COVID-19: A Systematic Review of Case Reports and Series. REPORTS 2022. [DOI: 10.3390/reports5030036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Cerebral vasculitides, both isolated or in systemic disorders, could be triggered by infections, and few cases have been associated to coronavirus disease 2019 (COVID-19). This study searched for publications in Pubmed, EMBASE, and Cochrane library databases for case reports and series of isolated central nervous system (CNS) vasculitides triggered by severe acute respiratory syndrome coronavirus-2. We included 12 studies (published from June 2020 to July 2022) and collected 39 adult patients (5/39 pathologically or radiologically proven, 34/39 suggestive for primary CNS vasculitis or PCNSV). All cases had a positive real-time polymerase chain reaction on a nasopharyngeal swab or a respiratory tract specimen. About the 85% of the included cases were males, and disease onset occurred later than 50 years old in all but three subjects. In total, 33/39 patients presented severe COVID-19 pneumonia, frequently requiring intensive care unit care. The most common neurological features were headache, obnubilation, and coma. PCNSV was suspected mainly on radiological findings, whereas the cerebrospinal fluid analysis was minimally altered. Magnetic resonance imaging showed vessel wall enhancement in 32/39 cases, generally with the concomitant presence of microbleeds, subarachnoid haemorrhages, and/or multiple ischemic lesions. Despite the severe respiratory and neurological disease course, most cases (93%) improved spontaneously or after a course of high-dose intravenous steroids with no need for immunosuppression. In conclusion, PCNSV could rarely relate to COVID-19 and independently from pulmonary disease severity. Adults with COVID-19-related PCNSV could have a favourable prognosis.
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Islam MA, Cavestro C, Alam SS, Kundu S, Kamal MA, Reza F. Encephalitis in Patients with COVID-19: A Systematic Evidence-Based Analysis. Cells 2022; 11:cells11162575. [PMID: 36010650 PMCID: PMC9406394 DOI: 10.3390/cells11162575] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/11/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022] Open
Abstract
Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) predominantly infects the respiratory system, several investigations have shown the involvement of the central nervous system (CNS) along the course of the illness, with encephalitis being one of the symptoms. The objective of this systematic review was to evaluate the characteristics (clinical, neuro-radiological aspects, and laboratory features) and outcomes of encephalitis in COVID-19 patients. PubMed, Scopus, and Google Scholar databases were searched from 1 December 2019 until 21 July 2022 to identify case reports and case series published on COVID-19 associated with encephalitis. The quality of the included studies was assessed by the Joanna Briggs Institute critical appraisal checklists. This systematic review included 79 studies, including 91 COVID-19 patients (52.7% male) experiencing encephalitis, where 85.6% were adults (49.3 ± 20.2 years), and 14.4% were children (11.2 ± 7.6 years). RT-PCR was used to confirm 92.2% of the COVID-19 patients. Encephalitis-related symptoms were present in 78.0% of COVID-19 patients at the time of diagnosis. In these encephalitis patients, seizure (29.5%), confusion (23.2%), headache (20.5%), disorientation (15.2%), and altered mental status (11.6%) were the most frequently reported neurologic manifestations. Looking at the MRI, EEG, and CSF findings, 77.6%, 75.5%, and 64.1% of the patients represented abnormal results. SARS-CoV-2-associated or -mediated encephalitis were the most common type observed (59.3%), followed by autoimmune encephalitis (18.7%). Among the included patients, 66.7% were discharged (37.8% improved and 28.9% fully recovered), whereas 20.0% of the reported COVID-19-positive encephalitis patients died. Based on the quality assessment, 87.4% of the studies were of high quality. Although in COVID-19, encephalitis is not a typical phenomenon, SARS-CoV-2 seems like a neuropathogen affecting the brain even when there are no signs of respiratory illness, causing a high rate of disability and fatality.
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Affiliation(s)
- Md Asiful Islam
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham B15 2TT, UK
| | - Cinzia Cavestro
- Headache Centre, Department of Neurology, San Lazzaro Hospital, ASL CN2, 12051 Alba, CN, Italy
| | - Sayeda Sadia Alam
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Shoumik Kundu
- Department of Biochemistry and Molecular Biology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh
| | - Mohammad Amjad Kamal
- Institutes for Systems Genetics, Frontiers Science Center for Disease-Related Molecular Network, West China Hospital, Sichuan University, Chengdu 610064, China
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 22230, Saudi Arabia
- Department of Pharmacy, Faculty of Allied Health Sciences, Daffodil International University, Dhaka 1207, Bangladesh
- Enzymoics, 7 Peterlee Place, Novel Global Community Educational Foundation, Hebersham, NSW 2770, Australia
| | - Faruque Reza
- Department of Neurosciences, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Kelantan, Malaysia
- Correspondence:
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Chandekar KR, Satapathy S, Singh H, Bhattacharya A. Molecular imaging as a tool for evaluation of COVID-19 sequelae – A review of literature. World J Radiol 2022; 14:194-208. [PMID: 36160629 PMCID: PMC9350609 DOI: 10.4329/wjr.v14.i7.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 05/17/2022] [Accepted: 07/11/2022] [Indexed: 02/06/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by the novel viral pathogen, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 primarily involves the lungs. Nucleic acid testing based on reverse-transcription polymerase chain reaction of respiratory samples is the current gold standard for the diagnosis of SARS-CoV-2 infection. Imaging modalities have an established role in triaging, diagnosis, evaluation of disease severity, monitoring disease progression, extra-pulmonary involvement, and complications. As our understanding of the disease improves, there has been substantial evidence to highlight its potential for multi-systemic involvement and development of long-term sequelae. Molecular imaging techniques are highly sensitive, allowing non-invasive visualization of physiological or pathological processes at a cellular or molecular level with potential for detection of functional changes earlier than conventional radiological imaging. The purpose of this review article is to highlight the evolving role of molecular imaging in evaluation of COVID-19 sequelae. Though not ideal for diagnosis, the various modalities of molecular imaging play an important role in assessing pulmonary and extra-pulmonary sequelae of COVID-19. Perfusion imaging using single photon emission computed tomography fused with computed tomography (CT) can be utilized as a first-line imaging modality for COVID-19 related pulmonary embolism. 18F-fluorodeoxyglucose positron emission tomography (PET)/CT is a sensitive tool to detect multi-systemic inflammation, including myocardial and vascular inflammation. PET in conjunction with magnetic resonance imaging helps in better characterization of neurological sequelae of COVID-19. Despite the fact that the majority of published literature is retrospective in nature with limited sample sizes, it is clear that molecular imaging provides additional valuable information (complimentary to anatomical imaging) with semi-quantitative or quantitative parameters to define inflammatory burden and can be used to guide therapeutic strategies and assess response. However, widespread clinical applicability remains a challenge owing to longer image acquisition times and the need for adoption of infection control protocols.
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Affiliation(s)
- Kunal R Chandekar
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Swayamjeet Satapathy
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Harmandeep Singh
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Anish Bhattacharya
- Department of Nuclear Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
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16
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Lersy F, Bund C, Anheim M, Mondino M, Noblet V, Lazzara S, Phillipps C, Collange O, Oulehri W, Mertes PM, Helms J, Merdji H, Schenck M, Schneider F, Pottecher J, Giraudeau C, Chammas A, Ardellier FD, Baloglu S, Ambarki K, Namer IJ, Kremer S. Evolution of Neuroimaging Findings in Severe COVID-19 Patients with Initial Neurological Impairment: An Observational Study. Viruses 2022; 14:949. [PMID: 35632691 PMCID: PMC9145920 DOI: 10.3390/v14050949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/26/2022] [Accepted: 04/26/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Cerebral complications related to the COVID-19 were documented by brain MRIs during the acute phase. The purpose of the present study was to describe the evolution of these neuroimaging findings (MRI and FDG-PET/CT) and describe the neurocognitive outcomes of these patients. METHODS During the first wave of the COVID-19 outbreak between 1 March and 31 May 2020, 112 consecutive COVID-19 patients with neurologic manifestations underwent a brain MRI at Strasbourg University hospitals. After recovery, during follow-up, of these 112 patients, 31 (initially hospitalized in intensive care units) underwent additional imaging studies (at least one brain MRI). RESULTS Twenty-three men (74%) and eight women (26%) with a mean age of 61 years (range: 18-79) were included. Leptomeningeal enhancement, diffuse brain microhemorrhages, acute ischemic strokes, suspicion of cerebral vasculitis, and acute inflammatory demyelinating lesions were described on the initial brain MRIs. During follow-up, the evolution of the leptomeningeal enhancement was discordant, and the cerebral microhemorrhages were stable. We observed normalization of the vessel walls in all patients suspected of cerebral vasculitis. Four patients (13%) demonstrated new complications during follow-up (ischemic strokes, hypoglossal neuritis, marked increase in the white matter FLAIR hyperintensities with presumed vascular origin, and one suspected case of cerebral vasculitis). Concerning the grey matter volumetry, we observed a loss of volume of 3.2% during an average period of approximately five months. During follow-up, the more frequent FDG-PET/CT findings were hypometabolism in temporal and insular regions. CONCLUSION A minority of initially severe COVID-19 patients demonstrated new complications on their brain MRIs during follow-up after recovery.
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Affiliation(s)
- François Lersy
- Service d’Imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.L.); (A.C.); (F.-D.A.); (S.B.)
| | - Caroline Bund
- ICANS, Service de Médecine Nucléaire, 67000 Strasbourg, France; (C.B.); (I.J.N.)
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
| | - Mathieu Anheim
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, CEDEX, 67200 Strasbourg, France; (M.A.); (C.P.)
- Institut de Génétique et de Biologie Moléculaire et Cellulaire (IGBMC), INSERM-U964/CNRS-UMR7104/Université de Strasbourg, 67400 Illkirch, France
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR 3072, Université de Strasbourg, 67000 Strasbourg, France;
| | - Mary Mondino
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
| | - Vincent Noblet
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
| | - Shirley Lazzara
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
| | - Clelie Phillipps
- Service de Neurologie, Hôpitaux Universitaires de Strasbourg, 1 Avenue Molière, CEDEX, 67200 Strasbourg, France; (M.A.); (C.P.)
| | - Olivier Collange
- Service d’Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (O.C.); (W.O.); (P.-M.M.)
| | - Walid Oulehri
- Service d’Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (O.C.); (W.O.); (P.-M.M.)
| | - Paul-Michel Mertes
- Service d’Anesthésie-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (O.C.); (W.O.); (P.-M.M.)
| | - Julie Helms
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (J.H.); (H.M.)
- INSERM (French National Institute of Health and Medical Research), UMR 1260, Regenerative Nanomedicine (RNM), CRBS (Centre de Recherche en Biomédecine de Strasbourg), FMTS (Fédération de Médecine Translationnelle de Strasbourg), Faculty of Medicine, University of Strasbourg, 67000 Strasbourg, France
| | - Hamid Merdji
- Service de Médecine Intensive-Réanimation, Nouvel Hôpital Civil, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (J.H.); (H.M.)
| | - Maleka Schenck
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires de Strasbourg, Hautepierre, 67000 Strasbourg, France; (M.S.); (F.S.)
| | - Francis Schneider
- Service de Médecine Intensive Réanimation, Hôpitaux Universitaires de Strasbourg, Hautepierre, 67000 Strasbourg, France; (M.S.); (F.S.)
| | - Julien Pottecher
- Fédération de Médecine Translationnelle de Strasbourg (FMTS), UR 3072, Université de Strasbourg, 67000 Strasbourg, France;
- Service d’Anesthésie-Réanimation et Médecine Péri-Opératoire, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France
| | - Céline Giraudeau
- Department of Radiology, IHU Strasbourg, 67000 Strasbourg, France;
| | - Agathe Chammas
- Service d’Imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.L.); (A.C.); (F.-D.A.); (S.B.)
| | - François-Daniel Ardellier
- Service d’Imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.L.); (A.C.); (F.-D.A.); (S.B.)
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
| | - Seyyid Baloglu
- Service d’Imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.L.); (A.C.); (F.-D.A.); (S.B.)
| | - Khalid Ambarki
- Siemens Healthcare, Siemens Healthcare SAS, 67200 Saint Denis, France;
| | - Izzie Jacques Namer
- ICANS, Service de Médecine Nucléaire, 67000 Strasbourg, France; (C.B.); (I.J.N.)
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
| | - Stéphane Kremer
- Service d’Imagerie 2, Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg, 67000 Strasbourg, France; (F.L.); (A.C.); (F.-D.A.); (S.B.)
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, University of Strasbourg-CNRS, UMR 7357, CEDEX, 67000 Strasbourg, France; (M.M.); (V.N.); (S.L.)
- Department of Radiology, IHU Strasbourg, 67000 Strasbourg, France;
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17
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Treating the body to prevent brain injury: lessons learned from the coronavirus disease 2019 pandemic. Curr Opin Crit Care 2022; 28:176-183. [PMID: 35058407 PMCID: PMC8891065 DOI: 10.1097/mcc.0000000000000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We aim to provide the current evidence on utility and application of neuromonitoring tools including electroencephalography (EEG), transcranial Doppler (TCD), pupillometry, optic nerve sheath diameter (ONSD), cerebral near-infrared spectroscopy (cNIRS), somatosensory-evoked potentials (SSEPs), and invasive intracranial monitoring in COVID-19. We also provide recent evidence on management strategy of COVID-19-associated neurological complications. RECENT FINDINGS Despite the common occurrence of neurological complications, we found limited use of standard neurologic monitoring in patients with COVID-19. No specific EEG pattern was identified in COVID-19. Frontal epileptic discharge was proposed to be a potential marker of COVID-19 encephalopathy. TCD, ONSD, and pupillometry can provide real-time data on intracranial pressure. Additionally, TCD may be useful for detection of acute large vessel occlusions, abnormal cerebral hemodynamics, cerebral emboli, and evolving cerebral edema at bedside. cNIRS was under-utilized in COVID-19 population and there are ongoing studies to investigate whether cerebral oxygenation could be a more useful parameter than peripheral oxygen saturation to guide clinical titration of permissive hypoxemia. Limited data exists on SSEPs and invasive intracranial monitoring. SUMMARY Early recognition using standardized neuromonitoring and timely intervention is important to reduce morbidity and mortality. The management strategy for neurological complications is similar to those without COVID-19.
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18
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Post-acute COVID-19 syndrome presented as a cerebral and systemic vasculitis: a case report. Acta Neurol Belg 2022; 122:1377-1379. [PMID: 35279794 PMCID: PMC8918071 DOI: 10.1007/s13760-022-01923-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 03/08/2022] [Indexed: 11/22/2022]
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19
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Tsvetanov KA, Spindler LRB, Stamatakis EA, Newcombe VFJ, Lupson VC, Chatfield DA, Manktelow AE, Outtrim JG, Elmer A, Kingston N, Bradley JR, Bullmore ET, Rowe JB, Menon DK. Hospitalisation for COVID-19 predicts long lasting cerebrovascular impairment: A prospective observational cohort study. Neuroimage Clin 2022; 36:103253. [PMID: 36451358 PMCID: PMC9639388 DOI: 10.1016/j.nicl.2022.103253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 10/06/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022]
Abstract
Human coronavirus disease 2019 (COVID-19) due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has multiple neurological consequences, but its long-term effect on brain health is still uncertain. The cerebrovascular consequences of COVID-19 may also affect brain health. We studied the chronic effect of COVID-19 on cerebrovascular health, in relation to acute severity, adverse clinical outcomes and in contrast to control group data. Here we assess cerebrovascular health in 45 patients six months after hospitalisation for acute COVID-19 using the resting state fluctuation amplitudes (RSFA) from functional magnetic resonance imaging, in relation to disease severity and in contrast with 42 controls. Acute COVID-19 severity was indexed by COVID-19 WHO Progression Scale, inflammatory and coagulatory biomarkers. Chronic widespread changes in frontoparietal RSFA were related to the severity of the acute COVID-19 episode. This relationship was not explained by chronic cardiorespiratory dysfunction, age, or sex. The level of cerebrovascular dysfunction was associated with cognitive, mental, and physical health at follow-up. The principal findings were consistent across univariate and multivariate approaches. The results indicate chronic cerebrovascular impairment following severe acute COVID-19, with the potential for long-term consequences on cognitive function and mental wellbeing.
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Affiliation(s)
- Kamen A Tsvetanov
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Psychology, University of Cambridge, Cambridge, United Kingdom.
| | - Lennart R B Spindler
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Emmanuel A Stamatakis
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Virginia F J Newcombe
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Victoria C Lupson
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom
| | - Doris A Chatfield
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Anne E Manktelow
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Joanne G Outtrim
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom
| | - Anne Elmer
- Cambridge Clinical Research Centre, NIHR Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Nathalie Kingston
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom; Department of Haematology, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - John R Bradley
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Edward T Bullmore
- Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom; Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - James B Rowe
- Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Medical Research Council Cognition and Brain Sciences Unit, Department of Psychiatry, Cambridge, United Kingdom
| | - David K Menon
- Division of Anaesthesia, Department of Medicine, University Cambridge, Cambridge, United Kingdom; Wolfson Brain Imaging Centre, University of Cambridge, Cambridge, United Kingdom; Cambridge Clinical Research Centre, NIHR Clinical Research Facility, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom; Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
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20
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Voruz P, Cionca A, Jacot de Alcântara I, Nuber-Champier A, Allali G, Benzakour L, Thomasson M, Lalive PH, Lövblad KO, Braillard O, Nehme M, Coen M, Serratrice J, Pugin J, Guessous I, Landis BN, Adler D, Griffa A, Van De Ville D, Assal F, Péron JA. OUP accepted manuscript. Brain Commun 2022; 4:fcac057. [PMID: 35350554 PMCID: PMC8956133 DOI: 10.1093/braincomms/fcac057] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 01/17/2022] [Accepted: 03/06/2022] [Indexed: 11/13/2022] Open
Abstract
Lack of awareness of cognitive impairment (i.e. anosognosia) could be a key
factor for distinguishing between neuropsychological post-COVID-19 condition
phenotypes. In this context, the 2-fold aim of the present study was to (i)
establish the prevalence of anosognosia for memory impairment, according to the
severity of the infection in the acute phase and (ii) determine whether
anosognosic patients with post-COVID syndrome have a different cognitive and
psychiatric profile from nosognosic patients, with associated differences in
brain functional connectivity. A battery of neuropsychological, psychiatric,
olfactory, dyspnoea, fatigue and quality-of-life tests was administered
227.07 ± 42.69 days post-SARS-CoV-2 infection to 102
patients (mean age: 56.35 years, 65 men, no history of neurological,
psychiatric, neuro-oncological or neurodevelopmental disorder prior to
infection) who had experienced either a mild (not hospitalized;
n = 45), moderate (conventional
hospitalization; n = 34) or severe
(hospitalization with intensive care unit stay and mechanical ventilation;
n = 23) presentation in the acute
phase. Patients were first divided into two groups according to the presence or
absence of anosognosia for memory deficits (26 anosognosic patients and 76
nosognosic patients). Of these, 49 patients underwent an MRI. Structural images
were visually analysed, and statistical intergroup analyses were then performed
on behavioural and functional connectivity measures. Only 15.6% of
patients who presented mild disease displayed anosognosia for memory
dysfunction, compared with 32.4% of patients with moderate presentation
and 34.8% of patients with severe disease. Compared with nosognosic
patients, those with anosognosia for memory dysfunction performed significantly
more poorly on objective cognitive and olfactory measures. By contrast, they
gave significantly more positive subjective assessments of their quality of
life, psychiatric status and fatigue. Interestingly, the proportion of patients
exhibiting a lack of consciousness of olfactory deficits was significantly
higher in the anosognosic group. Functional connectivity analyses revealed a
significant decrease in connectivity, in the anosognosic group as compared with
the nosognosic group, within and between the following networks: the left
default mode, the bilateral somatosensory motor, the right executive control,
the right salient ventral attention and the bilateral dorsal attention networks,
as well as the right Lobules IV and V of the cerebellum. Lack of awareness of
cognitive disorders and, to a broader extent, impairment of the self-monitoring
brain system, may be a key factor for distinguishing between the clinical
phenotypes of post-COVID syndrome with neuropsychological deficits.
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Affiliation(s)
- Philippe Voruz
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Alexandre Cionca
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Isabele Jacot de Alcântara
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Anthony Nuber-Champier
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
| | - Gilles Allali
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Leenaards Memory Center, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lamyae Benzakour
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Psychiatry Department, Geneva University Hospitals, Geneva, Switzerland
| | - Marine Thomasson
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Patrice H Lalive
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Karl-Olof Lövblad
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Diagnostic and Interventional Neuroradiology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Olivia Braillard
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Mayssam Nehme
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Matteo Coen
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Internal Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Serratrice
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Internal Medicine Department, Geneva University Hospitals, Geneva, Switzerland
| | - Jérôme Pugin
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Intensive Care Department, Geneva University Hospitals, Geneva, Switzerland
| | - Idris Guessous
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division and Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Basile N Landis
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Rhinology-Olfactology Unit, Otorhinolaryngology Department, Geneva University Hospitals, Geneva, Switzerland
| | - Dan Adler
- Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandra Griffa
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Dimitri Van De Ville
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Institute of Bioengineering, Center for Neuroprosthetics, Ecole Polytechnique Fédérale de Lausanne (EPFL), Lausanne, Switzerland
| | - Frédéric Assal
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Julie A Péron
- Clinical and Experimental Neuropsychology Laboratory, Faculty of Psychology, University of Geneva, Geneva, Switzerland
- Neurology Department, Geneva University Hospitals, Geneva, Switzerland
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21
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Kremer S, Gerevini S, Ramos A, Lersy F, Yousry T, Vernooij MW, Anzalone N, Jäger HR. Neuroimaging in patients with COVID-19: a neuroradiology expert group consensus. Eur Radiol 2022; 32:3716-3725. [PMID: 35044509 PMCID: PMC8766353 DOI: 10.1007/s00330-021-08499-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/27/2021] [Accepted: 11/30/2021] [Indexed: 02/06/2023]
Abstract
Neurological and neuroradiological manifestations in patients with COVID-19 have been extensively reported. Available imaging data are, however, very heterogeneous. Hence, there is a growing need to standardise clinical indications for neuroimaging, MRI acquisition protocols, and necessity of follow-up examinations. A NeuroCovid working group with experts in the field of neuroimaging in COVID-19 has been constituted under the aegis of the Subspecialty Committee on Diagnostic Neuroradiology of the European Society of Neuroradiology (ESNR). The initial objectives of this NeuroCovid working group are to address the standardisation of the imaging in patients with neurological manifestations of COVID-19 and to give advice based on expert opinion with the aim of improving the quality of patient care and ensure high quality of any future clinical studies. KEY POINTS: • In patients with COVID-19 and neurological manifestations, neuroimaging should be performed in order to detect underlying causal pathology. • The basic MRI recommended protocol includes T2-weighted, FLAIR (preferably 3D), and diffusion-weighted images, as well as haemorrhage-sensitive sequence (preferably SWI), and at least for the initial investigation pre and post-contrast T1 weighted-images. • 3D FLAIR should be acquired after gadolinium administration in order to optimise the detection of leptomeningeal contrast enhancement.
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Affiliation(s)
- Stéphane Kremer
- Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, Strasbourg, France.
- Engineering Science, Computer Science and Imaging Laboratory (ICube), Integrative Multimodal Imaging in Healthcare, UMR 7357, University of Strasbourg-CNRS, Strasbourg, France.
| | | | - Ana Ramos
- Sección de Neurorradiología, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | - François Lersy
- Hôpitaux Universitaires de Strasbourg, Service d'imagerie 2, Hôpital de Hautepierre, Strasbourg, France
| | - Tarek Yousry
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, Great Britain
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, Great Britain
| | - Meike W Vernooij
- Department of Radiology & Nuclear Medicine, Department of Epidemiology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Nicoletta Anzalone
- Department of Neuroradiology, IRCCS San Raffaele, Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Hans Rolf Jäger
- Neuroradiological Academic Unit, Queen Square UCL Institute of Neurology, London, Great Britain
- Lysholm Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London, Great Britain
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22
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Guo Y, Zhang Y, Hou Y, Guo P, Wang X, Zhang S, Yang P. Anticonstriction Effect of MCA in Rats by Danggui Buxue Decoction. Front Pharmacol 2021; 12:749915. [PMID: 34867357 PMCID: PMC8634798 DOI: 10.3389/fphar.2021.749915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Danggui Buxue decoction (DBD), consisting of Angelicae Sinensis Radix (ASR) and Astragali Radix (AR), is a famous prescription with the function of antivasoconstriction. This study intends to probe its mechanisms on the relaxation of the middle cerebral artery (MCA). Methods: Vascular tension of rat MCA was measured using a DMT620 M system. First, the identical series of concentrations of DBD, ASR, and AR were added into resting KCl and U46619 preconstricted MCA. According to the compatibility ratio, their dilatation effects were further investigated on KCl and U46619 preconstricted vessels. Third, four K+ channel blockers were employed to probe the vasodilator mechanism on KCl-contracted MCA. We finally examined the effects of DBD, ASR, and AR on the vascular tone of U46619-contracted MCA in the presence or absence of Ca2+. Results: Data suggested that DBD, ASR, and AR can relax on KCl and U46619 precontracted MCA with no effects on resting vessels. The vasodilator effect of ASR was greater than those of DBD and AR on KCl-contracted MCA. For U46619-contracted MCA, ASR showed a stronger vasodilator effect than DBD and AR at low concentrations, but DBD was stronger than ASR at high concentrations. Amazingly, the vasodilator effect of DBD was stronger than that of AR at all concentrations on two vasoconstrictors which evoked MCA. The vasodilator effect of ASR was superior to that of DBD at a compatibility ratio on KCl-contracted MCA at low concentrations, while being inferior to DBD at high concentrations. However, DBD exceeded AR in vasodilating MCA at all concentrations. For U46619-constricted MCA, DBD, ASR, and AR had almost identical vasodilation. The dilation of DBD and AR on KCl-contracted MCA was independent of K+ channel blockers. However, ASR may inhibit the K+ channel opening partially through synergistic interactions with Gli and BaCl2. DBD, ASR, and AR may be responsible for inhibiting [Ca2+]out, while ASR and AR can also inhibit [Ca2+]in. Conclusion: DBD can relax MCA with no effects on resting vessels. The mechanism may be related to ASR’s inhibition of KATP and Kir channels. Meanwhile, the inhibition of [Ca2+]out by DBD, ASR, and AR as well as the inhibition of [Ca2+]in by ASR and AR may contribute to dilate MCA.
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Affiliation(s)
- Ying Guo
- School of Basic Medical College, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu Fifth People's Hospital, Chengdu, China
| | - Yating Zhang
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Ya Hou
- School of Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Pengmei Guo
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiaobo Wang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Sanyin Zhang
- State Key Laboratory of Southwestern Chinese Medicine Resources, Innovative Institute of Chinese Medicine and Pharmacy, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Chengdu Integrated TCM and Western Medicine Hospital, Chengdu, China
| | - Peng Yang
- Chengdu Fifth People's Hospital, Chengdu, China
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23
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A Case of Post-COVID-19-Associated Paracentral Acute Middle Maculopathy and Giant Cell Arteritis-Like Vasculitis. J Neuroophthalmol 2021; 41:351-355. [PMID: 34415268 DOI: 10.1097/wno.0000000000001348] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
ABSTRACT A 47-year-old man with a history of COVID-19 infection 2 months before presentation, presented with a scotoma of the paracentral visual field of the right eye. After thorough testing and evaluation, a diagnosis of paracentral acute middle maculopathy (PAMM) was established. Two months later, the patient developed temporal headache and jaw claudication. High-dose steroids were initiated, and workup for giant cell arteritis (GCA) was undertaken. The patient experienced resolution of the symptoms within 24 hours of steroid initiation. ESR, CRP, and temporal artery biopsy results were normal, although all were obtained more than 2 weeks after steroid initiation. To the best of our knowledge, our patient represents the first individual to date to potentially implicate COVID-19 in both small and large vessel vasculitis in the ophthalmic setting.
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24
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Diagnosis and follow-up evaluation of central nervous system vasculitis: an evaluation of vessel-wall MRI findings. J Neurol 2021; 269:982-996. [PMID: 34236502 PMCID: PMC8264821 DOI: 10.1007/s00415-021-10683-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/19/2021] [Accepted: 06/21/2021] [Indexed: 01/14/2023]
Abstract
Objective To approach the clinical value of MRI with vessel wall imaging (VWI) in patients with central nervous system vasculitis (CNSV), we analyzed patterns of VWI findings both at the time of initial presentation and during follow-up. Methods Stenoocclusive lesions, vessel-wall contrast enhancement (VW-CE) and diffusion-restricted lesions were analyzed in patients with a diagnosis of CNSV. On available VWI follow-up, progression, regression or stability of VW-CE were evaluated and correlated with the clinical status. Results Of the 45 patients included, 28 exhibited stenoses visible on MR angiography (MRA-positive) while 17 had no stenosis (MRA-negative). VW-CE was found in 2/17 MRA-negative and all MRA-positive patients (p < 0.05). 79.1% (53/67) of stenoses showed VW-CE. VW-CE was concentric in 88.3% and eccentric in 11.7% of cases. Diffusion-restricted lesions were found more frequently in relation to stenoses with VW-CE than without VW-CE (p < 0.05). 48 VW-CE lesions in 23 patients were followed over a median time of 239.5 days. 13 VW-CE lesions (27.1%) resolved completely, 14 (29.2%) showed partial regression, 17 (35.4%) remained stable and 4 (8.3%) progressed. 22/23 patients received immunosuppressive therapy for the duration of follow-up. Patients with stable or progressive VW-CE were more likely (p < 0.05) to have a relapse (14/30 cases) than patients with partial or complete regression of VW-CE (5/25 cases). Conclusion Concentric VW-CE is a common finding in medium/large-sized vessel CNSV. VW-CE might represent active inflammation in certain situations. However, follow-up VWI findings proved ambiguous as persisting VW-CE despite immunosuppressive therapy and clinical remission was a frequent finding. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10683-7.
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25
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Vahedi A, Apap Mangion S, Silber E, Sibtain N, Chandra J. COVID-19 leukoencephalopathy with subacute magnetic resonance imaging findings of vasculitis and demyelination. J Neurovirol 2021; 27:656-661. [PMID: 34101087 PMCID: PMC8186364 DOI: 10.1007/s13365-021-00990-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/04/2021] [Accepted: 05/16/2021] [Indexed: 12/04/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly results in a respiratory illness in symptomatic patients; however, those critically ill can develop a leukoencephalopathy. We describe two patients who had novel subacute MRI findings in the context of coronavirus disease 2019 (COVID-19) leukoencephalopathy, which we hypothesize could implicate a potent small-vessel vasculitis, ischemic demyelination and the presence of prolonged ischemia. Recent evidence of the direct neuroinvasiness of SARS-CoV-2 leading to ischemia and vascular damage supports this hypothesis.
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Affiliation(s)
- Ali Vahedi
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Sean Apap Mangion
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Eli Silber
- Department of Neurology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Naomi Sibtain
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom
| | - Julie Chandra
- Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
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