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1.
Mymensingh Med J ; 30(1): 233-237, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33397881

RESUMEN

First branchial cleft anomalies are embryological defect account for 8-10% of all branchial cleft defects. Approximately 17% of all Paediatric cervical masses are due to branchial anomalies. Despite of the fact that these anomalies are benign, secondary infection, positional effect and complication of treatment like surgery account for morbidity. Here one such case of 30 years old lady who presented to us with one discharging sinus in the floor of the right external auditory canal with a swelling in the upper neck for about 20 years. On examination showed one discharging sinus opening in the floor of right external auditory canal (EAC) and a cystic swelling in upper neck between sternomastoid and mandible. While compression over the swelling cheesy discharge comes out from EAC. MRI showed oval shaped fluid signal intensity lesion measuring about 4 × 2.1 × 1.6cm in right infra auricular region with slit like curvilinear tract about 10mm extending from upper part of the lesion opening into the antero-inferior part of external auditory canal at the junction of bony and cartilaginous part. Histopathology report showed a cyst lined by stratified squamous epithelium; wall is composed of fibrocollagenous tissue with mucous gland. The wall is densely infiltrated with lymphocytes forming lymphoid follicles at places. This paper presents a case report of collaural sinus from Otology unit, Department of Otolaryngology-Head & Neck Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.


Asunto(s)
Región Branquial , Senos Paranasales , Adulto , Bangladesh , Niño , Conducto Auditivo Externo , Femenino , Humanos , Imagen por Resonancia Magnética
4.
Brain Nerve ; 73(1): 79-87, 2021 Jan.
Artículo en Japonés | MEDLINE | ID: mdl-33361515

RESUMEN

Although context can be presumed to exert effects on both language and visual information processing, the relevant brain regions have not been elucidated. In the present study, we used silent manga to focus on mental states induced by visual stimuli alone. When participants read manga on a double-page spread with preserved context, significant activation was observed in the bilateral visual cortex and cerebellum. Moreover, the activated region corresponded to lesions associated with hemispatial neglect, when this condition was directly compared with a single-page presentation that impaired context. These results indicate that higher-order visual information processing is enhanced by context.


Asunto(s)
Trastornos de la Percepción , Corteza Visual , Encéfalo , Mapeo Encefálico , Humanos , Imagen por Resonancia Magnética , Percepción Visual
5.
Clin Nucl Med ; 46(1): 47-48, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33156048

RESUMEN

A 62-year-old woman with history of stage III endometrial cancer was found to have a small enhancing liver lesion on follow-up abdominal CT and MRI, suspicious for metastasis. Subsequent F-FDG PET/CT was performed, demonstrating intense uptake within the liver lesion, consistent with metastasis. Subsequently, laparoscopic wedge liver lesion resection was performed. Histopathologic examination confirmed the diagnosis of inflammatory myofibroblastic tumor (IMT) with predominant inflammatory cells. Although solitary liver IMTs are rare occurrences with imaging features overlapping with malignancy, IMT should be considered in the differential diagnosis of suspicious liver lesions, especially when the pattern of spread is unusual.


Asunto(s)
Neoplasias Endometriales/patología , Fluorodesoxiglucosa F18 , Neoplasias Hepáticas/diagnóstico por imagen , Miofibroblastos/patología , Tomografía Computarizada por Tomografía de Emisión de Positrones , Diagnóstico Diferencial , Femenino , Humanos , Neoplasias Hepáticas/secundario , Imagen por Resonancia Magnética , Persona de Mediana Edad
7.
J Surg Res ; 257: 144-152, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32828998

RESUMEN

BACKGROUND: Invasive lobular carcinoma (ILC) has unique histologic growth pattern. Few studies have focused on the value of breast magnetic resonance imaging (MRI) specifically for ILC. We hypothesized that MRI adds value to the diagnostic workup in ILC by better defining the extent of disease and identifying additional foci of malignancy, which can change the surgical plan. MATERIALS AND METHODS: This was a single-institution retrospective review of women diagnosed with ILC from 1/2012 to 7/2019 who underwent preoperative MRI. Patient, tumor characteristics, and initial surgical plan were reviewed. MRI had added value if ILC size correlated best to final pathologic size or if additional malignancy was identified. MRI was considered harmful if additional biopsies were benign or if the size was overestimated. RESULTS: ILC was identified in 166 breasts in 165 women. Original surgical plan was for lumpectomy in 86 (52%), mastectomy in 49 (30%), and undecided in 31 (18%). MRI changed the plan in 25 (19%) with 24 (96%) changing from lumpectomy to mastectomy. Additional biopsy was performed in 28% after MRI, the majority (n = 41, 72%) were benign or high risk and 16 (28%) identified additional malignancy. MRI was not a better size estimate than mammogram/ultrasound. Re-excision rate after lumpectomy was 6.8% (5/73). MRI added value in 48 (28.9%) and was harmful in 48 (28.9%). CONCLUSIONS: Using breast MRI in the diagnostic workup of ILC has both positive and negative implications on surgical treatment planning. A shared decision-making conversation is warranted before proceeding with MRI to maximize value and minimize harms associated with this diagnostic tool.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/cirugía , Carcinoma Lobular/diagnóstico por imagen , Carcinoma Lobular/cirugía , Imagen por Resonancia Magnética , Cuidados Preoperatorios/métodos , Adulto , Anciano , Anciano de 80 o más Años , Biopsia , Neoplasias de la Mama/patología , Carcinoma Lobular/patología , Femenino , Humanos , Mastectomía , Mastectomía Segmentaria , Persona de Mediana Edad , Recurrencia Local de Neoplasia/epidemiología , Estudios Retrospectivos
8.
Clin Nucl Med ; 46(1): e18-e20, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32796244

RESUMEN

The patient was a 61-year-old man with a history of neck pain starting around October 2019. CT of the neck showed a lytic lesion at the right skull base. Subsequent MRI demonstrated an enhancing destructive mass in the right skull base centered in the occipital bone and condyle involving the jugular foramen and hypoglossal canal. An F-FDG PET/CT was performed showing increased FDG uptake in the right jugular foramen tumor. In addition, a PET/CT with Ga-[DOTA-Tyr3]-octreotate (Ga-DOTATATE) demonstrated a Ga-DOTATATE-avid lesion in the right jugular foramen eroding the adjacent osseous structures. Biopsy revealed a plasmacytoma and not paraganglioma.


Asunto(s)
Compuestos Organometálicos , Plasmacitoma/diagnóstico por imagen , Tomografía Computarizada por Tomografía de Emisión de Positrones , Neoplasias de la Base del Cráneo/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad
9.
Clin Nucl Med ; 46(1): e3-e5, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32956112

RESUMEN

A 60-year-old man with prostate adenocarcinoma status post radical prostatectomy and bilateral pelvic lymph node dissection referred for restaging F-fluciclovine PET/CT due to rising serum prostate-specific antigen levels (1.1 ng/mL at that time of imaging). PET/CT images were obtained from the proximal thighs to the vertex of the skull approximately 3 to 5 minutes after the IV administration of 347.8 MBq (9.4 mCi) of F-fluciclovine. PET/CT imaging demonstrated a focus of abnormally increased F-fluciclovine uptake at the right ureterovesical junction. Subsequent MRI of the pelvis revealed that this focus corresponded to a benign ureterocele.


Asunto(s)
Ácidos Carboxílicos/metabolismo , Ciclobutanos/metabolismo , Ureterocele/metabolismo , Transporte Biológico , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Tomografía Computarizada por Tomografía de Emisión de Positrones , Prostatectomía , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Ureterocele/diagnóstico por imagen , Ureterocele/patología
10.
Clin Nucl Med ; 46(1): e11-e12, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33156043

RESUMEN

McCune-Albright syndrome is a rare condition consisting of triad of fibrous dysplasia, hyperfunctioning endocrinopathy, and café au lait macules of skin. A 31-year-old man was diagnosed with fibrous dysplasia 18 years before presenting with pathologic fracture. No workup for polyostotic fibrous dysplasia was performed at that time. He now presented with left facial swelling and skeletal features of acromegaly. MRI revealed a 15-cm enhancing tumor diagnosed histopathologically as high-grade osteosarcoma. Tc-methylene diphosphonate bone scintigraphy revealed decreased uptake at the tumor site contrary to the usual finding of avid uptake by the neoplastic bone forming tumor.


Asunto(s)
Neoplasias Óseas/complicaciones , Neoplasias Óseas/diagnóstico por imagen , Displasia Fibrosa Poliostótica/complicaciones , Mandíbula/diagnóstico por imagen , Osteosarcoma/complicaciones , Osteosarcoma/diagnóstico por imagen , Acromegalia/complicaciones , Adulto , Humanos , Imagen por Resonancia Magnética , Masculino
12.
World Neurosurg ; 145: 356-359, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33045450

RESUMEN

BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic, a rapid screening method for COVID-19 detection is needed to decide the appropriate strategy to treat stroke patients. In acute ischemic stroke treatment, the efficacy and safety of emergent carotid artery stenting (eCAS) for hyperacute ischemic stroke (hAIS) due to internal carotid artery stenosis (ICS) have not been sufficiently established. CASE DESCRIPTION: A 71-year-old man with hAIS caused by severe ICS was treated via intravenous alteplase infusion. The patient underwent screening for COVID-19 by the loop-mediated isothermal amplification (LAMP) assay shortly after arrival at our institution. The LAMP result was obtained within 90 minutes, during intravenous alteplase infusion, and turned out to be negative. The symptom of hemiplegia worsened during alteplase infusion, and he, therefore, underwent eCAS after administration of aspirin (200 mg). Recanalization was achieved successfully by eCAS, and dual antiplatelet therapy and argatroban were administrated following eCAS. Hemorrhagic complications or restenosis/occlusion of the carotid artery were not observed. He was discharged without neurologic deficits 15 days following eCAS. Because of the rapid negative diagnosis for COVID-19 using the LAMP method, eCAS could be performed following standard procedures, along with infectious defense, without delay. CONCLUSIONS: This case report suggests that eCAS for hAIS due to ICS following intravenous alteplase can be an effective treatment, along with appropriate antiplatelet medication and management in select patients. During the COVID-19 pandemic, the LAMP assay for COVID-19 detection might be a suitable diagnostic strategy preceding stroke treatment because of the rapid turnaround time.


Asunto(s)
/diagnóstico , Estenosis Carotídea/cirugía , Fibrinolíticos/uso terapéutico , /cirugía , Técnicas de Diagnóstico Molecular , Técnicas de Amplificación de Ácido Nucleico , Stents , Activador de Tejido Plasminógeno/uso terapéutico , Anciano , Arginina/análogos & derivados , Arginina/uso terapéutico , Estenosis Carotídea/complicaciones , Estenosis Carotídea/diagnóstico por imagen , Terapia Combinada , Hemiplejía/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Ácidos Pipecólicos/uso terapéutico , Inhibidores de Agregación Plaquetaria/uso terapéutico , Sulfonamidas/uso terapéutico , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
13.
J Stroke Cerebrovasc Dis ; 30(1): 105380, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33166769

RESUMEN

BACKGROUND AND PURPOSE: Brain infarct growth, despite successful reperfusion, decreases the likelihood of good functional outcome after ischemic stroke. In patients undergoing reperfusion, admission glucose is associated with poor outcome but the effect of glucose level on infarct growth is not well studied. MATERIALS AND METHODS: This is a secondary analysis of the DEFUSE 3 trial. The primary predictor was baseline glucose level and the primary outcome is the change of the ischemic core volume from the baseline to 24-hour follow-up imaging (∆core), transformed as a cube root to reduce right skew. We included DEFUSE 3 patients who were randomized to endovascular therapy, had perfusion imaging data at baseline, an MRI at 24 hours, and who achieved TICI 2b or 3. Linear regression models, both unadjusted and adjusted, were fit to the primary outcome and all models included the baseline core volume as a covariate to normalize ∆core. RESULTS: We identified 62 patients who met our inclusion criteria. The mean age was 68.1±13.1 (years), 48.4% (30/62) were men, and the median (IQR) cube root of ∆core was 2.8 (2.0-3.8) mL. There was an association between baseline glucose level and normalized ∆core in unadjusted analysis (beta coefficient 0.010, p = 0.01) and after adjusting for potential confounders (beta coefficient 0.008, p = 0.03). CONCLUSION: In acute ischemic stroke patients with large vessel occlusion undergoing successful endovascular reperfusion, baseline hyperglycemia is associated with infarction growth. Further study is needed to establish potential neuroprotective benefits of aggressive glycemic control prior to and after reperfusion.


Asunto(s)
Glucemia/metabolismo , Infarto Encefálico/terapia , Procedimientos Endovasculares , Hiperglucemia/complicaciones , Reperfusión , Anciano , Anciano de 80 o más Años , Biomarcadores/sangre , Infarto Encefálico/complicaciones , Infarto Encefálico/diagnóstico por imagen , Procedimientos Endovasculares/efectos adversos , Femenino , Humanos , Hiperglucemia/sangre , Hiperglucemia/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Reperfusión/efectos adversos , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento
14.
Acad Radiol ; 28(1): 28-35, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33132007

RESUMEN

BACKGROUND AND PURPOSE: There is limited literature consisting of case reports or series on olfactory bulb imaging in COVID-19 olfactory dysfunction. An imaging study with objective clinical correlation is needed in COVID-19 anosmia in order to better understand underlying pathogenesis. MATERIAL AND METHODS: We evaluated 23 patients with persistent COVID-19 olfactory dysfunction. Patients included in this study had a minimum 1-month duration between onset of olfactory dysfunction and evaluation. Olfactory functions were evaluated with Sniffin' Sticks Test. Paranasal sinus CTs and MRI dedicated to olfactory nerves were acquired. On MRI, quantitative measurements of olfactory bulb volumes and olfactory sulcus depth and qualitative assessment of olfactory bulb morphology, signal intensity, and olfactory nerve filia architecture were performed. RESULTS: All patients were anosmic at the time of imaging based on olfactory test results. On CT, Olfactory cleft opacification was seen in 73.9% of cases with a mid and posterior segment dominance. 43.5% of cases had below normal olfactory bulb volumes and 60.9% of cases had shallow olfactory sulci. Of all, 54.2% of cases had changes in normal inverted J shape of the bulb. 91.3% of cases had abnormality in olfactory bulb signal intensity in the forms of diffusely increased signal intensity, scattered hyperintense foci or microhemorrhages. Evident clumping of olfactory filia was seen in 34.8% of cases and thinning with scarcity of filia in 17.4%. Primary olfactory cortical signal abnormality was seen in 21.7% of cases. CONCLUSION: Our findings indicate olfactory cleft and olfactory bulb abnormalities are seen in COVID-19 anosmia. There was a relatively high percentage of olfactory bulb degeneration. Further longitudinal imaging studies could shed light on the mechanism of olfactory neuronal pathway injury in COVID-19 anosmia.


Asunto(s)
Trastornos del Olfato , Humanos , Imagen por Resonancia Magnética , Trastornos del Olfato/diagnóstico por imagen , Bulbo Olfatorio/diagnóstico por imagen , Pandemias , Tomografía Computarizada por Rayos X
15.
Urol Oncol ; 39(1): 73.e1-73.e8, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32778478

RESUMEN

OBJECTIVE: Image guided biopsies are an integral part of prostate cancer evaluation. The effect of delaying biopsies of suspicious prostate mpMRI lesions is uncertain and clinically relevant during the COVID-19 crisis. We evaluated the association between biopsy delay time and pathologic findings on subsequent prostate biopsy. MATERIALS AND METHODS: After obtaining IRB approval we reviewed the medical records of 214 patients who underwent image-guided transperineal fusion biopsy of the prostate biopsy between 2017 and 2019. Study outcomes included clinically significant (ISUP grade group ≥2) and any prostate cancer on biopsy. Logistic regression was used to evaluate the association between biopsy delay time and outcomes while adjusting for known predictors of cancer on biopsy. RESULTS: The study cohort included 195 men with a median age of 68. Median delay between mpMRI and biopsy was 5 months, and 90% of patients had a ≤8 months delay. A significant association was found between PI-RADS 5 lesions and no previous biopsies and shorter delay time. Delay time was not associated with clinically significant or any cancer on biopsy. A higher risk of significant cancer was associated with older age (P = 0.008), higher PSA (0.003), smaller prostate volume (<0.001), no previous biopsy (0.012) and PI-RADS 5 lesions (0.015). CONCLUSIONS: Our findings suggest that under current practice, where men with PI-RADS 5 lesions and no previous biopsies undergo earlier evaluation, a delay of up to 8 months between imaging and biopsy does not affect biopsy findings. In the current COVID-19 crisis, selectively delaying image-guided prostate biopsies is unlikely to result in a higher rate of significant cancer.


Asunto(s)
/epidemiología , Próstata/patología , Tiempo de Tratamiento , Anciano , Humanos , Biopsia Guiada por Imagen , Modelos Logísticos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Próstata/diagnóstico por imagen , Neoplasias de la Próstata/diagnóstico , Neoplasias de la Próstata/diagnóstico por imagen , Neoplasias de la Próstata/patología , Neoplasias de la Próstata/cirugía , Estudios Retrospectivos , Factores de Riesgo , Tiempo de Tratamiento/estadística & datos numéricos
16.
Br J Radiol ; 94(1117): 20200383, 2021 Jan 01.
Artículo en Inglés | MEDLINE | ID: mdl-32822245

RESUMEN

Corpus luteum rupture presenting as acute abdomen is an underdiagnosed condition. Though a self-limiting entity, its differentiation from other causes is essential to prevent unnecessary surgical procedures. The radiologist should be aware of the possibility of a ruptured haemorrhagic ovarian cyst in a female of reproductive age group presenting with pelvic pain and a large amount of haemorrhagic ascites. Imaging characteristically reveals a thick-walled cystic structure in the adnexa with internal echoes, focal discontinuity or irregularity of its wall with haemoperitoneum. While sonography is usually indicative of corpus luteum rupture, cross-sectional imaging (CT/MRI) can be used to confirm the diagnosis.


Asunto(s)
Cuerpo Lúteo/diagnóstico por imagen , Hemoperitoneo/etiología , Rotura Espontánea/complicaciones , Rotura Espontánea/diagnóstico por imagen , Ultrasonografía/métodos , Abdomen Agudo/etiología , Diagnóstico Diferencial , Femenino , Hemoperitoneo/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Imagen Multimodal , Tomografía Computarizada por Rayos X
17.
Clin Oral Investig ; 25(1): 159-168, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32556656

RESUMEN

OBJECTIVES: The aim of this study was to evaluate diagnoses of temporomandibular (TMJ) disc displacement by comparing evaluations done on the basis of central sagittal scans only, the most often used in temporomandibular disorder (TMD) patients, with a multisection evaluation done with both sagittal and coronal scans. MATERIALS AND METHODS: Multisection MRI analysis of 382 TMJs was conducted in 191 patients with disc displacement according to RDC/TMD criteria. Disc position in the intercuspal position (IP) was assessed two times using two different methods. The first method involved a TMJ disc position evaluation on the central slide in the oblique sagittal plane only. In the second method, the TMJ disc position was assessed on all oblique sagittal and coronal images. McNemar's χ2 test was used to evaluate the differences between the sensitivities of two methods. RESULTS: The first method (central oblique sagittal scans assessment) identified 148 TMJs (38.7%) with normal disc position compared with 89 TMJs (23.3%) with normal disc position found by the second method (all oblique sagittal and coronal scans assessment). The sensitivity of analysis in both planes was significantly higher than in the sagittal plane only (p < 0.001). CONCLUSIONS: The multisection analysis in the sagittal and coronal plane allows to distinguish the correct disc position from disc displacement and thus improve evaluation of TMJ internal derangement. CLINICAL RELEVANCE: The multisection sagittal and coronal images should be recommended as a standard in MRI of the TMJ disc displacement in patients with TMD to avoid false-negative diagnoses.


Asunto(s)
Luxaciones Articulares , Prótesis Articulares , Trastornos de la Articulación Temporomandibular , Humanos , Luxaciones Articulares/diagnóstico por imagen , Imagen por Resonancia Magnética , Articulación Temporomandibular , Disco de la Articulación Temporomandibular/diagnóstico por imagen , Trastornos de la Articulación Temporomandibular/diagnóstico por imagen
18.
Eur Heart J Cardiovasc Imaging ; 22(1): 102-110, 2021 01 01.
Artículo en Inglés | MEDLINE | ID: mdl-31848575

RESUMEN

AIMS: Left atrial (LA) strain is a prognostic biomarker with utility across a spectrum of acute and chronic cardiovascular pathologies. There are limited data on intervendor differences and no data on intermodality differences for LA strain. We sought to compare the intervendor and intermodality differences between transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) derived LA strain. We hypothesized that various components of atrial strain would show good intervendor and intermodality correlation but that there would be systematic differences between vendors and modalities. METHODS AND RESULTS: We evaluated 54 subjects (43 patients with a clinical indication for CMR and 11 healthy volunteers) in a study comparing TTE- and CMR-derived LA reservoir strain (ƐR), conduit strain (ƐCD), and contractile strain (ƐCT). The LA strain components were evaluated using four dedicated types of post-processing software. We evaluated the correlation and systematic bias between modalities and within each modality. Intervendor and intermodality correlation was: ƐR [intraclass correlation coefficient (ICC 0.64-0.90)], ƐCD (ICC 0.62-0.89), and ƐCT (ICC 0.58-0.77). There was evidence of systematic bias between vendors and modalities with mean differences ranging from (3.1-12.2%) for ƐR, ƐCD (1.6-8.6%), and ƐCT (0.3-3.6%). Reproducibility analysis revealed intraobserver coefficient of variance (COV) of 6.5-14.6% and interobserver COV of 9.9-18.7%. CONCLUSION: Vendor derived ƐR, ƐCD, and ƐCT demonstrates modest to excellent intervendor and intermodality correlation depending on strain component examined. There are systematic differences in measurements depending on modality and vendor. These differences may be addressed by future studies, which, examine calibration of LA geometry/higher frame rate imaging, semi-quantitative approaches, and improvements in reproducibility.


Asunto(s)
Función del Atrio Izquierdo/fisiología , Ecocardiografía/instrumentación , Atrios Cardíacos/diagnóstico por imagen , Imagen por Resonancia Magnética/instrumentación , Adulto , Algoritmos , Estudios de Casos y Controles , Medios de Contraste , Femenino , Humanos , Interpretación de Imagen Asistida por Computador/métodos , Masculino , Persona de Mediana Edad , Contracción Miocárdica , Pronóstico
19.
Eur J Neurol ; 28(1): 248-258, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32853434

RESUMEN

BACKGROUND AND PURPOSE: Neurological manifestations in coronavirus disease (COVID)-2019 may adversely affect clinical outcomes. Severe COVID-19 and uremia are risk factors for neurological complications. However, the lack of insight into their pathogenesis, particularly with respect to the role of the cytokine release syndrome (CRS), is currently hampering effective therapeutic interventions. The aims of this study were to describe the neurological manifestations of patients with COVID-19 and to gain pathophysiological insights with respect to CRS. METHODS: In this longitudinal study, we performed extensive clinical, laboratory and imaging phenotyping in five patients admitted to our renal unit. RESULTS: Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Notably, neurological disturbances were accompanied by laboratory evidence of CRS. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) was undetectable in the cerebrospinal fluid (CSF). Hyperalbuminorrachia and increased levels of the astroglial protein S100B were suggestive of blood-brain barrier (BBB) dysfunction. Brain magnetic resonance imaging findings comprised evidence of acute leukoencephalitis (n = 3, one of whom had a hemorrhagic form), cytotoxic edema mimicking ischaemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted, resulting in rapid recovery from neurological disturbances in two cases. SARS-CoV2 was undetectable in 88 of the 90 patients with COVID-19 who underwent Reverse Transcription-PCR testing of CSF. CONCLUSIONS: Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory and imaging similarities with those of chimeric antigen receptor T-cell-related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.


Asunto(s)
Encefalopatías/etiología , Síndrome de Liberación de Citoquinas/etiología , Corticoesteroides/uso terapéutico , Anciano , Barrera Hematoencefálica/fisiopatología , Encéfalo/diagnóstico por imagen , Encefalopatías/fisiopatología , Edema Encefálico/etiología , /fisiopatología , Síndrome de Liberación de Citoquinas/metabolismo , Síndrome de Liberación de Citoquinas/fisiopatología , Femenino , Humanos , Inmunoglobulinas/uso terapéutico , Estudios Longitudinales , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Enfermedades del Sistema Nervioso/etiología , Enfermedades del Sistema Nervioso/fisiopatología , Resultado del Tratamiento
20.
Eur J Neurol ; 28(1): 358-360, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32997868

RESUMEN

COVID-19 can occasionally be associated with cranial nerve involvement, but facial palsy, particularly if bilateral, is exceptional. We here report a patient who presented with severe bilateral facial palsy and evidence of SARS-CoV-2 infection preceded by upper respiratory symptoms. He also had serological evidence of coinfection with Epstein-Barr virus, which could have also played a role in his neurological manifestations. PCR in the cerebrospinal fluid was negative for both EBV and SARS-CoV-2, which suggests an indirect, immune-mediated mechanism rather than direct, viral-induced damage. The patient was treated with prednisone 60 mg/24h with a tapering schedule and had a favorable outcome, with an almost complete recovery in 3 weeks. SARS-CoV-2 adds to the list of infectious agents causative of bilateral facial palsy. Coinfection with SARS-CoV-2 is not rare and should be considered in the differential diagnosis.


Asunto(s)
/complicaciones , Infecciones por Virus de Epstein-Barr/complicaciones , Parálisis Facial/etiología , Antiinflamatorios/uso terapéutico , Parálisis Facial/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Prednisona/uso terapéutico , Recuperación de la Función , Infecciones del Sistema Respiratorio/etiología , Infecciones del Sistema Respiratorio/fisiopatología , Resultado del Tratamiento , Adulto Joven
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