Microhemorrhages in the corpus callosum after treatment with extracorporeal membrane oxygenation

Riech, Sebastian; Hellen, Peter; Moerer, Onnen; Kallenberg, Kai; Müller, Michel; Quintel, Michael; Knauth, Michael

doi:10.1186/cc14357

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…In the current study, the majority of cerebral microbleeds were located in subcortical WM and the CC, similar to the patterns described with high-altitude cerebral edema and ARDS 16 , 17 and none of our patients demonstrated superficial siderosis. Hypoxemia is common to these disease processes, and hypoxia-induced hydrostatic or chemical effects on the blood-brain barrier could potentially account for extravasation of erythrocytes and lead to cerebral microbleeds.…”

Section: Discussionsupporting

confidence: 89%

Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19

Agarwal

Jain

Dogra

et al. 2020

Stroke

135

152

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Background and Purpose: We conducted this study to investigate the prevalence and distribution of cerebral microbleeds and leukoencephalopathy in hospitalized patients with coronavirus disease 2019 (COVID-19) and correlate with clinical, laboratory, and functional outcomes. Methods: We performed a retrospective chart review of 4131 COVID-19 positive adult patients who were admitted to 3 tertiary care hospitals of an academic medical center at the epicenter of the COVID-19 pandemic in New York City from March 1, 2020, to May 10, 2020, to identify patients who had magnetic resonance imaging (MRI) of the brain. We evaluated the MRIs in detail, and identified a subset of patients with leukoencephalopathy and/or cerebral microbleeds. We compared clinical, laboratory, and functional outcomes for these patients to patients who had a brain MRI that did not show these findings. Results: Of 115 patients who had an MRI of the brain performed, 35 (30.4%) patients had leukoencephalopathy and/or cerebral microbleeds. Patients with leukoencephalopathy and/or cerebral microbleeds had neuroimaging performed later during the hospitalization course (27 versus 10.6 days; P <0.001), were clinically sicker at the time of brain MRI (median GCS 6 versus 14; P <0.001), and had higher peak D-dimer levels (8018±6677 versus 3183±3482; P <0.001), lower nadir platelet count (116.9±62.2 versus 158.3±76.2; P =0.03), higher peak international normalized ratio (2.2 versus 1.57; P <0.001) values when compared with patients who had a brain MRI that did not show these findings. They required longer ventilator support (34.6 versus 9.1 days; P <0.001) and were more likely to have moderate and severe acute respiratory distress syndrome score (88.6% versus 23.8%, P <0.001). These patients had longer hospitalizations (42.1 versus 20.9 days; P <0.001), overall worse functional status on discharge (mRS 5 versus 4; P =0.001), and higher mortality (20% versus 9%; P =0.144). Conclusions: The presence of leukoencephalopathy and/or cerebral microbleeds is associated with a critical illness, increased mortality, and worse functional outcome in patients with COVID-19.

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Section: Discussionsupporting

confidence: 89%

Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19

Agarwal

Jain

Dogra

et al. 2020

Stroke

135

152

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“…[74][75][76][77] Furthermore, cytokine-and hypoxia-induced injury to the corpus callosum, particularly the splenium, has been reported within critical illness including acute respiratory distress syndrome and high-altitude cerebral oedema, potentially contributing to a vulnerability in COVID-19. 17,[78][79][80][81][82][83] Hypoxia directly induces chemical and hydrostatic endothelial cell disruption, promoting vascular permeability and hence contributing to neurological event pathogenesis. 84 Relative to the cortex, the thalamus, basal ganglia and deep white matter are poorly perfused due to their watershed end-arterial vascular architecture which could exacerbate their baseline hypoxic vulnerability and ultimately promote subcortical neurological events.…”

Section: Neurological Events In White and Grey Mattermentioning

confidence: 99%

Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review

Parsons

Outsikas

Parish

et al. 2020

Preprint

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Background Neuropathology caused by the coronavirus disease 2019 (COVID-19) has been reported across several studies. The characterisation of the spatial distribution of these pathology remains critical to assess long and short-term neurological sequelae of COVID-19. To this end, Mathematical models can be used to characterise the location and aetiologies underlying COVID-19-related neuropathology. Method We performed a systematic review of the literature to quantify the locations of small neurological events identified with magnetic resonance imaging (MRI) among COVID-19 patients. Neurological events were localised into the Desikan-Killiany grey and white matter atlases. A mathematical network diffusion model was then used to test whether the spatial distribution of neurological events could be explained via a linear spread through the structural connectome of the brain. Findings We identified 35 articles consisting of 123 patients that assessed the spatial distribution of small neurological events among COVID-19 patients. Of these, 91 patients had grey matter changes, 95 patients had white matter changes and 72 patients had confirmed cerebral microbleeds. White matter events were observed within 14 of 42 white matter bundles from the IIT atlas. The highest proportions (26%) of events were observed within the bilateral corticospinal tracts. The splenium and middle of the corpus callosum were affected in 14% and 9% of the cases respectively. Grey matter events were spatially distributed in the 41 brain regions within the Desikan-Killiany atlas. The highest proportions (~10%) of the events were observed in areas including the bilateral superior temporal, precentral, and lateral occipital cortices. Sub-cortical events were most frequently identified in the Pallidum. The application of a mathematical network diffusion model suggested that the spatial pattern of the small neurological events in COVID-19 can be modelled with a linear diffusion of spread from epicentres in the bilateral cerebellum and basal ganglia (Pearsons r=0.41, p<0.001, corrected). Interpretation To our knowledge, this is the first study to systematically characterise the spatial distribution of small neurological events in COVID-19 patients and test whether the spatial distribution of these events can be explained by a linear diffusion spread model. The location of neurological events is consistent with commonly identified neurological symptoms including alterations in conscious state among COVID-19 patients that require brain imaging. Given the prevalence and severity of these manifestations, clinicians should carefully monitor neurological symptoms within COVID-19 patients and their potential long-term sequelae.

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“…More recently, microbleeds have been reported in critically ill patients [1] , [4] , [5] , [6] . Based on our literature search we found 6 articles relating critical illness-associated microbleeds [1] , [4] , [5] , [6] , [7] , [8] . In 2015, Riech et al described 3 patients with severe ARDS with 2 of them receiving ECMO [6] .…”

Section: Resultsmentioning

confidence: 99%

“…In contrast to the cases presented above, these microbleeds were accompanied by corresponding FLAIR-hyperintensities [5] . Riech et al found that microbleeds with emphasis in the corpus callosum were present in 30% of patients who suffered from severe ARDS requiring ECMO and underwent brain MRI [8] . Establishing the etiopathogenesis of cerebral microbleeds in critically ill patients often is hampered by the lack of previous brain imaging.…”

Section: Resultsmentioning

confidence: 99%

Microbleed patterns in critical illness and COVID-19

Toeback

Depoortere

Vermassen

et al. 2021

Clinical Neurology and Neurosurgery

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Background Cerebral microbleeds are increasingly reported in critical ill patients with respiratory failure in need of mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO). Typically, these critical illness-associated microbleeds involve the juxtacortical white matter and corpus callosum. Recently, this pattern was reported in patients with respiratory failure, suffering from COVID-19. Materials and methods In this retrospective single-center study, we listed patients from March 11, 2020 to September 2, 2020, with laboratory-confirmed COVID-19, critical illness and cerebral microbleeds. Literature research was conducted through a methodical search on Pubmed databases on critical illness-associated microbleeds and cerebral microbleeds described in patients with COVID-19. Results and discussion On 279 COVID-19 admissions, two cases of cerebral microbleeds were detected in critical ill patients with respiratory failure due to COVID-19. Based on review of existing literature critical illness-associated microbleeds tend to predominate in subcortical white matter and corpus callosum. Cerebral microbleeds in patients with COVID-19 tend to follow similar patterns as reported in critical illness-associated microbleeds. Hence, one patient with typical critical illness-associated microbleeds and COVID-19 is reported. However, a new pattern of widespread cortico-juxtacortical microbleeds, predominantly in the anterior vascular territory with relative sparing of deep gray matter, corpus callosum and infratentorial structures is documented in a second case. The possible etiologies of these microbleeds include hypoxia, hemorrhagic diathesis, brain endothelial erythrophagocytosis and/or cytokinopathies. An association with COVID-19 remains to be determined. Conclusion Further systematic investigation of microbleed patterns in patients with neurological impairment and COVID-19 is necessary.

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Microhemorrhages in the corpus callosum after treatment with extracorporeal membrane oxygenation

Cited by 3 publications

References 3 publications

Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19

Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19

Modelling the Anatomical Distribution of Neurological Events in COVID-19 Patients: A Systematic Review

Microbleed patterns in critical illness and COVID-19

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