Posterior Reversible Encephalopathy Syndrome in Patients with Coronavirus Disease 2019: Two Cases and A Review of The Literature

Anand, Pria; Lau, K. H. Vincent; Chung, David Y.; Virmani, Deepti; Cervantes‐Arslanian, Anna M.; Mian, Asim; Takahashi, Courtney

doi:10.1016/j.jstrokecerebrovasdis.2020.105212

Cited by 46 publications

(59 citation statements)

References 31 publications

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“…Although the CSF RBC count was only reported for 61/430 (14%) patients [ 22 , 28 , 29 , 31 , 35 , 39 , 40 , 44 , 73 , 74 , 77 , 78 , 81 , 89 , 92 , 102 , 110 , 118 , [120] , [121] , [122] , [123] , 128 , 133 , 134 , [138] , [139] , [140] , 156 , 165 , 166 , [172] , [173] , [174] , [175] , [176] , 180 , 184 , 188 , 191 , 192 , 198 , 202 , 204 , 208 , 215 , 220 , 225 , 227 , 233 , 241 , 242 , 246 ], the CSF white blood cell (WBC) count was provided for 409/430 (95%) patients, 270 (66%) of whom had >0 cells/μL, >1 WBC:1,000 RBC or were noted to have “pleocytosis” ( Fig. 3 ) [ [5] , [6] , [7] , [8] , 10 , 13 , [15] , [16] , [17] , [18] ...…”

Section: Resultsmentioning

confidence: 99%

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

153

152

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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Section: Resultsmentioning

confidence: 99%

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

153

152

View full text Add to dashboard Cite

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“…According to the Literature, the majority of PRES patients had severe respiratory manifestations of COVID-19 requiring intensive respiratory support. PRES can develop also in asymptomatic COVID-19 patients [ 33 ]. The high number of COVID-19-related PRES cases can be also due to large use of interleukin 1 and 6 inhibitors (Anakinra and Tocilizumab) in COVID-19 therapy: these drugs can directly act on endothelial function favouriting typical PRES alterations [ 20 , 34 – 37 ].…”

Section: Posterior Reversible Encephalopathy Syndrome (Pres) In Covidmentioning

confidence: 99%

“…In 60% of patients with clinically suspected PRES brain MRI was normal. In about 40% of cases, typical PRES pattern is seen with often mild, posterior, bilateral, quite symmetric oedema [ 33 ]. In COVID-19 setting, as seen in our cases, there is an increased rate (10–30% of patients) of deep white matter, basal ganglia and cerebellum involvement as well as haemorrhagic contamination [ 14 , 38 , 39 ], cytotoxic oedema (diffusion restriction) and increased parenchymal and leptomeningeal contrast enhancement in a holo-hemispheric distribution with frequent basal ganglia and cerebellar involvement [ 14 , 39 ].…”

Section: Posterior Reversible Encephalopathy Syndrome (Pres) In Covidmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome (PRES) and Meningo-Encephalitis in COVID

Manara

Pezzetti

Gerevini

2021

Neuroimaging of Covid-19. First Insights Based on Clinical Cases

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Neurological symptoms described in COVID-19 infected patients can also occur in a more inflammatory related setting as in case of posterior reversible encephalopathy syndrome (PRES) that can be associated with SARS-CoV2 infection due to the massive cytokine storm, damage to endothelium and vasogenic oedema. At brain imaging, quite symmetric bilateral focal or confluent vasogenic oedema with posterior parietal and occipital lobe involvement are found. In severe cases like in COVID-setting, PRES can be complicated by ischemia or haemorrhage: we then describe in the atlas two cases of classic and complicated COVID-related PRES.

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“…Along with the common use of immunomodulatory medications, these associated characteristics make this pandemic disease a perfect storm for the development of PRES. [ 43 , 44 ] A larger study of 278 patients with confirmed COVID-19 undergoing imaging demonstrated a 1.1% prevalence of PRES. MRI as an imaging modality had a higher yield in detecting cases, demonstrating a 3.9% prevalence of PRES.…”

Section: Introductionmentioning

confidence: 99%

Posterior Reversible Encephalopathy Syndrome

Gewirtz

Gao

Parauda

et al. 2021

Curr Pain Headache Rep

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Purpose of Review This review provides an updated discussion on the clinical presentation, diagnosis and radiographic features, mechanisms, associations and epidemiology, treatment, and prognosis of posterior reversible encephalopathy syndrome (PRES). Headache is common in PRES, though headache associated with PRES was not identified as a separate entity in the 2018 International Classification of Headache Disorders. Here, we review the relevant literature and suggest criteria for consideration of its inclusion. Recent Findings COVID-19 has been identified as a potential risk factor for PRES, with a prevalence of 1–4% in patients with SARS-CoV-2 infection undergoing neuroimaging, thus making a discussion of its identification and treatment particularly timely given the ongoing global pandemic at the time of this writing. Summary PRES is a neuro-clinical syndrome with specific imaging findings. The clinical manifestations of PRES include headache, seizures, encephalopathy, visual disturbances, and focal neurologic deficits. Associations with PRES include renal failure, preeclampsia and eclampsia, autoimmune conditions, and immunosuppression. PRES is theorized to be a syndrome of disordered autoregulation and endothelial dysfunction resulting in preferential hyperperfusion of the posterior circulation. Treatment typically focuses on treating the underlying cause and removal of the offending agents.

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Posterior Reversible Encephalopathy Syndrome in Patients with Coronavirus Disease 2019: Two Cases and A Review of The Literature

Abstract: Highlights Posterior reversible encephalopathy syndrome may be associated with coronavirus disease. Risk factors may include modest blood pressure fluctuations and anakinra. All reported patients had clinical improvement.

Cited by 46 publications

References 31 publications

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Posterior Reversible Encephalopathy Syndrome (PRES) and Meningo-Encephalitis in COVID

Posterior Reversible Encephalopathy Syndrome

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