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PURPOSE OF REVIEW: Coronavirus disease 2019 (COVID-19) has become a global health crisis of our time. The disease arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. COVID-19 has a wide range of respiratory symptoms from mild to severe and affects several other organs, increasing the complexity of the treatment. There is accumulating evidence to suggest that SARS-CoV-2 can target the nervous system. In this review, we provide an account of the COVID-19 central nervous system (CNS) manifestations. RECENT FINDINGS: A broad spectrum of the CNS manifestations including headache, impaired consciousness, delirium, loss of smell and taste, encephalitis, seizures, strokes, myelitis, acute disseminated encephalomyelitis, neurogenic respiratory failure, encephalopathy, silent hypoxemia, generalized myoclonus, neuroleptic malignant syndrome and Kawasaki syndrome has been reported in patients with COVID-19. CNS manifestations associated with COVID-19 should be considered in clinical practice. There is a need for modification of current protocols and standing orders to provide better care for COVID-19 patients presenting with neurological symptoms.
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Betacoronavirus , Infecções por Coronavirus , Coronavirus , Doenças do Sistema Nervoso , Pandemias , Pneumonia Viral , COVID-19 , Humanos , Doenças do Sistema Nervoso/virologia , SARS-CoV-2RESUMO
Coronavirus disease 2019 (COVID-19) is a pandemic respiratory disease with serious public health risk and has taken the world off-guard with its rapid spread. As the COVID-19 pandemic intensifies, overwhelming the healthcare system and the medical community, current practice for the management of acute ischemic stroke (AIS) will require modification, and guidelines should be relaxed while maintaining high standard quality of care. The aim of these suggestions is to avoid contributing to the rapid spread of COVID-19 as well as to conserve what are likely to be very limited resources (including personnel, intensive care/hospital beds as well as physicians) while maintaining high quality care for patients with AIS. We present our recommendations for the management of acute stroke during the COVID-19 pandemics.
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Isquemia Encefálica/terapia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Doença Aguda , Isquemia Encefálica/complicações , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/reabilitação , COVID-19 , Hemorragia Cerebral/etiologia , Hemorragia Cerebral/prevenção & controle , Infecções Comunitárias Adquiridas/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/economia , Infecções por Coronavirus/epidemiologia , Infecção Hospitalar/prevenção & controle , Gerenciamento Clínico , Procedimentos Cirúrgicos Eletivos , Serviços Médicos de Emergência , Serviço Hospitalar de Emergência , Fidelidade a Diretrizes , Hospitalização , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Transmissão de Doença Infecciosa do Profissional para o Paciente/prevenção & controle , Unidades de Terapia Intensiva/provisão & distribuição , Máscaras , Programas de Rastreamento , Monitorização Fisiológica , Pandemias/economia , Alta do Paciente , Transferência de Pacientes , Pneumonia Viral/complicações , Pneumonia Viral/economia , Pneumonia Viral/epidemiologia , Guias de Prática Clínica como Assunto , Relações Profissional-Família , Alocação de Recursos , Visitas a PacientesRESUMO
INTRODUCTION: Remarkable advances have occurred in the management of acute ischemic stroke, especially in regards to reperfusion treatments. With advances in reperfusion treatments come the risk of complications associated with these treatments. Areas covered: The article focuses on three acute complications that can occur in the setting of acute ischemic stroke: cerebral edema, hemorrhagic transformation, and orolingual angioedema following administration of alteplase, a recombinant tissue plasminogen activator. Predictors of the development of these complications are reviewed. The management of cerebral edema and hemorrhagic transformation is also reviewed in depth including potential new treatments targeting the blood-brain barrier. The article also reviews the management of the rare but potentially fatal complication of orolingual angioedema secondary to alteplase. Expert commentary: An understanding of the pathophysiology leading to the development of malignant cerebral edema and hemorrhagic transformation allows the clinician to anticipate and properly manage these acute complications. Regardless of a patient's age or comorbidities, the decision to pursue decompressive hemicraniectomy in patients with malignant cerebral edema should be based on an honest assessment of expected outcome and guided by the patient's prior wishes regarding an acceptable quality of life.
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Angioedema/induzido quimicamente , Edema Encefálico/etiologia , Isquemia Encefálica/complicações , Hemorragia Cerebral/etiologia , Fibrinolíticos/efeitos adversos , Doenças Labiais/induzido quimicamente , Doenças da Boca/induzido quimicamente , Acidente Vascular Cerebral/complicações , Ativador de Plasminogênio Tecidual/efeitos adversos , Administração Intravenosa , Angioedema/tratamento farmacológico , Edema Encefálico/terapia , Isquemia Encefálica/tratamento farmacológico , Humanos , Doenças Labiais/tratamento farmacológico , Doenças da Boca/tratamento farmacológico , Qualidade de Vida , Reperfusão , Acidente Vascular Cerebral/tratamento farmacológicoRESUMO
Stroke in young women is commonly cryptogenic or associated with an underlying hypercoagulable state (e.g., hormonal contraception). Paradoxical embolization has been postulated as a potential risk factor for stroke in young adults. Many sources of venous thrombosis leading to paradoxical embolization have been described. There have been few reported cases of uterine enlargement leading to iliac vein compression and paradoxical embolization. We present the case of a young adult woman who had a left middle cerebral artery infarction related to patent foramen ovale and right common iliac vein compression from an enlarged fibroid uterus.
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Síndrome de Churg-Strauss/complicações , Síndrome de Churg-Strauss/diagnóstico , Hemianopsia/complicações , Hemianopsia/diagnóstico , Síndrome Hipereosinofílica/complicações , Síndrome Hipereosinofílica/diagnóstico , Síndrome de Churg-Strauss/diagnóstico por imagem , Diagnóstico Diferencial , Feminino , Hemianopsia/diagnóstico por imagem , Humanos , Síndrome Hipereosinofílica/diagnóstico por imagem , Pessoa de Meia-IdadeRESUMO
The neurocutaneous disorders (NCDs) embrace an extensive group of developmental disorders associated with involvement of the skin, central nervous system (CNS), and/or the peripheral nervous system (PNS). The neurocutaneous manifestations relate to the common ectodermal origin of these organs. This review intended for the practicing clinical neurologist focuses on selected aspects of the NCDs primarily those associated with cerebrovascular disease. Our emphasis is primarily on those NCDs with genetic heterogeneity and their neurological manifestations.
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Síndromes Neurocutâneas , Sistema Nervoso Central , Heterogeneidade Genética , Humanos , PeleRESUMO
A variety of neurologic diseases have cutaneous manifestations. These may precede, coincide with, or follow the neurologic findings. An array of autoimmune, genetic, and environmental factors play a role in expression and severity of the neurologic burden in these conditions. This chapter emphasizes congenital and genetic disorders, but we also discuss the pathophysiology and manifestation of various acquired neurocutaneous disorders with an emphasis Behcet's disease, dermatomyositis, Sjögren's syndrome, systemic lupus erythematosus, scleroderma, Parry-Romberg syndrome and Degos disease.
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Anormalidades Congênitas/fisiopatologia , Doenças Genéticas Inatas/complicações , Síndromes Neurocutâneas/complicações , Síndromes Neurocutâneas/genética , Síndrome de Behçet/fisiopatologia , Dermatomiosite/fisiopatologia , Humanos , Síndrome de Sjogren/fisiopatologiaRESUMO
A 12-year-old adolescent presented with refractory seizures and was found to have a mesial temporal lobe lesion. The patient underwent biopsy and was diagnosed with an arteriovenous malformation. Supratentorial lesions in the pediatric population can have a large variety of underlying etiologies, which can be challenging to differentiate on neuroimaging. In this report, we discuss the key features on MRI of several neoplastic, vascular, and infectious processes that can aide in the diagnosis.
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Pregnancy creates alterations in maternal physiology which predispose to unique neurologic disorders. Pre-eclampsia, eclampsia, certain types of ischemic and hemorrhagic stroke, reversible cerebral vasoconstriction syndrome, posterior reversible encephalopathy syndrome, and thunderclap headache all appear to share a common origin from vascular endothelial dysfunction, with overlapping clinical presentations. Multiple sclerosis often improves during pregnancy. Compression mononeuropathies may occur in the extremities. Myasthenia gravis may affect second stage labor. Various inflammatory peripheral neuropathies, dystrophies, myopathies may occur during pregnancy. The safety of specific immune suppressants is reviewed. Epilepsy does not have a significant effect upon the course of pregnancy, albeit there is a modest increase in the need for cesarean section. Certain antiepileptic drugs may produce fetal malformations, most notably valproic acid. Brain tumors are rare during pregnancy, but may increase in size due to activation of hormonal receptors on tumor cells surfaces, water retention, and engorged blood vessels.
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Doenças do Sistema Nervoso/etiologia , Complicações na Gravidez/terapia , Adulto , Neoplasias Encefálicas/complicações , Eclampsia , Epilepsia/etiologia , Feminino , Cefaleia/etiologia , Humanos , Esclerose Múltipla/complicações , Doenças Neuromusculares/complicações , Período Pós-Parto , Gravidez , Acidente Vascular Cerebral/complicaçõesRESUMO
A wide array of neurologic complications can occur in relation to cardiac surgical procedures, most of which are transient and do not result in permanent sequelae. Specific neurologic insults can occur depending on the type of cardiac procedure and are an important cause of morbidity and mortality. Neurologists practicing in the hospital setting as well as outpatient neurologists should be familiar with the cardiac surgical procedures currently available. Prompt identification of neurologic deficits is important in order to plan an appropriate systematic evaluation and initiate possible treatments in a timely manner. This chapter provides a comprehensive overview of all facets of neurologic complications after cardiac surgical procedures.
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Encefalopatias/etiologia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Complicações Pós-Operatórias/etiologia , Cardiopatias/terapia , HumanosRESUMO
Neurolymphomatosis (NL) refers to a lymphomatous infiltration of peripheral nerves associated with central nervous system or systemic lymphoma, or alternatively, neurodiagnostic evidence of nerve enhancement and/or enlargement beyond the dural sleeve in the setting of primary central nervous system lymphoma or systemic lymphoma. NL is a rare complication of systemic cancer with heterogeneous clinical presentations and an elusive diagnosis. Diagnosis usually requires the demonstration of infiltrating malignant lymphocytes in the peripheral nerve. Infiltration of brain parenchyma, meninges or Virchow-Robin spaces is characteristic of systemic disease at autopsy. We describe a patient presenting with biopsy negative NL affecting exclusively the peripheral nervous system at autopsy.
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Tumors of the olfactory groove may cause unilateral optic atrophy with contralateral papilledema and anosmia (Foster Kennedy syndrome). We describe a case of a young pregnant woman with Foster Kennedy syndrome due to an olfactory groove meningioma.
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Embolia Intracraniana , Artéria Cerebral Média , Acidente Vascular Cerebral/etiologia , Calcificação Vascular/complicações , Idoso de 80 Anos ou mais , Valva Aórtica/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Humanos , Embolia Intracraniana/complicações , Embolia Intracraniana/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Artéria Cerebral Média/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Calcificação Vascular/diagnóstico por imagemAssuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Embolia Intracraniana , Artéria Cerebral Média , Acidente Vascular Cerebral/etiologia , Calcificação Vascular/complicações , Valva Aórtica/cirurgia , Ponte de Artéria Coronária/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Embolia Intracraniana/complicações , Embolia Intracraniana , Artéria Cerebral Média , Tomografia Computadorizada por Raios X , Calcificação VascularRESUMO
OBJECTIVE: To assess evidence regarding periprocedural management of antithrombotic drugs in patients with ischemic cerebrovascular disease. The complete guideline on which this summary is based is available as an online data supplement to this article. METHODS: Systematic literature review with practice recommendations. RESULTS AND RECOMMENDATIONS: Clinicians managing antithrombotic medications periprocedurally must weigh bleeding risks from drug continuation against thromboembolic risks from discontinuation. Stroke patients undergoing dental procedures should routinely continue aspirin (Level A). Stroke patients undergoing invasive ocular anesthesia, cataract surgery, dermatologic procedures, transrectal ultrasound-guided prostate biopsy, spinal/epidural procedures, and carpal tunnel surgery should probably continue aspirin (Level B). Some stroke patients undergoing vitreoretinal surgery, EMG, transbronchial lung biopsy, colonoscopic polypectomy, upper endoscopy and biopsy/sphincterotomy, and abdominal ultrasound-guided biopsies should possibly continue aspirin (Level C). Stroke patients requiring warfarin should routinely continue it when undergoing dental procedures (Level A) and probably continue it for dermatologic procedures (Level B). Some patients undergoing EMG, prostate procedures, inguinal herniorrhaphy, and endothermal ablation of the great saphenous vein should possibly continue warfarin (Level C). Whereas neurologists should counsel that warfarin probably does not increase clinically important bleeding with ocular anesthesia (Level B), other ophthalmologic studies lack the statistical precision to make recommendations (Level U). Neurologists should counsel that warfarin might increase bleeding with colonoscopic polypectomy (Level C). There is insufficient evidence to support or refute periprocedural heparin bridging therapy to reduce thromboembolic events in chronically anticoagulated patients (Level U). Neurologists should counsel that bridging therapy is probably associated with increased bleeding risks as compared with warfarin cessation (Level B). The risk difference as compared with continuing warfarin is unknown (Level U).