18FDG-PET/CT Assessment of COVID-19-Induced Bell's Palsy

Karimi-Galougahi, Mahboobeh; Yousefi-Koma, Abbas; Raygani, Negar; Bakhshayeshkaram, Mehrdad; Haseli, Sara

doi:10.1016/j.acra.2020.11.001

Cited by 8 publications

(8 citation statements)

References 5 publications

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“…Other focal signs preliminarily investigated by 18 F-FDG PET include a case of facial palsy with putative hypometabolism of the respective facial nerve ( 34 ) and a patient with frequent focal seizures possibly due to subacute encephalitis after SARS-CoV-2 infection with a normal 18 F-FDG PET result ( 35 ) (Supplemental Table 1). Another group reported hypermetabolism of the inferior colliculi as a novel finding in patients with COVID-19 ( 36,37 ) that was associated with more frequent seizures and higher blood leukocytes at admission.…”

Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

et al. 2022

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Molecular imaging techniques like positron emission tomography (PET) and single-photon emission computed tomography (SPECT) have been used to shed light on how the Corona Virus Disease 2019 (COVID-19) affects the human brain. We provide a systematic review that summarizes the current literature according to five predominant topics: 1. Few case reports suggest reversible cortical and subcortical metabolic alterations in rare cases with concomitant, para-or post-infectious encephalitis. 2. Imaging findings in single patients with first manifestations of parkinsonism in the context of COVID-19 resemble those in neurodegenerative parkinsonism (loss of nigrostriatal integrity), but scarceness of data and a lack of follow-up preclude further etiological conclusions (e.g., unmasking/hastening of neurodegeneration vs. (para-) infectious parkinsonism). 3. Several case reports and few systematic studies addressed focal symptoms and lesions, most notably hyposmia. Results are variable, although some studies found regional hypometabolism of regions related to olfaction (e.g., orbitofrontal and mesiotemporal). 4. A case series and systematic studies in inpatients with COVID-19-related encephalopathy (acute to subacute stage) consistently found a frontoparietal-dominant neocortical dysfunction (on imaging and clinically) that proved to be grossly reversible in the majority of cases until 6 months. 5. Studies in "Post-COVID-19 syndrome" provided controversial results. In patients with a high level of self-reported complaints (e.g., fatigue, memory impairment, hyposmia, dyspnea) some authors found extensive areas of limbic and subcortical hypometabolism, while others found no metabolic alterations on PET and only minor cognitive impairments (if any) on neuropsychological assessment. Furthermore, we provide a critical appraisal of studies in regard of frequent methodological issues and current pathophysiological concepts. Finally, we devised possible applications of PET and SPECT in the clinical work-up of diagnostic questions related to COVID-19.

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Section: Insights From Molecular Imaging With Pet and Spectmentioning

confidence: 99%

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

et al. 2022

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“…Karimi-Galougahi et al noted decreased metabolic activity in the orbitofrontal cortex associated with the COVID-19 induced anosmia ( Figure 3 ) 32 . In addition, these authors used FDG-PET/CT to investigate COVID-19 induced facial nerve palsy, and FDG-PET/CT findings have also indicated reduced neurological radiotracer uptake in several brain areas prior to symptom onset, during active illness, and 6 months after infection 33 , 34 , 35 . The acute reduction in uptake was primarily found in the pre-frontal cortex, mimicking the patterns of several neurodegenerative disorders 33 , 34 , 35 .…”

Section: Fdg-pet/ct and Extrapulmonary Manifestations Of Covid-19mentioning

confidence: 99%

“…In addition, these authors used FDG-PET/CT to investigate COVID-19 induced facial nerve palsy, and FDG-PET/CT findings have also indicated reduced neurological radiotracer uptake in several brain areas prior to symptom onset, during active illness, and 6 months after infection 33 , 34 , 35 . The acute reduction in uptake was primarily found in the pre-frontal cortex, mimicking the patterns of several neurodegenerative disorders 33 , 34 , 35 . Other authors such as Sollini et al have identified increased FDG uptake in vasculature in those patients complaining of persistent symptoms post-infection 36 .…”

Section: Fdg-pet/ct and Extrapulmonary Manifestations Of Covid-19mentioning

confidence: 99%

FDG-PET/CT of COVID-19 and Other Lung Infections

Eibschutz

Rabiee

Asadollahi

et al. 2022

Seminars in Nuclear Medicine

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While not conventionally used as the first-line modality, [ 18 F]-2-fluoro-2-deoxy-D-glucose (FDG) - positron emission tomography/computed tomography (PET/CT) can identify infection and inflammation both earlier and with higher sensitivity than anatomic imaging modalities [including chest X-ray (CXR), computed tomography (CT), and magnetic resonance imaging (MRI)]. The extent of inflammation and, conversely, recovery within the lungs, can be roughly quantified on FDG-PET/CT using maximum standardized uptake value (SUVmax) values. The Coronavirus disease 2019 (COVID-19) pandemic has highlighted the value of FDG-PET/CT in diagnosis, elucidation of acute pulmonary and extra-pulmonary manifestations, and long-term follow up. Similarly, many other pulmonary infections such as previously documented coronaviruses, Aspergillosis, Blastomycosis, Candidiasis, Coccidioidomycosis, Cryptococcosis, Histoplasmosis, Mucormycosis, and typical/atypical Mycobacterial infections have all been identified and characterized using FDG-PET/CT imaging. The goal of this review is to summarize the actual and potential benefits of FDG-PET/CT in the imaging of COVID-19 and other lung infections. Further research is necessary to determine the best indications and clinical applications of FDG-PET/CT, improve its specificity, and ultimately ascertain how this modality can best be utilized in the diagnostic work up of infectious pathologies.

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“…Using these medications, 20 patients had clinical improvement or recovered completely from FNP, while 1 patient failed to show any recovery [ 11 ]. Additionally, three people were not reported [ 32 , 35 , 36 ]. Specifically, glucocorticoids were recommended for the treatment of Bell’s palsy, but glucocorticoids can be contraindicated in COVID-19.…”

Section: Discussionmentioning

confidence: 99%

“…This can cause a false sense of precision due to the unknown effects of the defining characteristics on the potential correlation between FNP and COVID-19. Finally, some papers have based the COVID-19 diagnosis on only the clinical findings, serological testing, and/or CT scan findings without the confirmation of a PCR test [ 35 , 41 , 42 ]. This was widely exercised at the beginning of the pandemic due to the scarcity of PCR tests, the overwhelming number of new cases, or the high cost of a PCR test, especially in low-to-middle income countries [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Epidemiology, clinical features, and treatment modalities of facial nerve palsy in COVID-19 patients: a systematic review

et al. 2022

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Background Coronavirus disease 2019 (COVID-19) is responsible for a wide variety of multi-system clinical features. Facial nerve palsy (FNP) is identified as one of the neurological complications of the virus. This work aims to systematically review the clinical picture, laboratory/imaging findings, treatment options, and prognostic factors of FNP in COVID-19 patients. Methods Using six online databases, a search was conducted to include all articles with patients infected with COVID-19 and presenting with unilateral or bilateral FNP. Screening for eligibility and data extraction were done by three and four independent reviewers, respectively. Descriptive analyses and data visualizations were done using Google Sheets. Survival analysis and Kaplan–Meier plotting were done by R software. Results The data from 22 studies included 32 patients who were infected with COVID-19 and presented with clinical features of FNP. Fourteen patients were male while 18 were female. FNP affected 29 patients unilaterally and 3 patients bilaterally. The imaging findings confirmed that complications of FNP were COVID-19 related. Additionally, antivirals combined with steroids had the lowest median time (21, IQR = 8) to clinical improvement compared to steroid-only (30, IQR = 15) and antiviral-only (33, IQR = 3.5) treatments. Conclusion This study has shown a potential correlation between the increased incidence of FNP and COVID-19. We have also found that combining antivirals with steroids may have better outcomes in patients with FNP and COVID-19 although the evidence to support this claim is not strong enough. Further studies are required to assess the extent of linkage between the two conditions and how to properly manage FNP when encountered in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13760-022-02026-8.

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18FDG-PET/CT Assessment of COVID-19-Induced Bell's Palsy

Cited by 8 publications

References 5 publications

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

Molecular Imaging Findings on Acute and Long-Term Effects of COVID-19 on the Brain: A Systematic Review

FDG-PET/CT of COVID-19 and Other Lung Infections

Epidemiology, clinical features, and treatment modalities of facial nerve palsy in COVID-19 patients: a systematic review

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