Acute disseminated encephalomyelitis: MR Diffusion weighted imaging: Potential diagnostic value and outcome predilection

Kamr, Wael Hamza; El-Tantawy, Amir Monier; Moustafa, Manar

doi:10.1016/j.ejrnm.2017.01.004

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…Up to one third of patients may present gadolinium-enhancing lesions, and up to one third may present spinal cord involvement 9 . Restricted diffusion in diffusion-weighted imaging (DWI) sequences can be present in acute settings, and has been associated with a more aggressive disease course 13 .…”

Section: Discussionmentioning

confidence: 99%

Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

Lopes

Brucki

Neto

et al. 2020

Arq. Neuro-Psiquiatr.

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Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in São Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.

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Section: Discussionmentioning

confidence: 99%

Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

Lopes

Brucki

Neto

et al. 2020

Arq. Neuro-Psiquiatr.

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“…Our patient did. It has been hypothesized that early restricted diffusion of ADEM lesions are due to myelin sheath cell edema and inflammation associated with decreased vascularity (Balasubramanya et al, 2007;Kamr et al, 2017).…”

Section: Fig 2 Different Mri Sequences Showing a Near Resolution Ofmentioning

confidence: 99%

Covid-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM)

Hussein

Elazim

Torbey

2020

Journal of Neuroimmunology

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Acute disseminated encephalomyelitis (ADEM) is an uncommon diagnosis in adults. It is known to be due to an abnormal immune response to a systemic infection rather than direct viral invasion to the central nervous system. There have been few reports of ADEM diagnosed in the setting of COVID-19 systemic infection. However, we report a case of Coxsackie induced ADEM that remitted but got exacerbated by COVID-19 infection. The patient contracted the COVID-19 infection shortly after being discharged to a rehabilitation facility. Direct COVID-19 neuroinvasion was ruled out via CSF PCR testing for the virus. The patient responded well to pulse steroid therapy and plasmapheresis in both occasions. We hypothesize that COVID-19 infection can flareup a recently remitted ADEM via altering the immune responses. It is known now that COVID-19 infection can produce cytokine storming. Cytokine pathway activation is known to be involved in the pathology of ADEM. Caution regarding discharging immune suppressed patient to the inpatient rehabilitation facility should be made in the era of COVID-19 pandemic.

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Acute disseminated encephalomyelitis: MR Diffusion weighted imaging: Potential diagnostic value and outcome predilection

Cited by 2 publications

References 23 publications

Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

Covid-19 systemic infection exacerbates pre-existing acute disseminated encephalomyelitis (ADEM)

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