Posterior reversible encephalopathy syndrome in patients with COVID-19

Parauda, Sarah C.; Gao, Virginia; Gewirtz, Alexandra N.; Parikh, Neal S; Merkler, Alexander E; Lantos, Joshua; White, Halina; Leifer, Dana; Navi, Babak B.; Segal, Alan Z.

doi:10.1016/j.jns.2020.117019

Cited by 91 publications

(94 citation statements)

References 16 publications

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“…Parauda et al [ 95 ] reported four COVID-19 patients with posterior reversible leukoencephalopathy. All the four patients required mechanical ventilation and were admitted to ICU.…”

Section: Cns Manifestations Associated With Covid-19mentioning

confidence: 99%

Central Nervous System Manifestations Associated with COVID-19

Divani

Andalib

Biller

et al. 2020

Curr Neurol Neurosci Rep

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Purpose of Review Coronavirus disease 2019 (COVID-19) has become a global health crisis of our time. The disease arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. COVID-19 has a wide range of respiratory symptoms from mild to severe and affects several other organs, increasing the complexity of the treatment. There is accumulating evidence to suggest that SARS-CoV-2 can target the nervous system. In this review, we provide an account of the COVID-19 central nervous system (CNS) manifestations. Recent Findings A broad spectrum of the CNS manifestations including headache, impaired consciousness, delirium, loss of smell and taste, encephalitis, seizures, strokes, myelitis, acute disseminated encephalomyelitis, neurogenic respiratory failure, encephalopathy, silent hypoxemia, generalized myoclonus, neuroleptic malignant syndrome and Kawasaki syndrome has been reported in patients with COVID-19. Summary CNS manifestations associated with COVID-19 should be considered in clinical practice. There is a need for modification of current protocols and standing orders to provide better care for COVID-19 patients presenting with neurological symptoms.

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“…Parauda et al [ 95 ] reported four COVID-19 patients with posterior reversible leukoencephalopathy. All the four patients required mechanical ventilation and were admitted to ICU.…”

Section: Cns Manifestations Associated With Covid-19mentioning

confidence: 99%

Central Nervous System Manifestations Associated with COVID-19

Divani

Andalib

Biller

et al. 2020

Curr Neurol Neurosci Rep

View full text Add to dashboard Cite

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“…PRES in the setting of COVID-19 may similarly involve elevated cytokines due to systemic hyperinflammation, leading to endothelial activation and increased cerebrovascular permeability and edema. In the patient presented, underlying hypertension and renal disease may have been predisposing factors exacerbated by COVID-19, with additional cases of PRES in COVID-19 also reported (15,16,18,48).…”

Section: Summaries Of the Pertinent Clinical Details Of Each Case Arementioning

confidence: 79%

“…This patient demonstrated classic findings of increased T2, DWI, and FLAIR hyperintensity without restricted diffusion in the setting of elevated blood pressure (Figures 2A-F) and with a few punctate foci of restricted diffusion and ischemic change. The association of PRES as a neurologic complication of COVID-19 has been recently documented in the literature (15)(16)(17)(18). The final patient was determined to have seizures later in her course, along with persistent altered mentation and radiographic findings suggestive of inflammatory changes and concern for immune-mediated necrotizing encephalopathy.…”

Section: Casementioning

confidence: 89%

Acute Seizures Occurring in Association With SARS-CoV-2

et al. 2020

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Seizures are an infrequent and serious neurological complication of SARS-CoV-2 infection, with limited data describing the etiology and the clinical context in which these occur or the associated electrographic and imaging findings. This series details four cases of seizures occurring in patients with COVID-19 with distinct time points, underlying pathology, and proposed physiological mechanisms. An enhanced understanding of seizure manifestations in COVID-19 and their clinical course may allow for earlier detection and improved patient management.

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“…We found 13 cases of PRES in patients with COVID-19 in the literature. 8 , 9 , 11 , 12 , 13 , 14 There was an additional case of PRES identified via virtuopsy (post-mortem imaging) but this was excluded from our results due to limited clinical details. 10 The included patients all had positive nasopharyngeal PCR for SARS-CoV-2.…”

Section: Resultsmentioning

confidence: 99%