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

Abstract

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-19eassociated encephalopathy, 2 (7%) with COVID-19eassociated acute necrotizing encephalopathy, and 5 (19%) with COVID-19eassociated

In Reply to the Letter to the Editor Regarding “Neurological Impact of Coronavirus Disease (COVID-19): Practical Considerations for the Neuroscience Community”

“…9 However, multiple reports, including one recently conducted to analyze the neurological manifestations in patients with critical COVID-19 at our own facility in New Orleans, Louisiana, have shown a high proportion of large territory anterior circulation infarcts with no evidence of LVO and the presence of segmental nonocclusive stenosis. 9,10 These findings suggest an alternative pathway of direct viral-associated vasculopathy, which has also been observed and reported with human immunodeficiency virus 1 and 2 and human herpes virus 3 infections. 10 The reported cases of COVID-19eassociated vasculopathy and secondary acute ischemic stroke have often occurred in the context of therapeutic anticoagulation, making thrombosis less likely.…”

“…9,10 These findings suggest an alternative pathway of direct viral-associated vasculopathy, which has also been observed and reported with human immunodeficiency virus 1 and 2 and human herpes virus 3 infections. 10 The reported cases of COVID-19eassociated vasculopathy and secondary acute ischemic stroke have often occurred in the context of therapeutic anticoagulation, making thrombosis less likely. 11 Although an interesting topic of active discussion concerning COVID-19eassociated cerebrovascular disease, coagulopathy would not account for the other CNS manifestations, including electrographic and radiographic encephalopathy.…”

“…7,8 We agree that this is an interesting area of future study; however, we would caution that difficulties could arise in that the systemic marker levels might not necessarily correlate with the presence or severity of neuroinflammation, 6 could be confounded by the presence of systemic severe disease, 6 and that COVID-19eassociated encephalopathy could, at times, have a noninflammatory etiology. 9,10 D-dimer elevations, an APR associated with hypercoagulability, were later discussed by Mishra et al 1 as a pathway of ischemic CNS injury without direct viral involvement. As they stated, D-dimer elevations have been documented to be correlated with severe COVID-19 and multiple associated thrombotic complications, including ischemic stroke.…”

Neuroimaging findings of brain MRI and CT in patients with COVID-19: A systematic review and meta-analysis

“…Among these, 164 were excluded after reviewing their titles and abstracts (84 case reports/series, 50 review/letters/editorials, 28 articles with irrelevant content, 1 non-English article, and 1 non-human study). The full texts of the remaining 19 articles were thoroughly reviewed; five articles were further excluded due to lack of neuroimaging findings [ 22 , 23 ], partially overlapping patient cohorts [ 24 ], high risks of bias based on the quality assessment [ 25 ], and not in the field of interest [ 26 ]. Between the two studies with overlapping cohorts, the study with a more recent study period was chosen.…”

Reversible Lesion of the Corpus Callosum Associated With COVID-19: A Case Report and Review of Literature

“…SARS-CoV-2 is a member of the coronaviridae family, responsible for a spectrum of respiratory and gastrointestinal diseases but with occasional neurotropism (1). Major CNS manifestations of SARS-CoV-2 include many symtoms from headache to stroke (2).…”