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    Autoimmune Encephalitis HP Presenting with Acute Excited Catatonia MESHD in a 40-Year-Old Male TRANS Patient with Covid-19

    Authors: Jan Mulder; Amalia Feresiadou; David Fallmar; Robert Frithiof; Johan Virhammar; Annica Rasmusson; Elham Rostami; Eva Kumlien; Janet Lynn Cunningham

    doi:10.1101/2020.07.23.20160770 Date: 2020-08-04 Source: medRxiv

    Acute malignant catatonia MESHD with autonomic instability developed in a previously healthy man with PCR-verified SARS-CoV-2. CT and MRI were normal, EEG showed slowing and cerebrospinal fluid showed a subtle indication of inflammation MESHD. There were no signs of pathology in other organs. 18F-FDG-PET conveyed high bilateral uptake in the striatum. While commercial tests were negative, immunohistochemical staining of mouse brain revealed anti-neuronal IgG antibodies SERO against neuronal targets in the hippocampus, thalamus, striatum and cortex. Early treatment with plasmapheresis and corticosteroid reversed disease progression and may have prevented large-scale neurological damage. We are not aware of other types of encephalitis HP encephalitis MESHD with such distinct pyramidal tract symptoms and raise the possibility that this may be a novel form of autoimmune encephalitis HP induced by infection MESHD with SARS-CoV-2.

    Neurological manifestations associated with COVID-19: a nationwide registry

    Authors: Elodie Meppiel; Nathan Peiffer-Smadja; Alexandra Maury; Imen Bekri; Cecile Delorme; Virginie Desestret; Lucas Gorza; Geoffroy Hautecloque-Raysz; Sophie Landre; Annie Lannuzel; Solene Moulin; Peggy Perrin; Paul Petitgas; Francois Sellal; Adrien Wang; Pierre Tattevin; Thomas de Broucker; - contributors to the NeuroCOVID registry

    doi:10.1101/2020.07.15.20154260 Date: 2020-07-16 Source: medRxiv

    Background: The clinical description of the neurological manifestations in COVID-19 patients is still underway. This study aims to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with SARS-CoV-2 infection MESHD. Methods: We conducted a nationwide, multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients with de novo neurological manifestations were eligible. Results: We included 222 COVID-19 patients with neurological manifestations from 46 centers throughout the country. Median age TRANS was 65 years (IQR 53-72), and 136 patients (61.3%) were male TRANS. COVID-19 was severe or critical in almost half of the patients (102, 45.2%). The most common neurological diseases MESHD were COVID-19 associated encephalopathy HP encephalopathy MESHD (67/222, 30.2%), acute ischemic cerebrovascular syndrome MESHD (57/222, 25.7%), encephalitis HP encephalitis MESHD (21/222, 9.5%), and Guillain-Barre Syndrome MESHD (15/222, 6.8%). Neurological manifestations appeared after first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy HP encephalopathy MESHD, 7 (5-10) days in encephalitis HP encephalitis MESHD, 12 (7-18) days in acute ischemic cerebrovascular syndrome MESHD and 18 (15-28) days in Guillain-Barre Syndrome MESHD. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Brain MRI of encephalitis HP encephalitis MESHD patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small ischemic lesion or microhemorrhages MESHD in 4 patients. Among patients with acute ischemic cerebrovascular syndrome MESHD, 13/57 (22.8%) had multi territory ischemic strokes HP ischemic strokes MESHD, with large vessel thrombosis MESHD in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with pleocytosis MESHD in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2 encephalitis HP encephalitis MESHD patients. Among patients with encephalitis HP encephalitis MESHD, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated seizure HP seizure MESHD (8/222, 3.6%), critical illness neuropathy MESHD (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%), intracranial hemorrhage HP intracranial hemorrhage MESHD (5/222, 2.3%), acute benign lymphocytic meningitis MESHD meningitis HP (3/222, 1.4%), cranial neuropathy MESHD (3/222, 1.4%), single acute demyelinating lesion MESHD (2/222, 0.9%), Tapia syndrome MESHD (2/222, 0.9%), cerebral venous thrombosis HP cerebral venous thrombosis MESHD (1/222, 0.5%), sudden paraparesis MESHD paraparesis HP (1/222, 0.5%), generalized myoclonus HP myoclonus MESHD and cerebellar ataxia MESHD ataxia HP (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms ( headache HP headache MESHD, anosmia HP anosmia MESHD, dizziness MESHD, sensitive or auditive symptoms MESHD, hiccups MESHD, 15/222, 6.8%). The median (IQR) follow-up of the 222 patients was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%). Conclusion: Neurological manifestations associated with COVID-19 mainly included CAE, AICS, encephalitis HP encephalitis MESHD and GBS MESHD. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.

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