Based on previous studies, seizure has been reported to accompany coronavirus disease 2019 (COVID-19). Underlying mechanisms are those leading to the direct central nervous system (CNS) invasion through hematogenous spread or trans-synaptic retrograde invasion, causing meningoencephalitis. On the other hand, there are pathophysiologic mechanisms that seizure would be one of their early consequences, such as cytokine storm, hypoxemia, metabolic derangement, and structural brain lesions. Herein, we focused on available evidence to provide an insight into the pathophysiologic mechanisms that link seizure and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as a better understanding of pathophysiology would lead to better diagnosis and treatment.
Introduction Coronavirus disease 2019 (COVID-19) is a devastating pandemic that may also affect the nervous system. One of its neurological manifestations is intracerebral hemorrhage (ICH). Data about pure spontaneous intraparenchymal hemorrhage related to COVID-19 is scarce. In this study, we present some patients with COVID-19 disease who also had spontaneous intraparenchymal hemorrhage along with a review of the literature.
Methods This single-center prospective study was done among 2,862 patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) between March 1 and November 1, 2020. Out of 2,862 patients with SARS-CoV-2, 14 patients with neurological manifestations were assessed with a noncontrast brain computed tomography scan. Seven patients with spontaneous intraparenchymal hemorrhage were enrolled.
Results All seven patients were male, with a mean age of 60.8 years old. Six patients (85.7%) only had minimal symptoms of COVID-19 without significant respiratory distress. The level of consciousness in two patients (28.5%) was less than eight, according to the Glasgow Coma Scale (GCS). Hypertension (71.4%) was the most common risk factor in their past medical history. The mean volume of hematoma was 41cc. Four patients died during hospitalization, and the others were discharged with a mean hospital stay of 42.6 days. All patients with GCS less than 11 died.
Conclusion It concluded that ICH patients with COVID-19 are related to higher blood volume, cortical and subcortical location of hemorrhage, higher fatality rate, and younger age that is different to spontaneous ICH in general population. We recommend more specific neuroimaging in patients with COVID 19 such as brain magnetic resonance imaging concomitant with vascular studies in future. The impact of COVID-19 on mortality rate is not clear because of limited epidemiologic studies, but identifying the causal relationship between COVID-19 and ICH requires further clinical and laboratory studies.
Background and Aim: Smoking has been extensively investigated in oncology, and controversial associations with brain tumor incidence have been reported. Caspase-3 and matrix metalloproteinases (MMPs) belong to an important cascade in tumor vasculogenesis. We aim to study the smoking impact on these signaling molecules in nontumoral rat brain tissue. Methods and Materials/Patients: A total of 60 Wistar rats were divided into two groups: treatment (cigarette smoke/electronic cigarette) and control groups with subgroups of male and female rats. After general anesthesia and decapitation, their brains were collected, and 3-μm thick coronal sections were prepared. Following immunohistochemical staining with rabbit anti-MMP-2 and anti-caspase-3 antigens, protein expressions were analyzed by selecting two fields at 400x magnification. Results: Our data suggest that the expression of MMP-2 was not significantly different between the studied groups. However, the significant inductive activity of cigarette smoking was observed on caspase-3. Conclusion: Cigarette smoking indicates pro-tumoral signaling impact in normal tissue with activation of caspase-3 in rat brain tissue.
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