Postinfectious Neurologic Complications in COVID-19: A Complex Case Report

Tiraboschi, Pietro; Xhani, Rubjona; Zerbi, Simone Maria; Corso, Angelo; Martinelli, Ida; Fusi, Laura; Grampa, G; Lombardo, Andrea; Cavalcante, Paola; Cappelletti, Cristina; Andreetta, Francesca; Sironi, Alberto; Redolfi, Alberto; Muscio, Cristina

doi:10.2967/jnumed.120.256099

Cited by 13 publications

(15 citation statements)

References 5 publications

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“…There were 3 independent case reports including 18 F-FDG PET in patients with autoimmune encephalitis in the acute to subacute phase of COVID-19 ( 22 – 24 ). Given the preliminary nature of case reports, we are summarizing only the most noteworthy findings and refer the interested reader to Supplemental Table 1 for more detail.…”

Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

“…Given the preliminary nature of case reports, we are summarizing only the most noteworthy findings and refer the interested reader to Supplemental Table 1 for more detail. PET showed diffuse cortical hypometabolism ( n = 1) and increased metabolism in the basal ganglia ( n = 3), mesiotemporal structures ( n = 1), and cerebellum ( n = 1), possibly rated to cerebellum- and basal ganglia–specific antineuronal antibodies in 2 of these patients ( 22 , 24 ). Interestingly, immunomodulating treatment led to improvement in all patients, with 6-mo follow-up 18 F-FDG PET having normal findings in 1 patient ( 24 ).…”

Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

“…PET showed diffuse cortical hypometabolism ( n = 1) and increased metabolism in the basal ganglia ( n = 3), mesiotemporal structures ( n = 1), and cerebellum ( n = 1), possibly rated to cerebellum- and basal ganglia–specific antineuronal antibodies in 2 of these patients ( 22 , 24 ). Interestingly, immunomodulating treatment led to improvement in all patients, with 6-mo follow-up 18 F-FDG PET having normal findings in 1 patient ( 24 ). The authors postulated para- or postinfectious encephalitis without evidence of direct virus invasion, which fits into other relative rare cases in the literature ( 13 ).…”

Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

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Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

et al. 2022

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Molecular imaging techniques like positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have been used to shed light on how the Corona Virus Disease 2019 (COVID-19) affects the human brain. We provide a systematic review that summarizes the current literature according to five predominant topics: 1. Few case reports suggest reversible cortical and subcortical metabolic alterations in rare cases with concomitant, para-or post-infectious encephalitis. 2. Imaging findings in single patients with first manifestations of parkinsonism in the context of COVID-19 resemble those in neurodegenerative parkinsonism (loss of nigrostriatal integrity), but scarceness of data and a lack of follow-up preclude further etiological conclusions (e.g., unmasking/hastening of neurodegeneration vs. (para-) infectious parkinsonism). 3. Several case reports and few systematic studies addressed focal symptoms and lesions, most notably hyposmia. Results are variable, although some studies found regional hypometabolism of regions related to olfaction (e.g., orbitofrontal and mesiotemporal). 4. A case series and systematic studies in inpatients with COVID-19-related encephalopathy (acute to subacute stage) consistently found a frontoparietal-dominant neocortical dysfunction (on imaging and clinically) that proved to be grossly reversible in the majority of cases until 6 months. 5. Studies in "Post-COVID-19 syndrome" provided controversial results. In patients with a high level of self-reported complaints (e.g., fatigue, memory impairment, hyposmia, dyspnea) some authors found extensive areas of limbic and subcortical hypometabolism, while others found no metabolic alterations on PET and only minor cognitive impairments (if any) on neuropsychological assessment. Furthermore, we provide a critical appraisal of studies in regard of frequent methodological issues and current pathophysiological concepts. Finally, we devised possible applications of PET and SPECT in the clinical work-up of diagnostic questions related to COVID-19.

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Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

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Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

et al. 2022

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“…A total of 16 papers were included, describing 20 cases that met our criteria (Table 2). [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] In 13 patients, SARS-CoV-2 infection was confirmed with a nasopharyngeal swab, found positive for SARS-CoV-2 in a real time reverse-transcription polymerase chain reaction (RT-PCR) assay. For the residual seven cases reported to have been diagnosed with 8,10,11,15,16,20) the diagnostic means of confirmation were not provided.…”

Section: Resultsmentioning

confidence: 99%

Coronavirus Disease 2019 and Related Parkinsonism: The Clinical Evidence Thus Far

Boura

2022

Movement Disord Clin Pract

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Background The Coronavirus disease 2019 (Covid‐19) pandemic has fueled both research and speculation, as to whether it could be a “perfect storm” for a post‐Covid emergence of parkinsonism in some susceptible individuals, analogous to the post‐encephalitic parkinsonism reported after the 1918 influenza epidemic. This theory is further augmented by reports of a pathogenic effect of the Severe Acute Respiratory Syndrome Coronavirus‐2 (SARS‐CoV‐2) on the central nervous system with specific impact on the dopaminergic pathway, as well as the possibility of the virus to selectively bind to Angiotensin‐Converting Enzyme‐2 (ACE‐2); these molecules are expressed abundantly in the midbrain dopamine neurons and, are likely involved in several cellular mechanisms cited in Parkinson's Disease (PD) pathophysiology. Objectives—Methods Therefore, we performed a review of the literature up to February 2022 to explore the current landscape considering published cases of new‐onset parkinsonism after a SARS‐CoV‐2 infection in otherwise healthy individuals. We summarized their clinical features, diagnostic and treatment approaches, discussing potential underlying mechanisms in light of PD pathogenesis theories. Results Twenty cases that developed parkinsonian features simultaneously or shortly after a reported SARS‐CoV‐2 infection were reviewed. In 11 of them, parkinsonism appeared in the context of encephalopathy, while four patients developed post‐infectious parkinsonism without encephalopathy, and four bore similarities to idiopathic PD. Nine patients exhibited a good response to dopaminergic therapy, while four responded to immunomodulatory treatment. Conclusions Available data does not yet justify a clear association between the Covid‐19 pandemic and a parkinsonism wave. However, vigilance is necessary, as long‐term effects might have not been revealed.

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“…Additionally, fluorodeoxyglucose positron-emission tomography may show hypermetabolism within affected areas. 3 Several other cases of SARS-CoV-2-associated infectious encephalitis reported in the literature 4 5 were not listed in the table of the case report. 1 …”

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confidence: 99%

Comments on “CSF-Confirmed SARS-CoV-2 Acute Encephalitis”: SARS-CoV-2-Associated Encephalitis Is Autoimmune Rather Than Infectious

Finsterer

Fiorini

2022

J Clin Neurol

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Postinfectious Neurologic Complications in COVID-19: A Complex Case Report

Cited by 13 publications

References 5 publications

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

Coronavirus Disease 2019 and Related Parkinsonism: The Clinical Evidence Thus Far

Comments on “CSF-Confirmed SARS-CoV-2 Acute Encephalitis”: SARS-CoV-2-Associated Encephalitis Is Autoimmune Rather Than Infectious

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