Neurological emergencies associated with COVID-19: stroke and beyond

Agarwal, Amit Kumar; Pinho, Marco da Cunha; Raj, Karuna M.; Yu, Frank; Bathla, Girish; Achilleos, Michael; O’Neill, Thomas; Still, Michael; Maldjian, Joseph A.

doi:10.1007/s10140-020-01837-7

Cited by 34 publications

(25 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In a multinational study on hospitalized patients with SARS-CoV-2 infection, Shahjouei et al [ 18 ] demonstrated an overall stroke risk of 0.5% (pooled 0.9%) with ischemic heart disease (OR 2.5, p = 0.006) and mechanical ventilaton (OR 1.9, p = 0.03) as independent predictors. Although less common, a subset of neurologic complications has been thought to be due a cytokine storm and multisystem inflammation resulting in acute demyelination, vasculitis, necrotizing encephalopathy, and posterior reversible encephalopathy syndrome [ 19 ]. Tsivgoulis et al [ 20 ] undertook a review of neurological manifestations during the COVID-19 pandemic and found predominantly mild neurological manifestations in the majority of infected patients, while multiple comorbidites were present with severe neurological disease.…”

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States

et al. 2021

View full text Add to dashboard Cite

Objective To examine the outcomes of adult patients with spontaneous intracranial and subarachnoid hemorrhage diagnosed with comorbid COVID-19 infection in a large, geographically diverse cohort. Methods We performed a retrospective analysis using the Vizient Clinical Data Base. We separately compared two cohorts of patients with COVID-19 admitted April 1–October 31, 2020—patients with intracerebral hemorrhage (ICH) and those with subarachnoid hemorrhage (SAH)—with control patients with ICH or SAH who did not have COVID-19 admitted at the same hospitals in 2019. The primary outcome was in-hospital death. Favorable discharge and length of hospital and intensive-care stay were the secondary outcomes. We fit multivariate mixed-effects logistic regression models to our outcomes. Results There were 559 ICH-COVID patients and 23,378 ICH controls from 194 hospitals. In the ICH-COVID cohort versus controls, there was a significantly higher proportion of Hispanic patients (24.5% vs. 8.9%), Black patients (23.3% vs. 20.9%), nonsmokers (11.5% vs. 3.2%), obesity (31.3% vs. 13.5%), and diabetes (43.4% vs. 28.5%), and patients had a longer hospital stay (21.6 vs. 10.5 days), a longer intensive-care stay (16.5 vs. 6.0 days), and a higher in-hospital death rate (46.5% vs. 18.0%). Patients with ICH-COVID had an adjusted odds ratio (aOR) of 2.43 [1.96–3.00] for the outcome of death and an aOR of 0.55 [0.44–0.68] for favorable discharge. There were 212 SAH-COVID patients and 5,029 controls from 119 hospitals. The hospital (26.9 vs. 13.4 days) and intensive-care (21.9 vs. 9.6 days) length of stays and in-hospital death rate (42.9% vs. 14.8%) were higher in the SAH-COVID cohort compared with controls. Patients with SAH-COVID had an aOR of 1.81 [1.26–2.59] for an outcome of death and an aOR of 0.54 [0.37–0.78] for favorable discharge. Conclusions Patients with spontaneous ICH or SAH and comorbid COVID infection were more likely to be a racial or ethnic minority, diabetic, and obese and to have higher rates of death and longer hospital length of stay when compared with controls.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States

et al. 2021

View full text Add to dashboard Cite

show abstract

“…Amidst the COVID-19 pandemic, multiple neurological manifestations are increasingly being reported, including, ischemic stroke, intracranial hemorrhage, diffuse leukoencephalopathy, acute demyelination, and transient cytotoxic edema [ 8 ]. A cross-sectional study conducted between March 23 and May 7, 2020 evaluated the neuroimaging findings in 73 patients with COVID-19 who had acute de novo neurological manifestations: 43 had abnormal MRI findings, including mainly cerebrovascular thrombotic events, in addition to restricted diffusion foci within the corpus callosum, which was consistent with CLOCC [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

A 23-Year-Old Man with SARS-CoV-2 Infection Who Presented with Auditory Hallucinations and Imaging Findings of Cytotoxic Lesions of the Corpus Callosum (CLOCC)

et al. 2020

View full text Add to dashboard Cite

Patient: Male, 23-year-old Final Diagnosis: Cytokine release syndrome • disseminated intravascular coagulation • multiple organ failure Symptoms: Auditory hallucinations • fever • headache • restlessness • suicidal thoughts Medication: — Clinical Procedure: — Specialty: Infectious Diseases • Neurology Objective: Unusual clinical course Background: Cytotoxic lesions of the corpus callosum (CLOCC) is a rare clinical and radiological syndrome that has been associated with various infectious etiologies. CLOCC are among the recently described neurological associations with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with coronavirus disease 2019 (COVID-19). We report a case of CLOCC in a man with SARS-CoV-2 infection who presented with auditory hallucinations and rapidly developed systemic inflammatory response syndrome (SIRS). Case Report: A 23-year-old man with no past medical and psychiatric history presented with auditory hallucinations, restlessness, and suicidal ideations. A nasopharyngeal swab specimen tested using real-time reverse transcriptase-polymerase chain reaction (RT-PCR) assay was positive for SARS-CoV-2. A brain MRI revealed an isolated oval-shaped lesion in the splenium of the corpus callosum, with hyperintense signal on diffusion-weighted imaging (DWI) and hypointense on apparent diffusion coefficient (ADC) maps, suggestive of CLOCC. After a dramatic hospital course associated with multiple organ dysfunction syndrome (MODS) and severe intra-abdominal and cerebral bleeding, he developed cardiac arrest and died on hospital day 15. Conclusions: This case highlights the need for increased vigilance for the atypical manifestations of SARS-CoV-2 infection. In addition, it suggests that CLOCC can be considered as a differential diagnosis by clinicians in patients with SARS-CoV-2 infection who present with unexplained neurological and neuropsychiatric symptoms, leading to poor outcome.

show abstract

“…In another case report, A 33-year-old male suffering from morbid obesity, diabetes mellitus, and hypoxemic showed a respiratory failure secondary to COVID-19 affection. MRI presented widespread foci of the demolition of the myelin with restricted diffusion, most located in the corpus callosum and the pericallosal white matter [ 41 ]. Furthermore, Karapanayiotides et al described a 57-year-old male affected by COVID-19 along with particular localization and a concentric demyelination pattern.…”

Section: Evidence Of Covid-19 Virus Involvement In Demyelinationmentioning

confidence: 99%

Demyelination as a result of an immune response in patients with COVID-19

Shabani

2021

Acta Neurol Belg

View full text Add to dashboard Cite

The coronavirus disease of 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus-2 (SARS CoV-2), that already appeared as a global pandemic. Presentation of the disease often includes upper respiratory symptoms like dry cough, dyspnea, chest pain, and rhinorrhea that can develop to respiratory failure, needing intubation. Furthermore, the occurrence of acute and subacute neurological manifestations such as stroke, encephalitis, headache, and seizures are frequently stated in patients with COVID-19. One of the reported neurological complications of severe COVID-19 is the demolition of the myelin sheath. Indeed, the complex immunological dysfunction provides a substrate for the development of demyelination. Nevertheless, few published reports in the literature describe demyelination in subjects with COVID-19. In this short narrative review, we discuss probable pathological mechanisms that may trigger demyelination in patients with SARS‐CoV‐2 infection and summarize the clinical evidence, confirming SARS-CoV-2 condition as a risk factor for the destruction of myelin.

show abstract

Neurological emergencies associated with COVID-19: stroke and beyond

Cited by 34 publications

References 20 publications

Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States

Impact of COVID-19 on the hospitalization, treatment, and outcomes of intracerebral and subarachnoid hemorrhage in the United States

A 23-Year-Old Man with SARS-CoV-2 Infection Who Presented with Auditory Hallucinations and Imaging Findings of Cytotoxic Lesions of the Corpus Callosum (CLOCC)

Demyelination as a result of an immune response in patients with COVID-19

Contact Info

Product

Resources

About