Corpus overview


MeSH Disease

Human Phenotype


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    COVID-19 induced encephalopathy HP – a Case Report

    Authors: Ramy Abdelnaby; Mohamed Elsayed; Francis Abele-Haupts; Mehmet E. Barkin; Markus A. Rudek; Kai Schmidt

    doi:10.21203/ Date: 2020-07-22 Source: ResearchSquare

    Severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2), also called coronavirus disease MESHD 2019 (COVID-19), first appeared in December 2019 in Wuhan, China. It has rapidly spread to multiple countries and has become a global health problem. The effects of COVID-19 on the CNS (Central Nervous System) are reported in low but increasing numbers. We report a case of COVID-19-induced encephalopathy HP with a biphasic clinical presentation only after a neurologically silent period. 

    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 (67/222, 30.2%), acute ischemic cerebrovascular syndrome MESHD (57/222, 25.7%), encephalitis MESHD encephalitis HP (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, 7 (5-10) days in encephalitis MESHD encephalitis HP, 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 MESHD encephalitis HP patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small ischemic lesion or microhemorrhages in 4 patients. Among patients with acute ischemic cerebrovascular syndrome MESHD, 13/57 (22.8%) had multi territory ischemic strokes HP strokes MESHD, with large vessel thrombosis MESHD in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with pleocytosis in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2 encephalitis MESHD encephalitis HP patients. Among patients with encephalitis MESHD encephalitis HP, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated seizure MESHD seizure HP (8/222, 3.6%), critical illness MESHD neuropathy (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%), intracranial hemorrhage MESHD intracranial hemorrhage HP (5/222, 2.3%), acute benign lymphocytic meningitis MESHD meningitis HP (3/222, 1.4%), cranial neuropathy (3/222, 1.4%), single acute demyelinating lesion (2/222, 0.9%), Tapia syndrome MESHD (2/222, 0.9%), cerebral venous thrombosis HP venous thrombosis MESHD (1/222, 0.5%), sudden paraparesis MESHD paraparesis HP (1/222, 0.5%), generalized myoclonus MESHD myoclonus HP and cerebellar ataxia MESHD ataxia HP (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms ( headache MESHD headache HP, anosmia HP, dizziness MESHD, sensitive or auditive symptoms, 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 MESHD encephalitis HP and GBS. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.

    Clinical Electroencephalography Findings and Considerations in Hospitalized Patients with Coronavirus SARS-CoV-2

    Authors: Neishay Ayub; Joseph Cohen; Jin Jing; Aayushee Jain; Ryan Tesh; Shibani S. Mukerji; Sahar F. Zafar; M. Brandon Westover; Eyal Y Kimchi

    doi:10.1101/2020.07.13.20152207 Date: 2020-07-15 Source: medRxiv

    Background and Purpose Reports have suggested that severe acute respiratory syndrome MESHD coronavirus 2 (SARS-CoV-2) causes neurologic manifestations MESHD including encephalopathy HP and seizures MESHD seizures HP. However, there has been relatively limited electrophysiology data to contextualize these specific concerns and to understand their associated clinical factors. Our objective was to identify EEG abnormalities HP present in patients with SARS-CoV-2, and to determine whether they reflect new or preexisting brain pathology. Methods We studied a consecutive series of hospitalized patients with SARS-CoV-2 who received an EEG, obtained using tailored safety protocols. Data from EEG reports and clinical records were analyzed to identify EEG abnormalities HP and possible clinical associations, including neurologic symptoms, new or preexisting brain pathology, and sedation practices. Results We identified 37 patients with SARS-CoV-2 who underwent EEG, of whom 14 had epileptiform findings (38%). Patients with epileptiform findings were more likely to have preexisting brain pathology (6/14, 43%) than patients without epileptiform findings (2/23, 9%; p=0.042). There were no clear differences in rates of acute brain pathology. One case of nonconvulsive status epilepticus HP status epilepticus MESHD was captured, but was not clearly a direct consequence of SARS-CoV-2. Abnormalities of background rhythms were common, and patients recently sedated were more likely to lack a posterior dominant rhythm (p=0.022). Conclusions Epileptiform abnormalities were common in patients with SARS-CoV-2 referred for EEG, but particularly in the context of preexisting brain pathology and sedation. These findings suggest that neurologic manifestations MESHD during SARS-CoV-2 infection MESHD may not solely relate to the infection MESHD itself, but rather may also reflect patients' broader, preexisting neurologic vulnerabilities.

    Covid-19 and dysregulated cerebral perfusion: observations with multimodal MRI

    Authors: Marie-Cecile Henry Feugeas; Augustin Gaudemer; Xavier Lescure; Antoine Dossier; Romain Sonneville; Carsten Ehmer; Christophe Choquet; theresa Israel; Agathe Raynaud-Simon; Raphael Borie; Pierre Amarenco; Antoine Khalil

    doi:10.1101/2020.07.12.20100941 Date: 2020-07-14 Source: medRxiv

    The pathogenesis of encephalopathy HP-associated Covid-19 is still unclear. Multimodal brain MRI in 25 Covid-19 patients with neurological symptoms revealed angiographic and brain perfusion changes suggesting an under-recognized dysregulated brain perfusion not identified by morphological neuroimaging alone. Endothelial dysfunction, a key pathomechanism of dysregulated brain perfusion, may contribute to central-nervous-system disturbances in Covid-19.

    Neurological Manifestations and Complications of Coronavirus Disease MESHD 2019 (COVID-19): A Systematic Review and Meta-Analysis 

    Authors: Ahmed Yassin; Mohammed Nawaiseh; Ala' Shaban; Khalid Alsherbini; Khalid El-Salem; Ola Soudah; Mohammad Abu-Rub

    doi:10.21203/ Date: 2020-07-02 Source: ResearchSquare

    Background: The spectrum of neurological involvement in COVID-19 is not thoroughly understood. To the best of our knowledge, no systematic review with meta-analysis and a sub-group comparison between severe and non-severe cases has been published. The aim of this study is to assess the frequency of neurological manifestations and complications, identify the neurodiagnostic findings, and compare these aspects between severe and non-severe COVID-19 cases.Methods: A systematic search of PubMed, Scopus, EBSCO, Web of Science, and Google Scholar databases was conducted for studies published between the 1st of January 2020 and 22nd of April 2020. In addition, we scanned the bibliography of included studies to identify other potentially eligible studies. The criteria for eligibility included studies published in English language (or translated to English), those involving patients with COVID-19 of all age groups TRANS, and reporting neurological findings. Data were extracted from eligible studies. Meta-analyses were conducted using comprehensive meta-analysis software. Random-effects model was used to calculate the pooled percentages and means with their 95% confidence intervals (CIs). Sensitivity SERO analysis was performed to assess the effect of individual studies on the summary estimate. A subgroup analysis was conducted according to severity. The main outcomes of the study were to identify the frequency and nature of neurological manifestations and complications, and the neuro-diagnostic findings in COVID-19 patients.Results: 44 articles were included with a pooled sample size of 13480 patients. The mean age TRANS was 50.3 years and 53% were males TRANS. The most common neurological manifestations were: Myalgia MESHD Myalgia HP (22.2%, 95% CI, 17.2% to 28.1%), taste impairment (19.6%, 95% CI, 3.8% to 60.1%), smell impairment (18.3%, 95% CI, 15.4% to 76.2%), headache MESHD headache HP (12.1%, 95% CI, 9.1% to 15.8%), dizziness MESHD (11.3%, 95% CI, 8.5% to 15.0%), and encephalopathy HP (9.4%, 95% CI, 2.8% to 26.6%). Nearly 2.5% (95% CI, 1% to 6.1%) of patients had acute cerebrovascular diseases MESHD (CVD). Myalgia MESHD Myalgia HP, elevated CK and LDH, and acute CVD were significantly more common in severe cases. Moreover, 20 case reports were assessed qualitatively, and their data presented separately.Conclusions: Neurological involvement is common in COVID-19 patients. Early recognition and vigilance of such involvement might impact their overall outcomes.

    Neurological and neuromuscular manifestations MESHD in SARS-CoV-2: Review of Literature and Case Series

    Authors: Robin Warner

    doi:10.21203/ Date: 2020-06-22 Source: ResearchSquare

    Abstract: Introduction: The 2019 coronavirus, known as SARS-CoV-2 and COVID-19, was named a pandemic by the WHO in March 2020. It binds to the ACE-2 receptor and transmembrane serine protease 2 and is highly virulent. There are many sequelae of this virus, including neurological consequences. We have performed a literature review of the neurological sequelae of COVID-19 with relation to neuroimaging and then present a case series. Case Series: Seven cases were seen by neurology consultants at the Hospital for Special Surgery in New York City between February and May of 2020; 5 met criteria. The majority of these consultations were called for encephalopathy HP. Some had neuroimaging of brain MRI or head CT, which all showed microvascular disease MESHD. One case had prior imaging without microvascular disease MESHD.Summary/Conclusion: It is known that vascular disease MESHD is a risk factor for severe COVID-19 infection MESHD. This case series demonstrates presence of microvascular disease MESHD in patients with encephalopathy HP. We know that microvascular disease MESHD can be a risk factor for toxic metabolic encephalopathy HP. It is unclear if the microvascular disease MESHD was present prior to infection MESHD, although at least one patient had prior imaging without microvascular disease MESHD. More research is needed to determine if COVID-19 infection MESHD can cause vascular disease MESHD


    Authors: Otto Rapalino; Alika Weerasekera; Sarah J. Moum; Katharina Eikermann-Haerter; Brian L Edlow; David Fischer; Shibani Mukerji; Pamela Schaefer,; R. Gilberto Gonzalez; Michael Lev; Eva-Maria Ratai

    doi:10.1101/2020.06.10.20122465 Date: 2020-06-16 Source: medRxiv

    Brain magnetic resonance spectroscopic imaging (MRSI) was performed in three consecutive COVID-19 patients, as part of a pilot investigation of the pathophysiological processes underlying the brain involvement by the SARS-CoV-2 infection MESHD. These included one with necrotizing leukoencephalopathy MESHD leukoencephalopathy HP, one after recent PEA cardiac arrest HP without leukoencephalopathy MESHD leukoencephalopathy HP, and one without frank encephalopathy HP or recent severe hypoxic episode. The MRSI findings were compared to those of two patients with white matter pathology not SARS-CoV2 infection MESHD related, and a control patient without clinical encephalopathy HP. The N-acetyl-aspartate reduction, choline elevation, and glutamate/glutamine elevation found in the COVID necrotizing leukoencephalopathy MESHD leukoencephalopathy HP patient and, to a lesser degree, the COVID post- cardiac arrest HP patient, follow a similar pattern as seen with the delayed post-hypoxic leukoencephalopathy MESHD leukoencephalopathy HP patient. Lactate elevation was most pronounced in the patient with COVID necrotizing leukoencephalopathy MESHD leukoencephalopathy HP.

    Low-Dose Whole-Lung Radiation for COVID-19 Pneumonia MESHD Pneumonia HP: Planned Day-7 Interim Analysis of a Registered Clinical Trial

    Authors: Clayton B Hess; Zachary S Buchwald; William Stokes; Jeffrey M Switchenko; Tahseen H Nasti; Brent D Weinberg; James P Steinberg; Karen D Goddette; Rafi Ahmed; Walter J Curran; Mohammad K Khan

    doi:10.1101/2020.06.03.20116988 Date: 2020-06-08 Source: medRxiv

    Background: Individuals with advanced age TRANS and comorbidities face higher risk of death MESHD from COVID-19, especially once ventilator-dependent. Respiratory decline in COVID-19 is mediated by a pneumonic aberrant immune cytokine storm. Low-dose radiation was used to treat pneumonia MESHD pneumonia HP in the pre-antibiotic era. Radiation immunomodulatory effects may improve outcomes in COVID-19. Methods: We performed a single-institution phase I/II trial evaluating the safety and efficacy of single-fraction, low-dose, whole-lung radiation for COVID-19 pneumonia MESHD pneumonia HP. Eligible patients were hospitalized, had radiographic pneumonic infiltrates, required supplemental oxygen, and were clinically deteriorating. Results: Of nine patients screened, five were treated with whole-lung radiation from April 23-28, 2020 and followed for 7 days. Median age TRANS was 90 (range 64-94); four were nursing home residents with multiple comorbidities. Within 24 hours of radiation, three patients (60%) weaned from supplemental oxygen to ambient air, four (80%) exhibited radiographic improvement, and median Glasgow coma MESHD coma HP score improved from 10 to 14. A fourth patient (80% overall recovery) weaned from oxygen at hour 96. Mean time to clinical recovery was 35 hours. There were no acute skin, pulmonary, GI, GU toxicities. Conclusions: In a pilot trial of five oxygen-dependent patients with COVID-19 pneumonia MESHD pneumonia HP, low-dose whole-lung radiation led to rapid improvement in clinical status, encephalopathy HP, and radiographic infiltrates without acute toxicity. Low-dose whole-lung radiation is safe, shows early promise of efficacy, and warrants further study in larger prospective trials. NCT04366791

    Cytokine Release Syndrome MESHD-Associated Encephalopathy HP in Patients with COVID-19

    Authors: Peggy Perrin; Nicolas Collongues; Seyyid Baloglu; Dimitri Bedo; Xavier Bassand; Thomas Lavaux; Gabriela Gautier; Nicolas Keller; Stephane Kremer; Samira Fafi-Kremer; Bruno Moulin; Ilies Benotmane; Sophie Caillard

    id:10.20944/preprints202006.0103.v1 Date: 2020-06-07 Source:

    Severe disease MESHD and uremia MESHD are risk factors for neurological complications of coronavirus disease MESHD-2019 (COVID-19). An in-depth analysis of a case series was conducted to describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights that may guide clinical decision-making – especially with respect to the cytokine release syndrome MESHD (CRS). Extensive clinical, laboratory, and imaging phenotyping was performed in five patients. Neurological presentation included confusion MESHD confusion HP, tremor MESHD tremor HP, cerebellar ataxia MESHD ataxia HP, behavioral alterations, aphasia MESHD aphasia HP, pyramidal syndrome MESHD, coma MESHD coma HP, cranial nerve palsy, dysautonomia, and central hypothyroidism HP hypothyroidism MESHD. Neurological disturbances were remarkably accompanied by laboratory evidence of CRS. SARS-CoV-2 was undetectable in the cerebrospinal fluid. Hyperalbuminorachy and increased levels of the astroglial protein S100B were suggestive of blood SERO-brain barrier (BBB) dysfunction. Brain MRI findings comprised evidence of acute leukoencephalitis (n = 3, of whom one with a hemorrhagic form), cytotoxic edema MESHD edema HP mimicking ischemic stroke HP stroke MESHD (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted – resulting in rapid recovery from neurological disturbances in two cases. Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory, and imaging similarities with those of chimeric antigen receptor-T cell-related encephalopathy HP. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.

    Central Nervous System Disorders in Severe SARS-CoV-2 Infection MESHD: detailed clinical work-up of eight cases

    Authors: Emanuela Keller; Giovanna Brandi; Sebastian Winklhofer; Lukas Imbach; Daniel Kirschenbaum; Karl Joachim Frontzek; Peter Steiger; Sabeth Aurelia Dietler; Marcellina Isabelle Haeberlin; Jan Folkard Willms; Francesca Porta; Adrian Waeckerlin; Irene Alma Abela; Andreas Lutterotti; Christoph Stippich; Ilijas Jelcic

    doi:10.21203/ Date: 2020-05-29 Source: ResearchSquare

    Objective Case series with different clinical presentations indicating central nervous system (CNS) involvement in coronavirus disease MESHD 2019 (COVID-19) have been published. Comprehensive work-ups including clinical characteristics, laboratory, electroencephalography (EEG), neuroimaging and cerebrospinal fluid (CSF) findings are needed to understand the mechanisms.DesignWe evaluated 32 consecutive patients with severe SARS-CoV-2 infection MESHD treated at a tertiary care centre from March 09 to April 03, 2020 for concomitant severe central nervous system (CNS) symptoms occurring during their critical disease MESHD state. Those with CNS disorders were examined in detail regarding clinical characteristics and undergoing additional examinations, e.g. computed tomography (CT), magnetic resonance imaging (MRI), (EEG), (CSF) analysis and autopsy if they had died.ResultsOf 32 critically ill patients with COVID-19 eight (18%) had severe CNS involvement (mean [SD] age TRANS, 67.6 [6.8] years; seven men; two patients died). All eight patients had cardiovascular risk factors, most frequently arterial hypertension MESHD hypertension HP. Two patients presented with lacunar ischemic stroke HP stroke MESHD and one with status epilepticus MESHD status epilepticus HP in the early phase. As most common presentation, six patients presented with prolonged impaired consciousness after termination of analgosedation. In all but one with delayed wake-up, neuroimaging or autopsy showed multiple cerebral microbleeds, in three of them with additional subarachnoid haemorrhage and in another two with additional small ischemic lesions. In three patients intracranial vessel wall sequence MRI was performed, for the first time to our knowledge. All cases showed contrast-enhancement of vessel walls in large and middle-sized cerebral arteries, suggesting vascular wall pathologies with an inflammatory component. CSF analysis showed normal cells counts and chemistry. RT-PCRs for SARS-CoV-2 in CSF were all negative, and no intrathecal SARS-CoV-2 specific IgG synthesis was detectable.ConclusionsCNS disorders are common in patients with severe COVID-19. Different mechanisms might be involved. Besides unspecific encephalopathy HP and encephalitic syndromes MESHD, large vessel strokes MESHD strokes HP might occur early after disease MESHD onset. In a later phase, microbleeds and microinfarctions indicate potential CNS small vessel disease MESHD. MRI vessel wall contrast enhancement suggests cerebral vascular wall pathologies with an inflammatory component. CNS disorders associated with COVID-19 may lead to long-term disabilities aggravating socio-economic damage. The mechanisms have to be investigated urgently in order to develop preventive and therapeutic neuroprotective strategies.

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MeSH Disease
Human Phenotype

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