tetano
Editor, Senior Moderator
J Clin Neurosci
. 2021 Jun;88:108-112.
doi: 10.1016/j.jocn.2021.03.028. Epub 2021 Mar 23.
Posterior reversible encephalopathy syndrome (PRES) associated with COVID-19
Sof?a Lallana[SUP] 1 [/SUP], Austin Chen[SUP] 2 [/SUP], Manuel Requena[SUP] 1 [/SUP], Marta Rubiera[SUP] 1 [/SUP], Anna Sanchez[SUP] 3 [/SUP], James E Siegler[SUP] 4 [/SUP], Mari?n Muchada[SUP] 1 [/SUP]
Affiliations
Abstract
The novel human coronavirus disease (COVID-19) has been associated with vascular and thrombotic complications, some of which may result from endothelial dysfunction, including the posterior reversible encephalopathy syndrome (PRES). We report a case series of 8 patients with COVID-19 and PRES diagnosed at two academic medical centers between March and July of 2020. The clinical, laboratory and radiographic data, treatment, and short-term outcomes were retrospectively analyzed. The mean age was 57.9 ? 12 years, and 50% were women. Four patients had previous vascular comorbidities. All the patients suffered from severe pneumonia, requiring intensive care unit admission. Five patients were not hypertensive at presentation (all SBP < 127 mmHg). Neurologic symptoms included seizures in 7 patients; impaired consciousness in 5 patients; focal neurological signs in 3 patients; and visual disturbances in 1 patient. All patients underwent brain magnetic resonance imaging which indicated asymmetric T2 prolongation or diffusion changes (50%), extensive fronto-parieto-occipital involvement (25%), vascular irregularities (12.5%) and intracranial hemorrhage (25%). Four patients were treated with tocilizumab. Three patients were discharged without neurologic disability, 2 patients had persistent focal neurologic deficits and 2 expired. One patient's prognosis remains guarded. Together, these data support the relationship between PRES and endothelial dysfunction associated with severe COVID-19. In patients with severe COVID-19, PRES can be triggered by uncontrolled hypertension, or occur independently in the setting of systemic illness and certain medications. Like other infectious processes, critically ill patients with COVID-19 may be at greater risk of PRES because of impaired vasoreactivity or the use of novel agents like Tocilizumab.
Keywords: COVID; Endothelial dysfunction; Posterior reversible encephalopathy syndrome; RES; SARS-CoV-2; Systemic inflammatory response syndrome.
. 2021 Jun;88:108-112.
doi: 10.1016/j.jocn.2021.03.028. Epub 2021 Mar 23.
Posterior reversible encephalopathy syndrome (PRES) associated with COVID-19
Sof?a Lallana[SUP] 1 [/SUP], Austin Chen[SUP] 2 [/SUP], Manuel Requena[SUP] 1 [/SUP], Marta Rubiera[SUP] 1 [/SUP], Anna Sanchez[SUP] 3 [/SUP], James E Siegler[SUP] 4 [/SUP], Mari?n Muchada[SUP] 1 [/SUP]
Affiliations
- PMID: 33992168
- DOI: 10.1016/j.jocn.2021.03.028
Abstract
The novel human coronavirus disease (COVID-19) has been associated with vascular and thrombotic complications, some of which may result from endothelial dysfunction, including the posterior reversible encephalopathy syndrome (PRES). We report a case series of 8 patients with COVID-19 and PRES diagnosed at two academic medical centers between March and July of 2020. The clinical, laboratory and radiographic data, treatment, and short-term outcomes were retrospectively analyzed. The mean age was 57.9 ? 12 years, and 50% were women. Four patients had previous vascular comorbidities. All the patients suffered from severe pneumonia, requiring intensive care unit admission. Five patients were not hypertensive at presentation (all SBP < 127 mmHg). Neurologic symptoms included seizures in 7 patients; impaired consciousness in 5 patients; focal neurological signs in 3 patients; and visual disturbances in 1 patient. All patients underwent brain magnetic resonance imaging which indicated asymmetric T2 prolongation or diffusion changes (50%), extensive fronto-parieto-occipital involvement (25%), vascular irregularities (12.5%) and intracranial hemorrhage (25%). Four patients were treated with tocilizumab. Three patients were discharged without neurologic disability, 2 patients had persistent focal neurologic deficits and 2 expired. One patient's prognosis remains guarded. Together, these data support the relationship between PRES and endothelial dysfunction associated with severe COVID-19. In patients with severe COVID-19, PRES can be triggered by uncontrolled hypertension, or occur independently in the setting of systemic illness and certain medications. Like other infectious processes, critically ill patients with COVID-19 may be at greater risk of PRES because of impaired vasoreactivity or the use of novel agents like Tocilizumab.
Keywords: COVID; Endothelial dysfunction; Posterior reversible encephalopathy syndrome; RES; SARS-CoV-2; Systemic inflammatory response syndrome.