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Mendonça Filho VCM, de Oliveira AG, Maia IDFVC, de Falcone ACM, Betini BG, Rezende LB, Magri Alves FH. COVID-19 in the nervous system: physiopathology and neurological manifestations. ARQUIVOS DE NEURO-PSIQUIATRIA 2023; 81:756-763. [PMID: 37402400 PMCID: PMC10468725 DOI: 10.1055/s-0043-1769123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/24/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although respiratory manifestations have received greater visibility during the pandemic caused by this virus, numerous neurological complaints related to coronavirus 2 infection have been documented in several countries. These records suggest that this pathogen presents neurotropism, and it can cause different neurological conditions of varying intensity. OBJECTIVE To investigate the ability of coronavirus 2 to invade the central nervous system (CNS) and its neurological clinical outcomes. METHODS The present study consists in a comprehensive literature review of the records available in the PubMed, SciELO, and Google Scholar databases. The descriptors COVID-19, brain and physiopathology, associated with the Boolean operator AND, were used in the search. Regarding the inclusion and exclusion criteria, we selected the papers published since 2020 with the highest number of citations. RESULTS We selected 41 articles, most of them in English. The main clinical manifestation associated with COVID-19 patients was headache, but cases of anosmia, hyposmia, Guillain-Barré syndrome, and encephalopathies were also described with considerable frequency. CONCLUSION Coronavirus-2 presents neurotropism, and it can reach the CNS by hematogenous dissemination and by direct infection of the nerve endings. It causes brain injuries through several mechanisms, such as cytokine storm, microglial activation, and an increase in thrombotic factors.
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Affiliation(s)
| | | | | | | | - Beatriz Gioppo Betini
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Neurologia, Ribeirão Preto SP, Brazil.
| | - Lucas Bruno Rezende
- Universidade Federal de Minas Gerais, Hospital das Clínicas, Belo Horizonte MG, Brazil.
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Melendez-Zaidi AE, Foroozan R, Orman G, Abid F. COVID-19 Vaccination May Provoke Intracranial Hypertension. JOURNAL OF PEDIATRIC NEUROLOGY 2022. [DOI: 10.1055/s-0042-1750788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
AbstractIn parallel to the spread of the novel severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), there has been the growing recognition that active SARS-CoV-2 infection has the potential to effect both the peripheral and central nervous systems. When it comes to the SARS-CoV-2 vaccine, however, reporting has been more uncertain. As the vaccination rate has risen, we have seen a rise in rare neurological complications thought to be associated with the vaccination including acute transverse myelitis, Guillain–Barre syndrome, optic neuritis, and Tolosa–Hunt syndrome. The Centers for Disease Control and Prevention (CDC) estimates 98 confirmed cases of Guillain–Barre syndrome out of 12.6 million doses. Given the initial age limits of vaccination eligibility, most reports have been limited to the adult population. Here, we report a case of intracranial hypertension (IH), evolving to fulminant IH in a healthy female after receiving the SARS-CoV-2 vaccine. While elevated intracranial pressure has been reported in the context of active SARS-CoV-2 infections and postinfection multisystem inflammatory syndrome (MIS-C), this is the first reported case of pediatric IH after vaccination alone.
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Affiliation(s)
- Alexandria E. Melendez-Zaidi
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Rod Foroozan
- Department of Ophthalmology, Baylor College of Medicine, Houston, Texas, United States
| | - Gunes Orman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital, Houston, Texas, United States
| | - Farida Abid
- Section of Pediatric Neurology and Developmental Neuroscience, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
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Sriuoginys S, Margareta S, Jon Hersir E. De Novo Presentation of Idiopathic Intracranial Hypertension (IIH) Associated With COVID-19 Infection. Neurohospitalist 2022; 12:691-692. [PMID: 36147772 PMCID: PMC9117983 DOI: 10.1177/19418744221102044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The COVID-19 virus has been associated with a variety of neurological complications. We present the case of a 41 year old woman who presented with visual symptoms associated with COVID-19 infection. Neurological examination revealed bilateral papilledema and after exclusion of other disorders such as brain tumour and sinus thrombosis she received a diagnosis of IIH, fulfilling the diagnostic criteria for this disorder. We believe there is a causal association between COVID-19 and IIH in her case. Doctors treating COVID-19 patients should be aware of this possible association as early diagnosis and treatment can be important to prevent visual deterioration.
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Affiliation(s)
- Saulius Sriuoginys
- Department of Neurology, Central Hospital in Kristianstad, Kristianstad, Sweden
| | - Sköld Margareta
- Department of Neurology, Central Hospital in Kristianstad, Kristianstad, Sweden
| | - Eliasson Jon Hersir
- Department of Neurology, Central Hospital in Kristianstad, Kristianstad, Sweden
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Li J, Huang J, Pang T, Chen Z, Li J, Wu L, Hu Y, Chen W. Risk Estimation of Infectious and Inflammatory Disorders in Hospitalized Patients With Acute Ischemic Stroke Using Clinical-Lab Nomogram. Front Neurol 2021; 12:710144. [PMID: 34956037 PMCID: PMC8702498 DOI: 10.3389/fneur.2021.710144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 08/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background: Infections after acute ischemic stroke are common and likely to complicate the clinical course and negatively affect patient outcomes. Despite the development of various risk factors and predictive models for infectious and inflammatory disorders (IAID) after stroke, more objective and easily obtainable predictors remain necessary. This study involves the development and validation of an accessible, accurate nomogram for predicting in-hospital IAID in patients with acute ischemic stroke (AIS). Methods: A retrospective cohort of 2,257 patients with AIS confirmed by neurological examination and radiography was assessed. The International Statistical Classification of Diseases and Health related Problem's definition was used for IAID. Data was obtained from two hospitals between January 2016 and March 2020. Results: The incidence of IAID was 19.8 and 20.8% in the derivation and validation cohorts, respectively. Using an absolute shrinkage and selection operator (LASSO) algorithm, four biochemical blood predictors and four clinical indicators were optimized from fifty-five features. Using a multivariable analysis, four predictors, namely age (adjusted odds ratio, 1.05; 95% confidence interval [CI], 1.038–1.062; p < 0.001), comatose state (28.033[4.706–536.403], p = 0.002), diabetes (0.417[0.27–0.649], p < 0.001), and congestive heart failure (CHF) (5.488[2.451–12.912], p < 0.001) were found to be risk factors for IAID. Furthermore, neutrophil, monocyte, hemoglobin, and high-sensitivity C-reactive protein were also found to be independently associated with IAID. Consequently, a reliable clinical-lab nomogram was constructed to predict IAID in our study (C-index value = 0.83). The results of the ROC analysis were consistent with the calibration curve analysis. The decision curve demonstrated that the clinical-lab model added more net benefit than either the lab-score or clinical models in differentiating IAID from AIS patients. Conclusions: The clinical-lab nomogram predicted IAID in patients with acute ischemic stroke. As a result, this nomogram can be used for identification of high-risk patients and to further guide clinical decisions.
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Affiliation(s)
- Junhong Li
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Jingjing Huang
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Tingting Pang
- Guangxi University of Chinese Medicine, Nanning, China
| | - Zikun Chen
- Guangxi University of Chinese Medicine, Nanning, China
| | - Jing Li
- Guangxi University of Chinese Medicine, Nanning, China
| | - Lin Wu
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Yuqiang Hu
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
| | - Wei Chen
- Department of Neurology, The First Affiliated Hospital of Guangxi University of Chinese Medicine, Nanning, China
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Characteristics and Outcomes of the Idiopathic Intracranial Hypertension Treatment in Intrinsic and Extrinsic Stenosis: A Single-Center Experience in China. Neurol Ther 2021; 10:1029-1044. [PMID: 34542867 PMCID: PMC8571462 DOI: 10.1007/s40120-021-00281-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 09/03/2021] [Indexed: 10/27/2022] Open
Abstract
INTRODUCTION This study aimed to explore the precipitating factors and evaluate the impact of different stenosis types on treatment outcomes in patients with idiopathic intracranial hypertension (IIH) and venous sinus stenosis (VSS). METHODS We recruited patients with IIH who presented with VSS, either intrinsic or extrinsic. We observed the clinical and laboratory findings, and we then compared the outcomes of stenting and medical treatment in different stenosis types. RESULTS Among 145 patients with IIH and VSS, 59 were of the intrinsic type and 86 were of the extrinsic type. Patients in the intrinsic group were older (42 vs. 34 years old, P < 0.001) and presented with higher pre-op gradient pressure (15 mmHg vs. 12 mmHg, P < 0.001). There was no significant difference between groups regarding other precipitating factors (P > 0.05). Stenting was significantly associated with complete resolution of the headache and impaired vision both in intrinsic (adjusted OR 0.017, 95% CI 0.001-0.35, P = 0.011; adjusted OR 0.056, 95% CI 0.004-0.697, P = 0.025, respectively) and extrinsic types of stenosis (adjusted OR 0.072, 95% CI 0.015-0.343, P = 0.001; adjusted OR 0.241, 95% CI 0.062-0.931, P = 0.039, respectively). Meanwhile, stenting was significantly associated with improvement of the papilledema in extrinsic-type stenosis compared with medical treatment (adjusted OR 0.017, 95% CI 0.002-0.135, P < 0.001). CONCLUSION Stenting may provide substantial clinical improvement in patients with IIH regardless of intrinsic or extrinsic stenosis type in our patient population, as noted in other series. TRIAL REGISTRATION Clinical trial registration number ChiCTR-ONN-17010421.
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Krueger MB, Montenegro RC, de Araújo Coimbra PP, de Queiroz Lemos L, Fiorenza RM, da Silva Fernandes CJ, Pessoa MSL, Rodrigues CL, da Cruz CG, de Araújo Verdiano V, de Carvalho Araújo FM, Braga-Neto P, Sobreira-Neto MA. A wide spectrum of neurological manifestations in pediatrics patients with the COVID-19 infection: a case series. J Neurovirol 2021; 27:782-786. [PMID: 34448147 PMCID: PMC8390102 DOI: 10.1007/s13365-021-01004-9] [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: 07/19/2020] [Revised: 07/07/2021] [Accepted: 07/28/2021] [Indexed: 01/26/2023]
Abstract
Neurological symptoms in COVID-19 patients can also be found in the pediatric population, but they are usually described as mild symptoms. Herein, we described a case series of four pediatric patients with severe and highly heterogeneous central and peripheral nervous system manifestations. The objective was to report neurological manifestations of COVID-19 in children and adolescents. The design is case series. The participants are four children and adolescents with confirmed COVID-19. The main outcome and measures are as follows: Clinical data were gathered from electronic medical records, and data of all neurologic symptoms were checked by a trained neurologist. We reported four pediatric patients with COVID-19 and different neurologic symptoms. Case 1 was a 16-year-old girl with a sensory and motor polyradiculopathy with RT-qPCR for COVID-19 and dengue both detected in CSF that improved after appropriate treatment. Case 2 was a 15-year-old boy with Guillain-Barre syndrome and had good response after using human immunoglobulin. Case 3 was a 5-year-old girl with acute intracranial hypertension that improved after going through lumbar puncture and using acetazolamide. Case 4 was a 2-month-old male infant with focal epileptic seizures that recovered after antiepileptic treatment. We highlight the need to consider different neurologic manifestations as part of the COVID-19 clinical spectrum.
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Affiliation(s)
- Mariana Braatz Krueger
- Universidade Federal de São Paulo, São Paulo, Brazil. .,Hospital Infantil Albert Sabin, Street Tertuliano Sáles, 544 - Vila União, Fortaleza, Ceará, 60410-794, Brazil.
| | - Raquel Carvalho Montenegro
- Department of Physiology and Pharmacology, Faculty of Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil
| | | | - Luanna de Queiroz Lemos
- Hospital Infantil Albert Sabin, Street Tertuliano Sáles, 544 - Vila União, Fortaleza, Ceará, 60410-794, Brazil
| | - Regiane Martins Fiorenza
- Hospital Infantil Albert Sabin, Street Tertuliano Sáles, 544 - Vila União, Fortaleza, Ceará, 60410-794, Brazil
| | | | | | | | - Camilla Gomes da Cruz
- Hospital Infantil Albert Sabin, Street Tertuliano Sáles, 544 - Vila União, Fortaleza, Ceará, 60410-794, Brazil
| | - Verlene de Araújo Verdiano
- Hospital Infantil Albert Sabin, Street Tertuliano Sáles, 544 - Vila União, Fortaleza, Ceará, 60410-794, Brazil
| | | | - Pedro Braga-Neto
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil.,Universidade Estadual Do Ceará, Fortaleza, Ceará, Brazil
| | - Manoel Alves Sobreira-Neto
- Division of Neurology, Department of Clinical Medicine, Faculty of Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil
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Sundholm A, Burkill S, Waldenlind E, Bahmanyar S, Nilsson Remahl AIM. A national Swedish case-control study investigating incidence and factors associated with idiopathic intracranial hypertension. Cephalalgia 2021; 41:1427-1436. [PMID: 34407644 PMCID: PMC8619724 DOI: 10.1177/03331024211024166] [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] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To study the incidence of idiopathic intracranial hypertension in Sweden and to explore whether previously proposed risk factors are associated with idiopathic intracranial hypertension by investigating the odds of exposure one year prior to diagnosis in patients compared to controls. METHODS Using Swedish health care registers and validated diagnostic algorithms, idiopathic intracranial hypertension patients diagnosed between 2000-2016 were compared with randomly selected matched controls, five from the general population and five with obesity. RESULTS We identified 902 idiopathic intracranial hypertension patients and 4510 matched individuals in each control group. Mean incidence among inhabitants ≥18 years of age was 0.71 per 100,000; rising from 0.53 in 2000-2005 to 0.95 in 2012-2016. There were increased odds for idiopathic intracranial hypertension patients compared to general population for exposure to: kidney failure (odds ratio =13.2 (4.1-42.0)), arterial hypertension (odds ratio =17.5 (10.5-29.3)), systemic lupus erythematosus (odds ratio =13.8 (4.3-44.7)), tetracyclines, sulphonamides, lithium, and corticosteroids. In obese controls, odds ratios were also significantly increased for these exposures. Hormonal contraceptive use and exposure to pregnancy did not appear to be associated factors for idiopathic intracranial hypertension development. CONCLUSIONS The incidence of idiopathic intracranial hypertension in Sweden is lower relative to reports from other countries but is on the rise. This case-control study confirms several previously reported risk factors associated with idiopathic intracranial hypertension.
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Affiliation(s)
- Anna Sundholm
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Department of Neurology, 59562Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Sarah Burkill
- Saw Swee Hock School of Public Health, 37580National University of Singapore, National University of Singapore, Singapore
| | - Elisabet Waldenlind
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Department of Neurology, 59562Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Shahram Bahmanyar
- Centre for Pharmacoepidemiology, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden and Centre for Phychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - A Ingela M Nilsson Remahl
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden and Department of Neurology, 59562Karolinska University Hospital, Karolinska University Hospital, Stockholm, Sweden
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Sudhakar P. Commentary: The role of inflammation in idiopathic intracranial hypertension. Indian J Ophthalmol 2021; 69:1506-1507. [PMID: 34011729 PMCID: PMC8302315 DOI: 10.4103/ijo.ijo_252_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Padmaja Sudhakar
- Department of Ophthalmology and Neurology, University of Kentucky, Lexington, KY, USA
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