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Amer WO, El Gharieb HA, Ahmed Z, Ibrahim H, Alanazi A, Meshref M. Special considerations and pitfalls for intracerebral bleeding followed COVID-19 case treated by ECMO. BRAIN HEMORRHAGES 2023:S2589-238X(23)00023-2. [PMID: 37359506 PMCID: PMC10257510 DOI: 10.1016/j.hest.2023.06.001] [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: 05/19/2023] [Accepted: 06/09/2023] [Indexed: 06/28/2023] Open
Abstract
COVID-19, or coronavirus infection, is an acute respiratory illness caused by the corona virus that can develop into a life-threatening form of ARDS. Extracorporeal membrane oxygenation (ECMO) is a highly effective treatment for life-threatening instances. One of the many complications associated with ECMO was bleeding. COVID patients are at risk for intracerebral bleeding due to several factors, including the drug's action on ACE2 receptors, leading to hypertension, as well as hypercoagulability, dysregulated immune response, DIC, and the use of anticoagulants.
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Affiliation(s)
- Wael Osman Amer
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Professor of Neurology, Faculty Of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hussein Awad El Gharieb
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Professor of Neurology, Faculty Of Medicine, Al-Azhar University, Cairo, Egypt
| | - Zakaria Ahmed
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Professor of Neurology, Faculty Of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Ahmed Alanazi
- Training Internal Medicine Resident, King Salman Armed Forces Hospital, Tabuk, Saudi Arabia
| | - Mostafa Meshref
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Meshref M, Hewila IM, Khlidj Y, Korissi R, Shaheen N, Nashwan AJ, Ouerdane Y, Amro Y, Taher KM, Ahmed MG. COVID-19-Associated Cerebrovascular Events: A Case Series Study and a Literature Review of Possible Mechanisms. Case Rep Neurol 2023; 15:11-23. [PMID: 36748059 PMCID: PMC9898811 DOI: 10.1159/000529122] [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: 08/25/2022] [Accepted: 12/29/2022] [Indexed: 02/05/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affects multiple body systems, including the nervous system. Cerebrovascular accidents can also occur. Patients with comorbid illnesses have severe manifestations and poor outcomes. Despite the proper mechanism of SARS-CoV-2 infection-associated stroke having not yet been settled, various possible mechanisms have been hypothesized. One possibility is that the virus causes endothelial dysfunction and immune-mediated injury. Another possibility is that the trans-neuronal spread of the virus affects brain tissue. In addition, hypercoagulability caused by SARS-CoV-2 infection could lead to a stroke. A virus-induced dysfunction of the renin-angiotensin system could also lead to a stroke. The immune response and vasculitis resulting from SARS-CoV-2 infection are also possible causes via a cytokine storm, immune dysfunction, and various inflammatory responses. SARS-CoV-2 infection may affect calcitonin gene-related peptides and cerebral blood flow and may lead to stroke. Finally, SARS-CoV-2 may cause hemorrhagic strokes via mechanisms stimulated by its interaction with angiotensin-converting enzyme 2 (ACE2), leading to arterial wall damage and blood pressure changes. In this article, we will present seven cases of stroke-associated SARS-CoV-2 infection.
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Affiliation(s)
- Mostafa Meshref
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ibrahim M. Hewila
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
- Neurology Department, Worcestershire Royal Hospital, Worcester, UK
| | - Yahia Khlidj
- Faculty of Medicine, University of Algiers Benyoucef Benkhedda, Algiers, Algeria
| | - Rafik Korissi
- Faculty of Medicine, University of Algiers Benyoucef Benkhedda, Algiers, Algeria
| | - Nour Shaheen
- Alexandria Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | | | | | - Yara Amro
- Pharmacist, Ministry of Health, Cairo, Egypt
| | - Khaled M. Taher
- Neurology Department, King Khaled Hospital, Najran, Saudi Arabia
| | - Mahmoud Galal Ahmed
- Neurology Department, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
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Lingas EC. A Case of Acute Transverse Myelitis in a Mildly Symptomatic Patient: An Emerging and Serious Neurological Manifestation of COVID-19. Cureus 2022; 14:e24222. [PMID: 35602843 PMCID: PMC9117864 DOI: 10.7759/cureus.24222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 11/21/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is known to have neurological manifestations and one of them is acute transverse myelitis (ATM). Despite being exceedingly rare (1.34-4.6 cases per million/year), COVID-19-associated ATM cases have continuously been reported and have significant health impact to patients. This case report presents a previously healthy, unvaccinated male who developed COVID-19-associated ATM.
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Post SARS-CoV-2 Guillain-Barré syndrome in a child: case report and review of the literature. Childs Nerv Syst 2022; 38:2011-2016. [PMID: 35461356 PMCID: PMC9034738 DOI: 10.1007/s00381-022-05536-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/16/2022] [Indexed: 12/27/2022]
Abstract
Guillain-Barré syndrome has been defined as a post-infectious immune-mediated polyneuropathy. COVID-19 usually presents with respiratory symptoms but can less commonly present with extra-respiratory manifestations such as neurological symptoms. Few cases were published in the literature regarding post-COVID-19 infection Guillain-Barré in the pediatric age group. In this paper, we present a 13-year-old male with possible Guillain-Barré syndrome occurring 2 weeks after a presumed COVID-19 infection. We conducted a systematic review and searched for published pediatric cases until March 2022. We included 35 patients in 25 publications.
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Guillain-Barré Syndrome in the COVID-19 Pandemic. Neurol Int 2021; 14:34-48. [PMID: 35076589 PMCID: PMC8788454 DOI: 10.3390/neurolint14010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
There have been several reported cases of severe acute respiratory syndrome (SARS-CoV-2) infection that were associated with an increased incidence of neurological manifestations, including Guillain–Barré syndrome (GBS). This review aims to present information on the reports of GBS associated with coronavirus disease 2019 (COVID-19) infection. Our review is retrospective work examining articles published from the 1 April 2020 to the 8 May 2021 in the English language. We used the diagnostic criteria and classification published by the National Institute of Neurological Disorders and Stroke and Brighton Collaboration. GBS is usually a postinfectious syndrome, but GBS in the COVID-19 pandemic also takes on a para-infectious profile. In the reports, the genetic factor has a role in developing GBS in some patients. In conclusion, the association between COVID-19 and GBS is not very clear. Still, one mechanism is strongly associated with COVID-19 and immune-mediated neurological complications, which is molecular mimicry between SARS-CoV-2 and human autoantigens.
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Guillain-Barré syndrome associated with COVID-19: a case report study. J Neurovirol 2021; 27:802-805. [PMID: 34046865 PMCID: PMC8158074 DOI: 10.1007/s13365-021-00984-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/29/2021] [Accepted: 04/27/2021] [Indexed: 01/13/2023]
Abstract
Acute respiratory distress syndrome (ARDS) caused by severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) is spreading around the world. Patients with coronavirus disease 2019 (COVID-19) typically present fever, cough, and respiratory illnesses. It has been revealed that the comorbidities can turn it into severe types, and the managements meet unpredicted complications. Here, we report a case of coronavirus disease 2019 (COVID-19) coincidence with confirmed acute Guillain-Barré syndrome (GBS). Ten days after admission and therapeutic process, the patient developed autonomic dysfunction. Despite respiratory support and receiving intravenous immunoglobulin, the patient died due to cardiac arrest. Albeit it is yet scientifically doubtful, there are raising concerns toward a possible association between GBS and SARS-CoV-2 infection, demonstrating potential neurological symptoms of COVID-19.
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