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Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience

BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has had a dramatic impact on health care systems and a variable disease course. Emerging evidence demonstrates that severe acute respiratory syndrome coronavirus 2 is associated with central nervous system disease. We describe central nervous syst...

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Autores principales: Scullen, Tyler, Keen, Joseph, Mathkour, Mansour, Dumont, Aaron S., Kahn, Lora
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier Inc. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255727/
https://www.ncbi.nlm.nih.gov/pubmed/32474092
http://dx.doi.org/10.1016/j.wneu.2020.05.192
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author Scullen, Tyler
Keen, Joseph
Mathkour, Mansour
Dumont, Aaron S.
Kahn, Lora
author_facet Scullen, Tyler
Keen, Joseph
Mathkour, Mansour
Dumont, Aaron S.
Kahn, Lora
author_sort Scullen, Tyler
collection PubMed
description BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has had a dramatic impact on health care systems and a variable disease course. Emerging evidence demonstrates that severe acute respiratory syndrome coronavirus 2 is associated with central nervous system disease. We describe central nervous system manifestations in critical patients with COVID-19 at our tertiary center. METHODS: We conducted a single-center retrospective analysis of all actively critical patients with COVID-19 admitted to our tertiary care academic center in New Orleans, Louisiana, on April 22, 2020, with new onset of neurologic disease. Patients were grouped into 1 of 3 categories according to imaging and clinical features; encephalopathy, acute necrotizing encephalopathy, and vasculopathy. RESULTS: A total of 27 of 76 (35.5%) critical patients with COVID-19 met inclusion criteria. Twenty patients (74%) were designated with COVID-19–associated encephalopathy, 2 (7%) with COVID-19–associated acute necrotizing encephalopathy, and 5 (19%) with COVID-19–associated vasculopathy. Sixty-three percent of neurologic findings were demonstrated on computed tomography, 30% on magnetic resonance imaging, and 44% on electroencephalography. Findings most often included ischemic strokes, diffuse hypoattenuation, subcortical parenchymal hemorrhages, and focal hypodensities within deep structures. Magnetic resonance imaging findings included diffuse involvement of deep white matter, the corpus callosum, and the basal ganglia. For patients with large-territory ischemic stroke, all but one displayed irregular proximal focal stenosis of the supraclinoid internal carotid artery. CONCLUSIONS: Analysis of active critical COVID-19 admissions at our revealed a high percentage of patients with new neurologic disease. Although variable, presentations followed 1 of 3 broad categories. A better understanding of the neurologic sequalae and radiographic findings will help clinicians mitigate the impact of this disease.
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spelling pubmed-72557272020-05-29 Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience Scullen, Tyler Keen, Joseph Mathkour, Mansour Dumont, Aaron S. Kahn, Lora World Neurosurg Original Article BACKGROUND: The coronavirus 2019 (COVID-19) pandemic has had a dramatic impact on health care systems and a variable disease course. Emerging evidence demonstrates that severe acute respiratory syndrome coronavirus 2 is associated with central nervous system disease. We describe central nervous system manifestations in critical patients with COVID-19 at our tertiary center. METHODS: We conducted a single-center retrospective analysis of all actively critical patients with COVID-19 admitted to our tertiary care academic center in New Orleans, Louisiana, on April 22, 2020, with new onset of neurologic disease. Patients were grouped into 1 of 3 categories according to imaging and clinical features; encephalopathy, acute necrotizing encephalopathy, and vasculopathy. RESULTS: A total of 27 of 76 (35.5%) critical patients with COVID-19 met inclusion criteria. Twenty patients (74%) were designated with COVID-19–associated encephalopathy, 2 (7%) with COVID-19–associated acute necrotizing encephalopathy, and 5 (19%) with COVID-19–associated vasculopathy. Sixty-three percent of neurologic findings were demonstrated on computed tomography, 30% on magnetic resonance imaging, and 44% on electroencephalography. Findings most often included ischemic strokes, diffuse hypoattenuation, subcortical parenchymal hemorrhages, and focal hypodensities within deep structures. Magnetic resonance imaging findings included diffuse involvement of deep white matter, the corpus callosum, and the basal ganglia. For patients with large-territory ischemic stroke, all but one displayed irregular proximal focal stenosis of the supraclinoid internal carotid artery. CONCLUSIONS: Analysis of active critical COVID-19 admissions at our revealed a high percentage of patients with new neurologic disease. Although variable, presentations followed 1 of 3 broad categories. A better understanding of the neurologic sequalae and radiographic findings will help clinicians mitigate the impact of this disease. Elsevier Inc. 2020-09 2020-05-28 /pmc/articles/PMC7255727/ /pubmed/32474092 http://dx.doi.org/10.1016/j.wneu.2020.05.192 Text en © 2020 Elsevier Inc. All rights reserved. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle Original Article
Scullen, Tyler
Keen, Joseph
Mathkour, Mansour
Dumont, Aaron S.
Kahn, Lora
Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience
title Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience
title_full Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience
title_fullStr Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience
title_full_unstemmed Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience
title_short Coronavirus 2019 (COVID-19)–Associated Encephalopathies and Cerebrovascular Disease: The New Orleans Experience
title_sort coronavirus 2019 (covid-19)–associated encephalopathies and cerebrovascular disease: the new orleans experience
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7255727/
https://www.ncbi.nlm.nih.gov/pubmed/32474092
http://dx.doi.org/10.1016/j.wneu.2020.05.192
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