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

Abstract

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.

The association of posterior reversible encephalopathy syndrome with COVID-19: A systematic review

“…The remaining 34 articles, including case reports, case series, letters to the editor, pictorial essays etc. reporting cases of PRES in COVID-19 were finally shortlisted after rigorous screening [ [16] , [17] , [18] , [19] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] ]. Since a total of 31 patients were described in the nine case series, individual data of 56 patients is described in our systematic review in the form of two tables [ Table 1 and Table 2 ].…”

“… – – 55 Hossein Mozhdehipanah et al (2020) [ 46 ] T2 FLAIR: Bilateral posterior parieto-occipital cortical and subcortical WMH extending to the frontal lobes. Bilateral posterior parieto-occipital hypodensity in the cortical and subcortical WM extending to frontal lobes, and cortical hemorrhage in the right parietal lobe – 56 Alejandro Garcia Rodriguez et al (2020) [ 47 ] – – – Abbreviations: PRES Posterior Reversible Encephalopathy Syndrome, FLAIR Fluid-Attenuated Inversion Recovery, DWI Diffusion Weighted Imaging, SWI Susceptibility Weighted Imaging, ADC Apparent Diffusion Coefficient, GRE Gradient Echo Sequences, WM White Matter, WMH White Matter Hyperintensities, CTA CT Angiography, CTV CT Venography, MRA Magnetic Resonance Angiography, MRV Magnetic Resonance Venography, (−) data not reported. …”