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Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature.
J Neurol. 2021 Jul 21 [Online ahead of print]JN

Abstract

BACKGROUND

SARS-CoV-2 infection has been associated with various neurological manifestations. Since patients affected by SARS-CoV-2 infection present coagulation and immune system dysregulation, ischemic or haemorragic stroke is not uncommon, irrespective of respiratory distress. However, the occurrence of focal neurological deficits together with other symptoms like headache, cortical blindness, seizure and altered mental status should prompt the diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES). Antithrombotic treatment, the alteration of endothelial function, and coagulopathy due to COVID-19 and PRES leading to the breakdown of blood-brain barrier may then contribute to the occurrence of a brain haemorrhage.

METHODS

We describe the case of a COVID-19 patient who developed bilateral occipital lobe haemorrhages suggestive of haemorrhagic PRES. We then reviewed the available literature about haemorrhagic evolution of PRES in COVID-19.

RESULTS

We describe the clinical and radiological features of five COVID-19 patients who developed haemorrhagic PRES.

CONCLUSIONS

Coagulopathy and endothelial dysfunction resulting from the massive release of cytokines during the host immune response may be key factors in the pathogenesis of COVID-19-related PRES. Antithrombotic therapy and the leakage of the blood-brain barrier can subsequently increase the risk of haemorrhagic transformation of the lesioned brain tissue. A prompt diagnosis of PRES is mandatory, since the timely interruption/reversal of antithrombotic therapy may be a key determinant for a good prognosis.

Authors+Show Affiliations

Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy. f.motolese@unicampus.it.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Departmental Faculty of Medicine and Surgery, Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Emergency Department, Università Campus Bio-Medico di Roma, Rome, Italy.Division of Geriatric Medicine, Università Campus Bio-Medico di Roma, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Viale Alvaro del Portillo, 21, 00128, Rome, Italy.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

34291313

Citation

Motolese, Francesco, et al. "Posterior Reversible Encephalopathy Syndrome and Brain Haemorrhage as COVID-19 Complication: a Review of the Available Literature." Journal of Neurology, 2021.
Motolese F, Ferrante M, Rossi M, et al. Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature. J Neurol. 2021.
Motolese, F., Ferrante, M., Rossi, M., Magliozzi, A., Sbarra, M., Ursini, F., Marano, M., Capone, F., Travaglino, F., Antonelli Incalzi, R., Di Lazzaro, V., & Pilato, F. (2021). Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature. Journal of Neurology. https://doi.org/10.1007/s00415-021-10709-0
Motolese F, et al. Posterior Reversible Encephalopathy Syndrome and Brain Haemorrhage as COVID-19 Complication: a Review of the Available Literature. J Neurol. 2021 Jul 21; PubMed PMID: 34291313.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature. AU - Motolese,Francesco, AU - Ferrante,Mario, AU - Rossi,Mariagrazia, AU - Magliozzi,Alessandro, AU - Sbarra,Martina, AU - Ursini,Francesca, AU - Marano,Massimo, AU - Capone,Fioravante, AU - Travaglino,Francesco, AU - Antonelli Incalzi,Raffaele, AU - Di Lazzaro,Vincenzo, AU - Pilato,Fabio, Y1 - 2021/07/21/ PY - 2021/03/20/received PY - 2021/07/12/accepted PY - 2021/07/11/revised PY - 2021/7/22/entrez PY - 2021/7/23/pubmed PY - 2021/7/23/medline KW - COVID-19 KW - Haemorrhage KW - PRES KW - Posterior Reversible Encephalopathy Syndrome KW - SARS-CoV-2 JF - Journal of neurology JO - J Neurol N2 - BACKGROUND: SARS-CoV-2 infection has been associated with various neurological manifestations. Since patients affected by SARS-CoV-2 infection present coagulation and immune system dysregulation, ischemic or haemorragic stroke is not uncommon, irrespective of respiratory distress. However, the occurrence of focal neurological deficits together with other symptoms like headache, cortical blindness, seizure and altered mental status should prompt the diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES). Antithrombotic treatment, the alteration of endothelial function, and coagulopathy due to COVID-19 and PRES leading to the breakdown of blood-brain barrier may then contribute to the occurrence of a brain haemorrhage. METHODS: We describe the case of a COVID-19 patient who developed bilateral occipital lobe haemorrhages suggestive of haemorrhagic PRES. We then reviewed the available literature about haemorrhagic evolution of PRES in COVID-19. RESULTS: We describe the clinical and radiological features of five COVID-19 patients who developed haemorrhagic PRES. CONCLUSIONS: Coagulopathy and endothelial dysfunction resulting from the massive release of cytokines during the host immune response may be key factors in the pathogenesis of COVID-19-related PRES. Antithrombotic therapy and the leakage of the blood-brain barrier can subsequently increase the risk of haemorrhagic transformation of the lesioned brain tissue. A prompt diagnosis of PRES is mandatory, since the timely interruption/reversal of antithrombotic therapy may be a key determinant for a good prognosis. SN - 1432-1459 UR - https://www.unboundmedicine.com/medline/citation/34291313/Posterior_Reversible_Encephalopathy_Syndrome_and_brain_haemorrhage_as_COVID-19_complication:_a_review_of_the_available_literature. L2 - https://dx.doi.org/10.1007/s00415-021-10709-0 DB - PRIME DP - Unbound Medicine ER -
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