Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient

Abstract

Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2. Keywords Reversible encephalopathy syndrome PRES • COVID-19 • Endothelial dysfunction Abbreviations COVID-19 Corona virus disease 19 CTA Computed tomography angiography ED Endothelial dysfunction SARS-Cov2 Severe acute respiratory syndrome covid 2 Case presentation * Maurizio Versino

Clinical and Imaging Characteristics in Patients with SARS-CoV-2 Infection and Acute Intracranial Hemorrhage

“…Vascular disorders are the main underlying cause, including cortical vein thrombosis, vascular malformations, reversible cerebral vasoconstriction syndrome (RVCS), vasculitides, infectious aneurysms, reversible encephalopathy syndrome (PRES), and cerebral amyloid angiopathy [14]. PRES with secondary hemorrhage has recently been described in a series of severe COVID-19 infections with circumscribed parenchymal hemorrhage along the convexities [15,16]. Etiology of PRES can be diverse but is highly associated with sepsis, also found in 8 out of 18 patients in our case series (44.4%).…”

Brain abnormalities in COVID-19 acute/subacute phase: A rapid systematic review

“…Hypodensities were noted in additional 29/124 (23% affected cases), and were primarily registered as diffuse changes in bilateral WM [E (Cariddi et al, 2020); X : 26/242 cases]. Two case studies described hypodensities in amygdala [F] (Dixon et al, 2020), supratentorial leptomeningeal [N] (Hepburn et al, 2020), left occipital lobe [F] (Dixon et al, 2020) in WM and gray matter).…”

“…Posterior brain regions presented bilateral abnormalities in 22/124 (18% of patients with brain abnormalities). One patient showed subcortical WM hypodensities reaching from occipito-parieto-temporal reaching toward posterior frontal tracts [E] (Cariddi et al, 2020). Subcortical and deep WM hyperintensities were diffuse [U] (Parsons et al, 2020), included occipital and parietal regions [P (Kandemirli et al, 2020): 4/27 and 3/27 cases respectively], or were accompanied by mild restricted diffusion in subcortical and deep WM in occipital lobe [W : 10/11 cases, including 7 cases with additional abnormalities in juxtacortical WM].…”

“…and amygdala[F] (Dixon et al, 2020); as well as left frontal [T](Muhammad et al, 2020) and occipital areas [E](Cariddi et al, 2020); right temporal area [E](Cariddi et al, 2020); temporal plus frontal lobes and Sylvian fissure…”

An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era

“…The outbreak of COVID-19 has had a significant impact on health systems worldwide. The involvement of the nervous system in the SARS-CoV2 virus is now recognized (9,10), and endothelial involvement is likely to play a key role (11)(12)(13)(14)(15). Thus, the management of stroke in the COVID-19 era has two aspects: one concerning COVID-19-related stroke (16,17), and another about the need to meet the standards for the treatment of a time-dependent disease, despite having to allocate health system resources to the management of COVID-19.…”