Clinical Spectrum and Neuroimagistic Features in Hospitalized Patients with Neurological Disorders and Concomitant Coronavirus-19 Infection

In the first months of the COVID-19 pandemic, several research studies focused on understanding the damage to the respiratory and circulatory systems. However, the evidence of neurological manifestations as part of the clinical spectrum of the disease has increased. The aim of this retrospective study was to determine the potential association of neurological disorders with concomitant COVID-19 infection. We reviewed 101 patients (mean age, 70.05 years; 62.37% men) diagnosed with different neurological disorders and COVID-19 who were referred to the Department of Neurology between March 2020 and May 2021. The protocol included demographic, clinical, and neuroimagistic features, biochemical evaluation data, and prognosis. In the first group of patients with non-severe COVID-19 infection (<50% lung damage), we enrolled 75 cases (mean age, 69.13 years; 65.33% men), and the second group, with 26 patients (mean age, 72.69 years; 53.84% men), developed severe COVID-19 infection (>50% lung damage). Severe COVID-19 infection was significantly correlated with an increased highly sensitive C-reactive protein level (hsCRP) (p < 0.05), lactate dehydrogenase level (LDH) (p < 0.05), erythrocyte sedimentation rate (ESR) (p < 0.05), D-dimer (p < 0.05), fibrinogen level (p < 0.05), and blood glucose (p < 0.05) when compared to the first group. These biochemical parameters were increased in both groups, but the levels were much higher in the second group. Headaches (72.27%) and dizziness (14.85%) were present in the early stage of infection. Cerebrovascular events were also reported: ischemic stroke (48% vs. 57.69%; p < 0.05), cerebral hemorrhage (4.95%), and cerebral venous sinus thrombosis (1.98%). Encephalitis (1.98%) and Guillain–Barré Syndrome (1.98%) were found but less frequently. Cranial nerve abnormalities were statistically more common in the non-severe group: anosmia (32% vs. 26.92%; p < 0.05), dysgeusia/ageusia (48% vs. 42.30%; p < 0.05), impaired eye movement (1.33% vs. 0%), and facial nerve palsy (2.66% vs. 0%). Seizures (13.33% vs. 11.53%; p < 0.05) and a depressed level of consciousness (31.68%) occurred commonly. We detected the neuropsychiatric symptoms of anxiety (23.76%) and depression (14.85%). Mortality was increased in both groups but was much higher in the second group (46.15% vs. 21.33%). Neurological complications during COVID-19 infection are common in hospitalized patients, but the mechanism of these complications is not fully understood, representing a continuous challenge for neurologists.

Download Full-text

Abstract WP59: A Clot Burden Score Predicts Functional Outcome and Neurological Complications After Cerebral Venous Sinus Thrombosis

Stroke ◽

10.1161/str.49.suppl_1.wp59 ◽

2018 ◽

Vol 49 (Suppl_1) ◽

Author(s):

Amir Shaban ◽

Edgar Samaniego ◽

Nazan Aksan ◽

Biyue Dai ◽

Uzair Ahmed ◽

...

Keyword(s):

Functional Outcome ◽

Sinus Thrombosis ◽

Neurological Complications ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Clot Burden

Download Full-text

Spectrum of neurological disorders during pregnancy and postpartum period from a tertiary hospital

International Journal of Advances in Medicine ◽

10.18203/2349-3933.ijam20195168 ◽

2019 ◽

Vol 6 (6) ◽

pp. 1869

Author(s):

Karthik Nagaraj ◽

Chaithra S. P.

Keyword(s):

Posterior Reversible Encephalopathy Syndrome ◽

Sinus Thrombosis ◽

Neurological Complications ◽

Tertiary Hospital ◽

Cerebral Venous Sinus Thrombosis ◽

Cerebrovascular Diseases ◽

Posterior Reversible Encephalopathy ◽

Increased Risk ◽

Pregnancy And Postpartum ◽

Reversible Encephalopathy

Background: Pregnancy and puerperium are states of hypercoagulability. This predisposes women in these phases to increased risk of cerebrovascular diseases. These neurological complications are important causes of maternal and foetal morbidity and mortality. These must be recognized and managed to decrease their burden on maternal and child health.Methods: The aim of this study was to consider the occurrence of neurological complications in pregnancy and puerperium and to analyse the clinical and radiological spectrum of them. This was a prospective study carried out with 1200 patients from January 2014 to August 2015.Results: Of the 1200 women, 87(7.25%) were diagnosed to have neurological complications. Overall mortality was 11.4%. Eclampsia (63.2%), Cerebral Venous sinus Thrombosis (CVT) (18.3%) and Posterior Reversible Encephalopathy Syndrome (PRES) in (8%) accounted for the majority of cases (Table 1). Eclampsia carried a significant mortality rate of 12.7% whereas CVT and PRES had favourable outcomes. Imaging of CVT revealed involvement of deep venous system in 12% and haemorrhagic infarcts in 69%.Conclusions: The commonest neurological complications seen in this cohort were eclampsia, cerebral venous thrombosis and posterior reversible encephalopathy syndrome. Hence a physician needs to bear in mind the common neurological complications that can occur during pregnancy and puerperium to avert poor pregnancy outcomes for both mother and child.

Download Full-text

Cerebral venous sinus thrombosis

Phlebology The Journal of Venous Disease ◽

10.1177/0268355514526712 ◽

2014 ◽

Vol 30 (1) ◽

pp. 3-10 ◽

Cited By ~ 9

Author(s):

Marcin Hartel ◽

Ewa Kluczewska ◽

Eliza Gancarczyk-Urlik ◽

Krystyna Pierzchała ◽

Karolina Bień ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Computed Tomography ◽

Magnetic Resonance ◽

Early Stage ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Resonance Imaging ◽

Venous Sinus Thrombosis ◽

Magnetic Resonance Imaging Mri

Diagnostic imaging in cerebral venous sinus thrombosis poses difficulties due to the relatively rare incidence of this pathology and its usually inconclusive clinical and radiological symptoms. The preliminary examination is usually performed using computed tomography, whereas magnetic resonance imaging (MRI) provides better visualisation of the lesion. Computed tomography and magnetic resonance imaging angiography enable the characterisation of the blood flow in the pathologically affected vessels in more detail. Familiarity with the anatomic variations of the venous system and with the advantages and limitations of computed tomography/magnetic resonance imaging enables faster diagnosis of the pathology. This is significant for treatment, which, in many cases, can be efficient only if introduced at a sufficiently early stage.

Download Full-text

CEREBROVASCULAR COMPLICATIONS OF COVID-19

Eastern Ukrainian Medical Journal ◽

10.21272/eumj.2021;9(3):219-227 ◽

2021 ◽

Vol 9 (3) ◽

Author(s):

Volodymyr Lychko ◽

Mykola Burtyka

Keyword(s):

Cerebrovascular Disease ◽

Clinical Laboratory ◽

Sinus Thrombosis ◽

Case Reports ◽

Clinical Manifestations ◽

Relevant Information ◽

Neurological Complications ◽

Cerebral Venous Sinus Thrombosis ◽

Systemic Review ◽

Stroke Patients

The systematic online search of articles utilizing the search terms ”Coronavirus, SARS-COV-2 and Neurological complications”, published between January 2019 and September 2021, was performed. Neurological manifestations are prevalent during infection with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is a clear association between cerebrovascular disease and coronavirus disease 2019 (COVID-19). But today, whether this association is causal or incidental is still unknown. This systemic review presents the possible pathophysiological mechanisms linking COVID-19 and cerebrovascular disease, describes the most often neurological complications and their prognosis, discusses several clinical and laboratory characteristics. A systematic literature search was conducted, and relevant information was abstracted. Angiotensin-converting enzyme-2 receptor dysregulation, uncontrollable immune storm with inflammation, coagulopathy, complications due to critical illness and prolonged hospitalization can all contribute as potential etiological and pathogenic mechanisms leading to diverse cerebrovascular clinical manifestations. Acute ischemic stroke, intracerebral haemorrhage, and cerebral venous sinus thrombosis have been described in case reports and cohorts of COVID-19 patients, with a prevalence ranging between 0.5 % and 5.0 %. SARS-CoV-2-positive stroke patients have higher mortality rates, worse functional outcomes at discharge and longer duration of hospitalization as compared with SARS-CoV-2-negative stroke patients. Understanding of the specific demographic, clinical, laboratory and radiological characteristics may be used as ‘red flags’ in recognizing COVID-19-related acute neurological complications.

Download Full-text

Clinical Spectrum And Outcome Of Cerebral Venous Sinus Thrombosis In Children

Journal of College of Physicians And Surgeons Pakistan ◽

10.29271/jcpsp.2018.05.390 ◽

2018 ◽

Vol 28 (5) ◽

pp. 390-393 ◽

Cited By ~ 2

Author(s):

Iram Javed ◽

Tipu Sultan ◽

Zia ur Rehman ◽

Muhammad Rizwan Yaseen

Keyword(s):

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Clinical Spectrum ◽

Venous Sinus Thrombosis

Download Full-text

Cerebral Venous Sinus Thrombosis

Acute Medicine Journal ◽

10.52964/amja.0158 ◽

2007 ◽

Vol 6 (2) ◽

pp. 51-54

Author(s):

Joanna K Lovett ◽

◽

Ashwin Pinto ◽

Keyword(s):

Neurological Disorders ◽

Clinical Presentation ◽

Sinus Thrombosis ◽

Cerebral Venous Sinus Thrombosis ◽

Venous Sinus ◽

Venous Sinus Thrombosis ◽

Wide Range ◽

Diagnostic Difficulties ◽

Dural Venous Sinus ◽

Dural Venous Sinus Thrombosis

Cerebral (or dural) venous sinus thrombosis (CVST) is a condition distinct from other cerebrovascular disease, which presents its own particular diagnostic difficulties and treatment controversies. The clinical presentation is variable and may mimic a wide range of other neurological disorders that include subarachnoid haemorrhage, encephalitis, eclampsia, idiopathic intracranial hypertension and arterial stroke.

Download Full-text

Multiple myeloma with multiple neurological presentations

Practical Neurology ◽

10.1136/practneurol-2019-002205 ◽

2019 ◽

Vol 19 (6) ◽

pp. 511-517

Author(s):

Nicholas Smith ◽

Katja Kimberger ◽

Christopher Parrish ◽

Stuart Currie ◽

Stephen Butterworth ◽

...

Keyword(s):

Multiple Myeloma ◽

Sinus Thrombosis ◽

Optic Chiasm ◽

Neurological Complications ◽

Cerebral Venous Sinus Thrombosis ◽

Normal Brain ◽

Monoclonal Immunoglobulins ◽

Cranial Neuropathies ◽

Leptomeningeal Infiltration ◽

Brain And Spinal Cord

Multiple myeloma is a haematological malignancy with clonal plasma cell proliferation and production of monoclonal immunoglobulins. Its neurological complications are relatively common, caused by both the disease and the treatment. Neurologists should therefore be familiar with its neurological manifestations and complications. We describe a 40-year-old woman who presented with lower cranial neuropathies mimicking variant Guillain-Barré syndrome, with normal brain and spinal cord imaging and cerebrospinal fluid (CSF) albuminocytological dissociation, and subsequently diagnosed with IgD myeloma. She relapsed repeatedly with differing neurological presentations: numb chin syndrome and twice with impaired vision, first from cerebral venous sinus thrombosis and later from leptomeningeal infiltration of the optic chiasm. We discuss the neurological complications of myeloma, emphasising the need to consider it in a wide variety of neurological presentations and repeatedly to reassess its associated neurological diagnoses. We also highlight the complexity of myeloma treatment.

Download Full-text

COVID-19 Associated Stroke—A Single Centre Experience

10.1101/2021.02.15.21249420 ◽

2021 ◽

Author(s):

Uma Sundar ◽

Niteen D Karnik ◽

Amita Mukhopadhyay ◽

Pramod Darole ◽

Shaonak Kolte ◽

...

Keyword(s):

Hospital Mortality ◽

Sinus Thrombosis ◽

Neurological Complications ◽

Cerebral Venous Sinus Thrombosis ◽

Respiratory Support ◽

Vascular Territory ◽

Single Centre ◽

Single Centre Experience ◽

Age Range ◽

Early Stroke

AbstractBackground and PurposeVarious neurological complications have been reported in association with COVID-19. We report our experience of COVID-19 with stroke at a single center over a period of eight months spanning 1 March to 31 October 2020.MethodsWe recruited all patients admitted to Internal Medicine with an acute stroke, who also tested positive for COVID-19 on RTPCR. We included all stroke cases in our analysis for prediction of in-hospital mortality, and separately analyzed arterial infarcts for vascular territory of ischemic strokes.ResultsThere were 62 stroke cases among 3923 COVID-19 admissions (incidence 1.6%). Data was available for 58 patients {mean age 52.6 years; age range 17–91; F/M=20/38; 24% (14/58) aged ≤40; 51% (30/58) hypertensive; 36% (21/58) diabetic; 41% (24/58) with O2 saturation <95% at admission; 32/58 (55.17 %) in-hospital mortality}. Among 58 strokes, there were 44 arterial infarcts, seven bleeds, three arterial infarcts with associated cerebral venous sinus thrombosis, two combined infarct and bleed, and two of indeterminate type. Among the total 49 infarcts, Carotid territory was the commonest affected (36/49; 73.5%), followed by vertebrobasilar (7/49; 14.3%) and both (6/49; 12.2%). Concordant arterial block was seen in 61% (19 of 31 infarcts with angiography done). ‘Early stroke’ (within 48 hours of respiratory symptoms) was seen in 82.7% (48/58) patients. Patients with poor saturation at admission were older (58 vs 49 years) and had more comorbidities and higher mortality (79% vs 38%). Mortality was similar in young strokes and older patients, although the latter required more intense respiratory support. Logistic regression analysis showed that low GCS and requirement for increasing intensity of respiratory support predicted in-hospital mortality.ConclusionsWe had a 1.6% incidence of COVID-19 related stroke of which the majority were carotid territory infarcts. In-hospital mortality was 55.17%, predicted by low GCS at admission.

Download Full-text