Neurological complications encountered in imaging studies in association with COVID-19 – a single center analysis
DOI:
https://doi.org/10.15584/ejcem.2022.1.1Keywords:
COVID-19, direct viral toxicity, endotheliitisAbstract
Introduction and aim. COVID-19 is a viral infectious disease, which was first reported in patients with unusual pneumonia in December 2019. However, as the pandemic progressed, extrapulmonary manifestations including various neurologic complications have been started to be increasingly reported. In this retrospective study, we tried to search the neurological complications seen in our patients with positive rRT-PCR test for COVID-19 and examine the underlying associated risk factors.
Material and methods. We have retrospectively analyzed the neuroimaging studies performed in our patients with positive rRT-PCR test for COVID-19 between April, 2020 and August, 2021. Both computed tomography (CT) scans and magnetic resonance imagings (MRI) of brain, head & neck region and the spine were retrospectively evaluated for the presence of any complications in patients with positive rRT-PCR test for COVID-19.
Results. There were 147 patients having neuroradiological imaging studies performed for various neurological symptoms. Among these patients we detected 10 acute neurologicalcomplications.The most common was acute ischemic stroke in 5 patients and intracranial hemorrhage in 3 patients, two of which were intraventricular hemorrhage. The other complications included a preasumed cytotoxic lesion of corpus callosum in a 18 year old girl and lumbar spondylodiscitis complicated with psoas abcess in a 47 year-old man.
Conclusion. In COVID-19 patients severe neurological complications can occur even as a presenting manifestation. Early cytotoxic endothelial injury can be the underlying cause in these patients and should be further studied in larger series in terms of what the susceptibility factors in these patients.
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References
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395:497-506.
Mahase E. COVID-19: WHO declares pandemic because of "alarming levels" of spread, severity, and inaction. BMJ. 2020;368:m1036.
Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323:1061-1069.
Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with Coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020;77:683-690.
Ellul M, Benjamin L, Singh B, et al. Neurological associations of COVID-19. Lancet Neurol. 2020;19:767-783.
Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B: COVID-19-associated acute hemorrhagic necrotizing encephalopathy: imaging features. Radiology. 2020;296:119-120.
Li Y, Wang M, Zhou Y, Chang J, Xian Y, Mao L. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. SSRN Electron J. 2020;5(3):279-284.
Thachil J, Tang N, Gando S, et al. ISTH interim guidance on recognition and management of coagulopathy in COVID-19. J Thromb Haemost. 2020;18:1023-1026.
Connors J, Levy J. Thromboinflammation and hypercoagulability of COVID‐19. J Thromb Haemost. 2020;8(7):1559-1561.
Kwee T. C., Kwee R. Chest CT in COVID-19: What the Radiologist Needs to Know. RadioGraphics. 2020;40:1848-1865.
Ackermann ME, Verleden S, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in COVID-19. N Engl J Med. 2020;383:120-128.
Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet. 2020;395(10234):1417-1418.
Sharifi-Razavi A, Karimi N, Rouhani N: COVID-19 and intracerebral haemorrhage: causative or coincidental? New Microbes New Infect. 2020;35:100669.
Cezar-Junior AB, Faquini IV, Silva JLJ, et al. Subarachnoid hemorrhage and COVID-19: association or coincidence? Medicine (Baltimore). 2020;99:e23862.
Mousa-Ibrahim F, Berg S, TPDetola OO, Teitcher M, Ruland S. Intracranial hemorrhage in hospitalized SARS-CoV-2 patients: a case series. J Stroke Cerebrovasc Dis. 2021;30:105428.
Harris CL, Achuthanandan S, Para K, Shetty V. A Fatal Extrapulmonary Manifestation of COVID-19. Cureus. 2021;13(3):e14068.
Li Y, Li M, Wang M, et al. Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol. 2020;5(3):279-284.
Qureshi AI, Baskett WI, Huang W, et al. Acute Ischemic Stroke and COVID-19. Stroke. March 2021;52(3):905-912.
Cheruiyot I, Sehmi P, Ominde B, et al. Intracranial hemorrhage in coronavirus disease 2019 (COVID-19) patients. Neurol Sci. 2021;42(1):25-33.
Oxley TJ, Mocco J, Majidi S, et al. Large vessel stroke as a presenting feature of COVID-19 in the young [letter]. N Engl J Med. 2020;382(20):e60.
Saavedra JM: Brain angiotensin II: new developments, unanswered questions and therapeutic opportunities. Cell Mol Neurobiol. 2005;25:485-512.
Coutard B, Valle C, de Lamballerie X, Canard B, Seidah NG, Decroly E. The spike glycoprotein of the new coronavirus 2019-nCoV contains a furin-like cleavage site absent in CoV of the same clade. Antiviral Res. 2020;176:104742.
Letko M, Marzi A, Munster V. Functional assessment of cell entry and receptor usage for SARS-CoV-2 and other lineage B beta-coronaviruses. Nat Microbiol. 2020;5(4):562-569.
Gaur P, Dixon L, Jones B, Lyall H, Jan W. COVID-19- Associated Cytotoxic Lesions of the Corpus Callosum. Am J Neuroradiol. 2020;41:1905-1907.
Lin J, Lawson E, Verma S, Peterson R, Sidhu R. Cytotoxic Lesion of the Corpus Callosum in an Adolescent with Multisystem Inflammatory Syndrome and SARS-CoV-2 Infection. Am J Neuroradiol. 2020;41:2017-2019.
Rasmussen C, Niculescu I, Patel S, Krishnan A. COVID-19 and Involvement of the Corpus Callosum: Potential Effect of the Cytokine Storm? Am J Neuroradiol. 2020;41:1625-1628.
Lallana S, Chen A, Requena M, et al. Posterior reversible encephalopathy syndrome (PRES) associated with COVID-19. Journal of Clinical Neuroscience. 2021;88:108-112.
Fountain JH, Lappin SL. Physiology, Renin Angiotensin System. Stat Pearls Publishing, Treasure Island. FL; 2020.
Erok B, Kıbıcı K. COVID-19 Infection Manifesting with Lumbar Spondylodiscitis Complicating With Psoas Abscess without Pneumonia. Indian J Neurosurg. 2021. doi: 10.1055/s-0041-1741405
Erok B, Atca AO, Kıbıcı K. Chest CT imaging features of progressive phase COVID-19 pneumonia and evolution of findings. Acta Medica Mediterranea. 2021,37:1.
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