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Trevino TN, Fogel AB, Otkiran G, Niladhuri SB, Sanborn MA, Class J, Almousawi AA, Vanhollebeke B, Tai LM, Rehman J, Richner JM, Lutz SE. Engineered Wnt7a ligands rescue blood-brain barrier and cognitive deficits in a COVID-19 mouse model. Brain 2024; 147:1636-1643. [PMID: 38306655 PMCID: PMC11068107 DOI: 10.1093/brain/awae031] [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: 10/22/2023] [Revised: 12/18/2023] [Accepted: 01/19/2024] [Indexed: 02/04/2024] Open
Abstract
Respiratory infection with SARS-CoV-2 causes systemic vascular inflammation and cognitive impairment. We sought to identify the underlying mechanisms mediating cerebrovascular dysfunction and inflammation following mild respiratory SARS-CoV-2 infection. To this end, we performed unbiased transcriptional analysis to identify brain endothelial cell signalling pathways dysregulated by mouse adapted SARS-CoV-2 MA10 in aged immunocompetent C57Bl/6 mice in vivo. This analysis revealed significant suppression of Wnt/β-catenin signalling, a critical regulator of blood-brain barrier (BBB) integrity. We therefore hypothesized that enhancing cerebrovascular Wnt/β-catenin activity would offer protection against BBB permeability, neuroinflammation, and neurological signs in acute infection. Indeed, we found that delivery of cerebrovascular-targeted, engineered Wnt7a ligands protected BBB integrity, reduced T-cell infiltration of the brain, and reduced microglial activation in SARS-CoV-2 infection. Importantly, this strategy also mitigated SARS-CoV-2 induced deficits in the novel object recognition assay for learning and memory and the pole descent task for bradykinesia. These observations suggest that enhancement of Wnt/β-catenin signalling or its downstream effectors could be potential interventional strategies for restoring cognitive health following viral infections.
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Affiliation(s)
- Troy N Trevino
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Avital B Fogel
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Guliz Otkiran
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Seshadri B Niladhuri
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Mark A Sanborn
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Jacob Class
- Department of Microbiology and Immunology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Ali A Almousawi
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Benoit Vanhollebeke
- Laboratory of Neurovascular Signaling, Department of Molecular Biology, ULB Neuroscience Institute, Université libre de Bruxelles (ULB), Gosselies B-6041, Belgium
| | - Leon M Tai
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Jalees Rehman
- Department of Biochemistry and Molecular Genetics, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Justin M Richner
- Department of Microbiology and Immunology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
| | - Sarah E Lutz
- Department of Anatomy and Cell Biology, University of Illinois at Chicago, College of Medicine, Chicago, IL 60612, USA
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Freidel MR, Vakhariya PA, Sardarni SK, Armen RS. The Dual-Targeted Fusion Inhibitor Clofazimine Binds to the S2 Segment of the SARS-CoV-2 Spike Protein. Viruses 2024; 16:640. [PMID: 38675980 PMCID: PMC11054727 DOI: 10.3390/v16040640] [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: 03/01/2024] [Revised: 03/29/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
Clofazimine and Arbidol have both been reported to be effective in vitro SARS-CoV-2 fusion inhibitors. Both are promising drugs that have been repurposed for the treatment of COVID-19 and have been used in several previous and ongoing clinical trials. Small-molecule bindings to expressed constructs of the trimeric S2 segment of Spike and the full-length SARS-CoV-2 Spike protein were measured using a Surface Plasmon Resonance (SPR) binding assay. We demonstrate that Clofazimine, Toremifene, Arbidol and its derivatives bind to the S2 segment of the Spike protein. Clofazimine provided the most reliable and highest-quality SPR data for binding with S2 over the conditions explored. A molecular docking approach was used to identify the most favorable binding sites on the S2 segment in the prefusion conformation, highlighting two possible small-molecule binding sites for fusion inhibitors. Results related to molecular docking and modeling of the structure-activity relationship (SAR) of a newly reported series of Clofazimine derivatives support the proposed Clofazimine binding site on the S2 segment. When the proposed Clofazimine binding site is superimposed with other experimentally determined coronavirus structures in structure-sequence alignments, the changes in sequence and structure may rationalize the broad-spectrum antiviral activity of Clofazimine in closely related coronaviruses such as SARS-CoV, MERS, hCoV-229E, and hCoV-OC43.
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Affiliation(s)
| | | | | | - Roger S. Armen
- Department of Pharmaceutical Sciences, College of Pharmacy, Thomas Jefferson University, 901 Walnut St. Suite 918, Philadelphia, PA 19170, USA (P.A.V.); (S.K.S.)
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Hu C. Marine natural products and human immunity: novel biomedical resources for anti-infection of SARS-CoV-2 and related cardiovascular disease. NATURAL PRODUCTS AND BIOPROSPECTING 2024; 14:12. [PMID: 38282092 PMCID: PMC10822835 DOI: 10.1007/s13659-024-00432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Abstract
Marine natural products (MNPs) and marine organisms include sea urchin, sea squirts or ascidians, sea cucumbers, sea snake, sponge, soft coral, marine algae, and microalgae. As vital biomedical resources for the discovery of marine drugs, bioactive molecules, and agents, these MNPs have bioactive potentials of antioxidant, anti-infection, anti-inflammatory, anticoagulant, anti-diabetic effects, cancer treatment, and improvement of human immunity. This article reviews the role of MNPs on anti-infection of coronavirus, SARS-CoV-2 and its major variants (such as Delta and Omicron) as well as tuberculosis, H. Pylori, and HIV infection, and as promising biomedical resources for infection related cardiovascular disease (irCVD), diabetes, and cancer. The anti-inflammatory mechanisms of current MNPs against SARS-CoV-2 infection are also discussed. Since the use of other chemical agents for COVID-19 treatment are associated with some adverse effects in cardiovascular system, MNPs have more therapeutic advantages. Herein, it's time to protect this ecosystem for better sustainable development in the new era of ocean economy. As huge, novel and promising biomedical resources for anti-infection of SARS-CoV-2 and irCVD, the novel potential mechanisms of MNPs may be through multiple targets and pathways regulating human immunity and inhibiting inflammation. In conclusion, MNPs are worthy of translational research for further clinical application.
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Affiliation(s)
- Chunsong Hu
- Department of Cardiovascular Medicine, Jiangxi Academy of Medical Science, Nanchang University, Hospital of Nanchang University, No. 461 Bayi Ave, Nanchang, 330006, Jiangxi, China.
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4
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Zuin M, Mazzitelli M, Rigatelli G, Bilato C, Cattelan AM. Risk of ischemic stroke in patients recovered from COVID-19 infection: A systematic review and meta-analysis. Eur Stroke J 2023; 8:915-922. [PMID: 37491810 PMCID: PMC10372514 DOI: 10.1177/23969873231190432] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Data regarding the risk of ischemic stroke within 1 year after the post-acute phase of COVID-19 remain scant. We assess the risk of ischemic stroke in COVID-19 survivors after SARS-CoV-2 infection by performing a systematic review and meta-analysis of the available data. METHODS Following the PRISMA guidelines, we searched Medline and Scopus to locate all articles published up to February 11, 2023, reporting the risk of incident ischemic stroke in adult patients recovered from COVID-19 infection compared to non-infected patients (controls) defined as those who did not experience the infection over the same follow-up period. Ischemic stroke risk was evaluated using the Mantel-Haenszel random effects models with adjusted Hazard ratio (HR) as the effect measure with 95% confidence interval (CI) while heterogeneity was assessed using Higgins I2 statistic. RESULTS Overall, 23,559,428 patients (mean age 56, 1 year, 54.3% males), of whom 1,595,984 had COVID-19, were included. Over a mean follow-up of 9.2 months, ischemic stroke occurred in 4.40 [95% CI: 4.36-4.43] out of 1000 patients survived to COVID-19 compared to 3.25 [95% CI:3.21-3.29] out of 1000 controls. Recovered COVID-19 patients presented a higher risk of ischemic stroke ((HR: 2.06, 95% CI: 1.75-2.41, p < 0.0001, I2 = 63.7%) compared to people who did not have COVID-19. COVID-19 patients hospitalized at the time of the infection have a subsequent higher risk of stroke during the follow-up compared to those non-hospitalized. CONCLUSIONS Recovered COVID-19 patients have a higher risk of ischemic stroke compared to subjects from the general population within 9 months from the index infection.
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Affiliation(s)
- Marco Zuin
- Department of Translational Medicine, University of Ferrara, Ferrara, Italy
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Italy
| | - Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
| | | | - Claudio Bilato
- Department of Cardiology, West Vicenza Hospitals, Arzignano, Italy
| | - Anna Maria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, Padua, Italy
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5
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Brown RL, Benjamin L, Lunn MP, Bharucha T, Zandi MS, Hoskote C, McNamara P, Manji H. Pathophysiology, diagnosis, and management of neuroinflammation in covid-19. BMJ 2023; 382:e073923. [PMID: 37595965 DOI: 10.1136/bmj-2022-073923] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
Although neurological complications of SARS-CoV-2 infection are relatively rare, their potential long term morbidity and mortality have a significant impact, given the large numbers of infected patients. Covid-19 is now in the differential diagnosis of a number of common neurological syndromes including encephalopathy, encephalitis, acute demyelinating encephalomyelitis, stroke, and Guillain-Barré syndrome. Physicians should be aware of the pathophysiology underlying these presentations to diagnose and treat patients rapidly and appropriately. Although good evidence has been found for neurovirulence, the neuroinvasive and neurotropic potential of SARS-CoV-2 is limited. The pathophysiology of most complications is immune mediated and vascular, or both. A significant proportion of patients have developed long covid, which can include neuropsychiatric presentations. The mechanisms of long covid remain unclear. The longer term consequences of infection with covid-19 on the brain, particularly in terms of neurodegeneration, will only become apparent with time and long term follow-up.
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Affiliation(s)
- Rachel L Brown
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Institute of Immunity and Transplantation, London, UK
| | - Laura Benjamin
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- UCL Laboratory of Molecular and Cell Biology, London, UK
| | - Michael P Lunn
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Tehmina Bharucha
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- Department of Biochemistry, University of Oxford, UK
| | - Michael S Zandi
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Chandrashekar Hoskote
- Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Patricia McNamara
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Hadi Manji
- University College London, Queen Square Institute of Neurology, London, UK
- National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
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6
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Omidian N, Mohammadi P, Sadeghalvad M, Mohammadi-Motlagh HR. Cerebral microvascular complications associated with SARS-CoV-2 infection: How did it occur and how should it be treated? Biomed Pharmacother 2022; 154:113534. [PMID: 35994816 PMCID: PMC9381434 DOI: 10.1016/j.biopha.2022.113534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 01/08/2023] Open
Abstract
Cerebral microvascular disease has been reported as a central feature of the neurological disorders in patients with SARS-CoV-2 infection that may be associated with an increased risk of ischemic stroke. The main pathomechanism in the development of cerebrovascular injury due to SARS-CoV-2 infection can be a consequence of endothelial cell dysfunction as a structural part of the blood-brain barrier (BBB), which may be accompanied by increased inflammatory response and thrombocytopenia along with blood coagulation disorders. In this review, we described the properties of the BBB, the neurotropism behavior of SARS-CoV-2, and the possible mechanisms of damage to the CNS microvascular upon SARS-CoV-2 infection.
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Affiliation(s)
- Neda Omidian
- Department of Physiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Pantea Mohammadi
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mona Sadeghalvad
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Hamid-Reza Mohammadi-Motlagh
- Medical Biology Research Center, Health Technology Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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7
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Keep RF, Jones HC, Drewes LR. Advances in brain barriers and brain fluids research in 2021: great progress in a time of adversity. Fluids Barriers CNS 2022; 19:48. [PMID: 35681151 PMCID: PMC9178944 DOI: 10.1186/s12987-022-00343-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022] Open
Abstract
This editorial highlights advances in brain barrier and brain fluid research in 2021. It covers research on components of the blood–brain barrier, neurovascular unit and brain fluid systems; how brain barriers and brain fluid systems are impacted by neurological disorders and their role in disease progression; and advances in strategies for treating such disorders.
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Affiliation(s)
- Richard F Keep
- Department of Neurosurgery, University of Michigan, R5018 BSRB, 109 Zina Pitcher Place, Ann Arbor, MI, 48109-2200, USA.
| | | | - Lester R Drewes
- Department of Biomedical Sciences, University of Minnesota Medical School Duluth, Duluth, MN, 55812, USA
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8
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Alkayed NJ, Cipolla MJ. Role of Endothelial Cells and Platelets in COVID-Related Cerebrovascular Events. Stroke 2022; 53:2389-2392. [PMID: 35674044 PMCID: PMC9232245 DOI: 10.1161/strokeaha.122.039971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nabil J. Alkayed
- Department of Anesthesiology and Perioperative Medicine and Knight Cardiovascular Institute, Portland, OR (N.J.A.)
| | - Marilyn J. Cipolla
- Department of Neurological Sciences, University of Vermont Larner College of Medicine, Burlington (M.J.C.)
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9
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Akhtar N, Abid F, Singh R, Kamran S, Imam Y, Al Jerdi S, Salameh S, Al Attar R, Yasir M, Shabir H, Morgan D, Joseph S, AlMaslamani M, Shuaib A. Characteristics and comparisons of acute stroke in "recovered" to "active COVID-19 and "pre-pandemic" in Qatar database. J Thromb Thrombolysis 2022; 53:824-828. [PMID: 35244832 PMCID: PMC8894126 DOI: 10.1007/s11239-021-02581-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/28/2021] [Indexed: 12/02/2022]
Abstract
Understanding the relationship of COVID-19 to stroke is important. We compare characteristics of pre-pandemic stroke (PPS), cases in acute COVID infection (CS) and in patients who have recovered from COVID-19 infection (RCS). We interrogated the Qatar stroke database for all stroke admissions between Jan 2020 and Feb 2021 (PPS) to CS and RCS to determine how COVID-19 affected ischemic stroke sub-types, clinical course, and outcomes prior to, during and post-pandemic peak. There were 3264 cases admitted (pre-pandemic: 3111, stroke in COVID-19: 60 and recovered COVID-19 stroke: 93). Patients with CS were significantly younger, had more severe symptoms, fever on presentation, more ICU admissions and poor stroke recovery at discharge when compared to PPS and RCS. Large vessel disease and cardioembolic disease was significantly higher in CS compared to PPS or RCS. There was a significant decline in stroke mimics in CS. Stroke in RCS has characteristics similar to PPS with no evidence of lasting effects of the virus on the short-term. However, CS is a more serious disease and tends to be more severe and have a poor prognosis.
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Affiliation(s)
- Naveed Akhtar
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Abid
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Hamad Medical Corporation, Doha, Qatar
| | - Saadat Kamran
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Yahia Imam
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | | | - Sarah Salameh
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Rand Al Attar
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Muhammad Yasir
- Emergency Department, Hamad Medical Corporation, Doha, Qatar
| | - Hammad Shabir
- Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Deborah Morgan
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Sujatha Joseph
- The Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Muna AlMaslamani
- Infectious Diseases Section, Medicine Department, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Department of Medicine, University of Alberta, Edmonton, AB Canada
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10
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Urbanek C, Grau AJ. Abgeschlagenheit mit rechtsseitiger Lähmung und Sprachstörung 2 Wochen nach SARS-CoV‑2-Infektion. DGNEUROLOGIE 2022. [PMCID: PMC8990601 DOI: 10.1007/s42451-022-00427-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- C. Urbanek
- Neurologische Klinik mit Klinischer Neurophysiologie, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063 Ludwigshafen, Deutschland
| | - A. J. Grau
- Neurologische Klinik mit Klinischer Neurophysiologie, Klinikum der Stadt Ludwigshafen am Rhein, Bremserstr. 79, 67063 Ludwigshafen, Deutschland
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11
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Yus M, Matias‐Guiu JA, Gil‐Martínez L, Gómez‐Ruiz N, Polidura C, Jorquera M, Delgado‐Alonso C, Díez‐Cirarda M, Matías‐Guiu J, Arrazola J. Persistent olfactory dysfunction after COVID-19 is associated with reduced perfusion in the frontal lobe. Acta Neurol Scand 2022; 146:194-198. [PMID: 35467007 PMCID: PMC9111206 DOI: 10.1111/ane.13627] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/18/2022] [Indexed: 12/24/2022]
Abstract
Background Olfactory dysfunction is common during SARS‐CoV‐2 infection. The pathophysiology of the persistence of this symptom and the potential relationship with central nervous system involvement is unknown. Aim of the study To evaluate the neural correlates of persistent olfactory dysfunction in a series of patients with post‐COVID syndrome. Methods Eighty‐two patients with post‐COVID syndrome were assessed with the Brief Smell Identification Test and a multimodal MRI study including 3D‐T1, T2‐FLAIR, diffusion‐tensor imaging, and arterial spin labeling. Olfactory and neuroimaging examinations were performed 11.18 ± 3.78 months after the acute infection. Voxel‐based brain mapping analyses were conducted to correlate the olfactory test with brain volumes, white matter microstructure, and brain perfusion. Results Olfactory dysfunction was associated with lower tissue perfusion in the orbital and medial frontal regions in the arterial spin labeling sequence. Conversely, no statistically significant findings were detected in brain volumes and diffusion‐tensor imaging. Mild changes in paranasal sinuses and nasal cavities were detected in 9.75% of cases, with no association with olfactory deficits. Conclusions We provide new insights regarding the pathophysiology of persistent olfactory dysfunction after COVID‐19, involving the main brain regions associated with the olfactory system.
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Affiliation(s)
- Miguel Yus
- Department of Radiology Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Jordi A. Matias‐Guiu
- Department of Neurology Hospital Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Lidia Gil‐Martínez
- Department of Radiology Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Natividad Gómez‐Ruiz
- Department of Radiology Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Carmen Polidura
- Department of Radiology Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Manuela Jorquera
- Department of Radiology Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Cristina Delgado‐Alonso
- Department of Neurology Hospital Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - María Díez‐Cirarda
- Department of Neurology Hospital Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Jorge Matías‐Guiu
- Department of Neurology Hospital Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
| | - Juan Arrazola
- Department of Radiology Clínico San Carlos Health Research Institute “San Carlos” (IdISSC) Universidad Complutense de Madrid Madrid Spain
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12
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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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13
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Hernández VS, Zetter MA, Guerra EC, Hernández-Araiza I, Karuzin N, Hernández-Pérez OR, Eiden LE, Zhang L. ACE2 expression in rat brain: Implications for COVID-19 associated neurological manifestations. Exp Neurol 2021; 345:113837. [PMID: 34400158 PMCID: PMC8361001 DOI: 10.1016/j.expneurol.2021.113837] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/12/2021] [Accepted: 08/06/2021] [Indexed: 02/07/2023]
Abstract
We examined cell type-specific expression and distribution of rat brain angiotensin-converting enzyme 2 (ACE2), the receptor for SARS-CoV-2, in the rodent brain. ACE2 is ubiquitously present in brain vasculature, with the highest density of ACE2 expressing capillaries found in the olfactory bulb, the hypothalamic paraventricular, supraoptic, and mammillary nuclei, the midbrain substantia nigra and ventral tegmental area, and the hindbrain pontine nucleus, the pre-Bötzinger complex, and nucleus of tractus solitarius. ACE2 was expressed in astrocytes and astrocytic foot processes, pericytes and endothelial cells, key components of the blood-brain barrier. We found discrete neuronal groups immunopositive for ACE2 in brainstem respiratory rhythm generating centers, including the pontine nucleus, the parafascicular/retrotrapezoid nucleus, the parabrachial nucleus, the Bötzinger, and pre-Bötzinger complexes and the nucleus of tractus solitarius; in the arousal-related pontine reticular nucleus and gigantocellular reticular nuclei; in brainstem aminergic nuclei, including substantia nigra, ventral tegmental area, dorsal raphe, and locus coeruleus; in the epithalamic habenula, hypothalamic paraventricular and supramammillary nuclei; and in the hippocampus. Identification of ACE2-expressing neurons in rat brain within well-established functional circuits facilitates prediction of possible neurological manifestations of brain ACE2 dysregulation during and after COVID-19 infection.
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Affiliation(s)
- Vito S Hernández
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico)
| | - Mario A Zetter
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico)
| | - Enrique C Guerra
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico)
| | - Ileana Hernández-Araiza
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico); School of Medicine University of Maryland, Baltimore, MD, USA
| | - Nikita Karuzin
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico); School of Medicine, Pan-American University, Mexico City, Mexico
| | - Oscar R Hernández-Pérez
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico)
| | - Lee E Eiden
- Section on Molecular Neuroscience, NIMH-IRP, NIH, Bethesda, MD, USA
| | - Limei Zhang
- Dept. Physiology, Laboratory of Systems Neuroscience, School of Medicine, National Autonomous University of Mexico (UNAM, Mexico City, Mexico).
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14
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Delorme C, Houot M, Rosso C, Carvalho S, Nedelec T, Maatoug R, Pitron V, Gassama S, Sambin S, Bombois S, Herlin B, Ouvrard G, Bruneteau G, Hesters A, Gales AZ, Millet B, Lamari F, Lehericy S, Navarro V, Rohaut B, Demeret S, Maisonobe T, Yger M, Degos B, Mariani LL, Bouche C, Dzierzynski N, Oquendo B, Ketz F, Nguyen AH, Kas A, Lubetzki C, Delattre JY, Corvol JC. The wide spectrum of COVID-19 neuropsychiatric complications within a multidisciplinary centre. Brain Commun 2021; 3:fcab135. [PMID: 34401746 PMCID: PMC8344449 DOI: 10.1093/braincomms/fcab135] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/29/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
A variety of neuropsychiatric complications has been described in association
with COVID-19 infection. Large scale studies presenting a wider picture of these
complications and their relative frequency are lacking. The objective of our
study was to describe the spectrum of neurological and psychiatric complications
in patients with COVID-19 seen in a multidisciplinary hospital centre over 6
months. We conducted a retrospective, observational study of all patients
showing neurological or psychiatric symptoms in the context of COVID-19 seen in
the medical and university neuroscience department of Assistance Publique
Hopitaux de Paris—Sorbonne University. We collected demographic data,
comorbidities, symptoms and severity of COVID-19 infection, neurological and
psychiatric symptoms, neurological and psychiatric examination data and, when
available, results from CSF analysis, MRI, EEG and EMG. A total of 249 COVID-19
patients with a de novo neurological or psychiatric
manifestation were included in the database and 245 were included in the final
analyses. One-hundred fourteen patients (47%) were admitted to the
intensive care unit and 10 (4%) died. The most frequent neuropsychiatric
complications diagnosed were encephalopathy (43%), critical illness
polyneuropathy and myopathy (26%), isolated psychiatric disturbance
(18%) and cerebrovascular disorders (16%). No patients showed
CSF evidence of SARS-CoV-2. Encephalopathy was associated with older age and
higher risk of death. Critical illness neuromyopathy was associated with an
extended stay in the intensive care unit. The majority of these neuropsychiatric
complications could be imputed to critical illness, intensive care and systemic
inflammation, which contrasts with the paucity of more direct SARS-CoV-2-related
complications or post-infection disorders.
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Affiliation(s)
- Cécile Delorme
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Marion Houot
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Institut de la Mémoire et de la maladie d'Alzheimer, Paris 75013, France.,Centre of Excellence of Neurodegenerative Disease (CoEN), Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Charlotte Rosso
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Urgences cérébro-Vasculaires, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France.,Paris Brain Institute-ICM Stroke Network, STAR Team, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Stéphanie Carvalho
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France
| | - Thomas Nedelec
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,INRIA, Aramis Project-Team, Paris 75013, France
| | - Redwan Maatoug
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Service de Psychiatrie adulte, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Victor Pitron
- Service de Psychiatrie adulte, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France.,Institut Jean-Nicod, UMR 8129, ENS/EHESS/CNRS, IEC, PSL Research University, Paris 75005, France
| | - Salimata Gassama
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Sara Sambin
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Stéphanie Bombois
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Institut de la Mémoire et de la maladie d'Alzheimer, Paris 75013, France
| | - Bastien Herlin
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Unité d'épileptologie, Paris 75013, France.,Département de Médecine Physique et de réadaptation, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié Salpêtrière Hospital, Paris 75013, France
| | - Gaëlle Ouvrard
- Service de Neuro-orthopédie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Rothschild Hospital, Paris 75012, France
| | - Gaëlle Bruneteau
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France.,Centre de Recherche en Myologie, UMRS974, Association Institut de Myologie, Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Paris 75013, France
| | - Adèle Hesters
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Ana Zenovia Gales
- Service des Pathologies du sommeil, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Bruno Millet
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Service de Psychiatrie adulte, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Foudil Lamari
- Département de Biochimie Métabolique, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Stéphane Lehericy
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neuroradiologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Vincent Navarro
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Unité d'épileptologie, Paris 75013, France.,Département de Neurophysiologie Clinique, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Benjamin Rohaut
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Sophie Demeret
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Thierry Maisonobe
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France.,Département de Neurophysiologie Clinique, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Marion Yger
- Unité de Soins intentifs neurovasculaires, Assistance Publique Hôpitaux de Paris, Sorbonne Université Saint-Antoine Hospital, Paris 75012, France
| | - Bertrand Degos
- Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Avicenne Hospital, Bobigny 93000, France
| | - Louise-Laure Mariani
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Christophe Bouche
- Service de Psychiatrie adulte, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Nathalie Dzierzynski
- Département de Psychiatrie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Tenon Hospital, Paris 75020, France
| | - Bruno Oquendo
- Service de Gériatrie à orientation neurologique, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Charles Foix Hospital, Paris 94200, France
| | - Flora Ketz
- Service de Gériatrie polyvalente, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Charles Foix Hospital, Paris 94200, France
| | - An-Hung Nguyen
- Service d'Addictologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière, Paris 75013, France
| | - Aurélie Kas
- Service de Médecine Nucléaire et LIB, INSERM U1146, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié- Salpêtrière Hospital, Paris 75013, France
| | - Catherine Lubetzki
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
| | - Jean-Yves Delattre
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France
| | - Jean-Christophe Corvol
- CNRS UMR 7225, Sorbonne Université, Paris Brain Institute-ICM, Inserm U1127, Paris 75013, France.,Département de Neurologie, Assistance Publique Hôpitaux de Paris, Sorbonne Université, Pitié-Salpêtrière Hospital, Paris 75013, France
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15
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de Marcellus C, Dupic L, Roux CJ, El Aouane El Ghomari I, Parize P, Luscan R, Moulin F, Kossorotoff M. Case Report: Cerebrovascular Events Associated With Bacterial and SARS-CoV-2 Infections in an Adolescent. Front Neurol 2021; 12:606617. [PMID: 33897582 PMCID: PMC8060448 DOI: 10.3389/fneur.2021.606617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/12/2021] [Indexed: 01/19/2023] Open
Abstract
Neurologic manifestations associated with Covid-19 are increasingly reported, especially stroke and acute cerebrovascular events. Beyond cardiovascular risk factors associated with age, some young adults without medical or cardiovascular history had stroke as a presenting feature of Covid-19. Suggested stroke mechanisms in this setting are inflammatory storm, subsequent hypercoagulability, and vasculitis. To date, a handful of pediatric stroke cases associated with Covid-19 have been reported, either with a cardioembolic mechanism or a focal cerebral arteriopathy. We report the case of an adolescent who presented with febrile meningism and stupor. Clinical, biological, and radiological features favored the diagnosis of Lemierre syndrome (LS), with Fusobacterium necrophorum infection (sphenoid sinusitis and meningitis) and intracranial vasculitis. The patient had concurrent SARS-CoV-2 infection. Despite medical and surgical antimicrobial treatment, stroke prevention, and venous thrombosis prevention, he presented with severe cerebrovascular complications. Venous thrombosis and stroke were observed, with an extension of intracranial vasculitis, and lead to death. As both F. necrophorum and SARS-CoV-2 enhance inflammation, coagulation, and activate endothelial cells, we discuss how this coinfection may have potentiated and aggravated the usual course of LS. The potentiation by SARS-CoV-2 of vascular and thrombotic effects of a bacterial infection may represent an underreported cerebrovascular injury mechanism in Covid-19 patients. These findings emphasize the variety of mechanisms underlying stroke in this disease. Moreover, in the setting of SARS-CoV-2 pandemic, we discuss in what extent sanitary measures, namely, lockdown and fear to attend medical facilities, may have delayed diagnosis and influenced outcomes. This case also emphasizes the role of clinical assessment and the limits of telemedicine for acute neurological condition diagnosis.
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Affiliation(s)
- Charles de Marcellus
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Laurent Dupic
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Charles-Joris Roux
- Pediatric Radiology Department, APHP University Hospital Necker-Enfants Malades, Paris, France
| | | | - Perrine Parize
- Department of Infectious Diseases and Tropical Medicine, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - Romain Luscan
- Université de Paris, Paris, France.,Pediatric Otorhinolaryngology Department, APHP University Hospital Necker-Enfants Malades, Paris, France
| | - Florence Moulin
- Pediatric Intensive Care Unit, APHP University Hospital Necker-Enfants Malades, Paris, France.,Université de Paris, Paris, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, Pediatric Neurology Department, APHP University Hospital Necker-Enfants Malades, Paris, France.,Inserm U1266, Paris, France
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