Intact Brain Network Function in an Unresponsive Patient with COVID‐19

Abstract

Many patients with severe coronavirus disease 2019 (COVID-19) remain unresponsive after surviving critical illness. Although several structural brain abnormalities have been described, their impact on brain function and implications for prognosis are unknown. Functional neuroimaging, which has prognostic significance, has yet to be explored in this population. Here we describe a patient with severe COVID-19 who, despite prolonged unresponsiveness and structural brain abnormalities, demonstrated intact functional network connectivity, and weeks later recovered the ability to follow commands. When prognosticating for survivors of severe COVID-19, clinicians should consider that brain networks may remain functionally intact despite structural injury and prolonged unresponsiveness.

Brain abnormalities in COVID-19 acute/subacute phase: A rapid systematic review

“…However, the analyzed data further suggest that the prevalence of LA is higher in this patient population than expected for age. Other possible interpretations may include encephalitis as suggested in several reports (Anzalone et al, 2020;Asfar et al, 2020;Espinosa et al, 2020;Hayashi et al, 2020;Kremer et al, 2020), acute necrotizing encephalitis (Virhammar et al, 2020), encephalomyelitis (Abdi et al, 2020;Zoghi et al, 2020), demyelination (Zanin et al, 2020;Parsons et al, 2020;Zoghi et al, 2020), or microangiopathy (Fischer et al, 2020). Therefore, we encourage future studies to report more detailed description of the WM changes in order to establish differential characteristics of COVID-19-related vs. age-related changes in WM.…”

“…Smaller olfactory bulb was noted in one case report 1/124 (1%). One report on spontaneous brain activity revealed no abnormalities in the Default Mode Network [H] (Fischer et al, 2020).…”

“…A cumulative of 62/124 (50%) of cases presented brain abnormality in either anterior areas [D (Asfar et al, 2020); N (Hepburn et al, 2020); α (Zanin et al, 2020), X : 9/242 cases, Z (Virhammar et al, 2020) (Zanin et al, 2020). Unspecified brain location for brain waves slowing on EEG recording was reported in four cases [G (Espinosa et al, 2020); H (Fischer et al, 2020); U (Parsons et al, 2020); Z (Virhammar et al, 2020).…”

Understanding the Immunologic Characteristics of Neurologic Manifestations of SARS-CoV-2 and Potential Immunological Mechanisms

“…Electroencephalogram (EEG) studies demonstrate high amplitude monomorphic delta waves, indicating the central nervous system (CNS) involvement in SARS-CoV-2 patients [7]. Also, functional magnetic resonance imaging (fMRI) is recently proposed as an independent predictor of neurologic outcomes [8]. SARS-CoV-2 patients present with elevated plasma levels of neurofilament light chain protein (NfL) and glial fibrillary acidic protein (GFAP), which are known as biochemical indicators of neuronal injury and glial activation, respectively [9].…”

Delayed reemergence of consciousness in survivors of severe COVID-19

“…The pathophysiologic mechanisms of brain injury in severe COVID-19 appear to include hypoxia, inflammation, hypercoagulability [3], endothelial infection by the virus (SARS-CoV-2) [13], and possibly direct infection of the central nervous system by SARS-CoV-2 [14]. The clinical manifestations [1,3], EEG characteristics [1,15], CT/MRI findings [3,16,17] and histopathological hallmarks [18,19] of these injurious processes, including elevated stroke risk, are just beginning to be recognized.…”