Rıdvan AÇIKALIN, Murat GÖKTEN, Can SEZER

COVID-19'un santral sinir sistemi tutulumunu değerlendirmek için bir araç olarak manyetik rezonans görüntülemenin etkinliği

Amaç: Çalışmamızın amacı, COVID-19 ile ilişkili akut nörolojik bulguları olan hastaları tanımlamayı ve tanısında manyetik rezonans görüntüleme (MRG) etkinliğinin gösterilmesini amaçlamaktır. Gereç ve Yöntem: Haziran 2020 ve Aralık 2021 tarihleri arasında kliniğimizde Covid-19 tanısı almış, akciğerde pnömoni bulguları olan, akut nörolojik bulguları olan ve Beyin MRG olan 90 hasta çalışmaya alındı. Bulgular santral sinir sistemi (SSS) tutulumu bulgulari olmayan 46 hasta ve SSS bulgulari olan 44 hasta retrospektif olarak değerlendirildi. Bulgular: COVID-19 hastalarında en sık görülen nörolojik belirtiler; tedavi ile açıklanamayan şuur kayıbı (28/44, %63,6), focal nörolojik defisit (21/44, %47,7) and nöbet (9/44, %20,4). SSS tutulumu olan hastalarda yoğunbakımda yatış sürelerinde uzama, ventilator desteği gereksinimde artış ve mortalitede artış görüldü. Nörolojik semptomları olan 44 hastaya beyin MRG çekildi. MRG çekilen hastalarda 68,3 ortalama yaş (45–78). 32 hastanın (%72) MRG’nda akut bulgular saptandı. Beyin MR görüntülemesinde en sık konulan tanılar akut ve subakut infarktlardı. Sonuç: Merkezi sinir sistemi bulgularının mekanizması hala belirsizdir, COVID-19 hastalarında nörolojik semptomlar özellikle yoğun bakım ünitelerinde önemli bir sorundur. Bu nedenle SSS tutulumunun erken tespiti ve tedavisi çok önemlidir.

Efficacy of magnetic resonance imaging as a tool to assess central nervous system involvement of COVID-19

Purpose: The aim of this study was to identify patients with acute neurological findings associated with COVID-19 and to demonstrate the effectiveness of magnetic resonance imaging (MRI) in its diagnosis. Materials and Methods: Between June 2020 and December 2021, 90 patients who were diagnosed with Covid-19 in our clinic, had pneumonia findings in the lung, acute neurological findings, and brain MRI were included in the study. Results were evaluated retrospectively for 46 patients without central nervous system (CNS) involvement and 44 patients with CNS findings. Results: The most common neurological symptoms in COVID-19 patients; Unexplained loss of consciousness by treatment (28/44, 63.6%), focal neurologic deficits (21/44, 47.7%), and seizures (9/44, 20.4%). Increased mortality, increment in the need for ventilator support, and prolonged stay in the intensive care unit were observed in patients with CNS findings. Brain MRI was performed on 44 patients with neurological symptoms. Mean age of 68.3 years (45–78) in patients undergoing MRI. Acute findings were detected in MRI of 32 patients (72%). The most common diagnoses in brain MRI were acute and subacute infarcts. Conclusion: The mechanism of CNS manifestations is still unclear, and neurological symptoms in COVID-19 patients are an important problem, especially in intensive care units. Therefore, early detection and treatment of CNS involvement are very important.

PDF

___

1. Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS et al. Extrapulmonary manifestations of COVID-19. Nat Med. 2020;26:1017–32.
2. Uluöz M. Impact of COVID-19 pandemic on orthopedics and traumatology service. Dicle Tıp Derg. 2021;48:375–81.
3. Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A et al. Neurological associations of COVID- 19. Lancet Neurol. 2020;19:767–83.
4. Meinhardt J, Radke J, Dittmayer C, Franz J, Thomas C, Mothes R et al. Olfactory transmucosal SARS- CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci. 2021;24:168–75.
5. Cooper KW, Brann DH, Farruggia MC, Bhutani S, Pellegrino R, Tsukahara T et al. COVID-19 and the chemical senses: supporting players take center stage. Neuron. 2020;107:219–33.
6. Paniz-Mondolfi A, Bryce C, Grimes Z, Gordon RE, Reidy J, Lednicky J et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). J Med Virol. 2020;92:699–702.
7. Reichard RR, Kashani KB, Boire NA, Constantopoulos E, Guo Y, Lucchinetti CF. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol. 2020;140:1–6.
8. Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033-4.
9. Jain R, Young M, Dogra S, Kennedy H, Nguyen V, Jones S et al. COVID-19 related neuroimaging findings: A signal of thromboembolic complications and a strong prognostic marker of poor patient outcome. J Neurol Sci. 2020;414:116923..
10. Radmanesh A, Raz E, Zan E, Derman A, Kaminetzky M. Brain imaging utilization and findings in COVID- 19: A single academic center experience in the epicenter of disease in the United States. Am J Neuroradiol. 2020;41:1179–83.
11. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP et al. Large-vessel stroke as a presenting feature of Covid-19 in the young.. New Engl J Med. 2020;382:60.
12. Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E et al. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75:2950–73.
13. Ye Q, Wang B, Mao J. The pathogenesis and treatment of the `Cytokine Storm' in COVID-19. J Infect. 2020;80:607-13.
14. Franceschi AM, Ahmed O, Giliberto L, Castillo M. Hemorrhagic posterior reversible encephalopathy syndrome as a manifestation of COVID-19 infection. Am J Neuroradiol. 2020;41:1173–6.
15. Rogg J, Baker A, Tung G. Posterior reversible encephalopathy syndrome (PRES): Another imaging manifestation of COVID-19. Interdiscip Neurosurg Adv Tech Case. 2020;22:100808.
16. Glass WG, Subbarao K, Murphy B, Murphy PM. Mechanisms of host defense following severe acute respiratory syndrome-coronavirus (SARS-CoV) pulmonary infection of mice. J Immunol. 2004;173:4030–9.
17. Fischer M, Schmutzhard E. Posterior reversible encephalopathy syndrome. J Neurol. 2017;264:1608– 16.
18. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;39:507–13.
19. Cai H. Sex difference and smoking predisposition in patients with COVID-19. Lancet Respir Med. 2020;8:e20.
20. Koeller KK, Shih RY. Viral and prion infections of the central nervous system: Radiologic-pathologic correlation. Radiographics. 2017;37:199–233.
21. Kelley BP, Patel SC, Marin HL, Corrigan JJ, Mitsias PD, Griffith B. Autoimmune encephalitis: pathophysiology and imaging review of an overlooked diagnosis. Am J Neuroradiol. 2017;38:1070–8.
22. Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C et al. Death from Covid-19 of 23 health care workers in China. N Engl J Med. 2020;382:2268–70.
23. Schweitzer AD, Parikh NS, Askin G, Nemade A, Lyo J KS. Imaging characteristics associated with clinical outcomes in posterior reversible encephalopathy syndrome. Rev Col Am Cardiol. 2018;59:379–86.
24. McKinney AM, Sarikaya B, Gustafson C, Truwit CL. Detection of microhemorrhage in posterior reversible encephalopathy syndrome using susceptibility- weighted imaging. Am J Neuroradiol. 2012;33:896– 903.
25. Yeahia R, Schefflein J, Chiarolanzio P, Rozenstein A, Gomes W, Ali S, Mehta H, Al-Mufti F, McClelland A, Gulko E. Brain MRI findings in COVID-19 patients with PRES: A systematic review. Clin Imaging. 2022;81:107-113..