Nervous system manifestations of COVID-19 infection - hemorrhagic reversible post-encephalopathy syndrome.

The new coronavirus (COVID-19) has become popular around the worldIn the literature, the diagnosis and treatment of COVID-19 disease is mainly concentrated in the respiratory system, but the symptoms of the nervous system have attracted more and more attentionThe neurological manifestations of people infected with COVID-19 are partly attributed to severe acute respiratory syndrome coronavirus 2 (Acute Respiratory Syndrome coronavirus 2, SARS-CoV-2) affinity against angiotensin-converting enzyme 2 (ACE2) receptors; ACE2 is a common functional receptor in the respiratory system and nervous systemIn some PEOPLE infected with COVID-19, neurological symptoms occur a few days earlier than respiratory disease, or the only indicator of other asymptomatic COVID-19 carriersAMFranceschi et al., in May 2020, online AJNR Am J Neuroradiol, reported two hospitalized patients diagnosed with COVID-19 infection, whose brain imaging manifests as hemorrhagic reversibility post-encephalopathic encephalopathic syndrome (hemorrhagic posterior reversolikevision, saarhagic PRES) and discusses the possible causes of symptoms and their relationship to the infectionStudy Method S1:48-year-old male patient, admitted to hospital with a fever and cough positive nucleic acid test 5 days after exposure to COVID-19 infectionAfter 2 days of fever progression and difficulty breathing to stay in the ICUIn ICU shock, diagnosed as inflammatory cytokine release syndromeThe patient experienced a mental state change, a CT examination of the head found that the two-sided back-top restion area bureau of the ventrial vascular source / cytotoxic encephalopathy, distributed under the cortex, accompanied by a small amount of bleeding on the right pillow leaf (Figure 1); Figure 1The CT shaft position flat sweep shows that the edema (black arrow) in the rear top pillow area is accompanied by a small haemorrhage stove on the right side (white arrow)Figure 28 days after CT for cerebral MRI shaft DWI (A), FLAIR (B), enhanced pre-T1 weighted (C), enhanced T1 weighted (D) and magnetic ally sensitivity weighted (E and F) sequence imaging show, right pillow area small infarction (arrow, A), back top rest area cerebral edema (hollow black arrow, B), subacute bleeding (solid white arrow, C) and contrast enhancement (D- The entire carcass on the SWI diffuses spot-like bleeding (white arrows, E and F)cases 2: 67-year-old female patients, have a history of hypertension, diabetes, gout and asthmaMental state changes during the COVID-19 outbreak, including drowsiness and confusion, were transferred from nursing centres Emergency check body no fever, denied respiratory symptoms, 2 days later the new coronavirus nucleic acid test positive The patient's skull CT suggests the presence of occupant-effect cerebral edema and the disappearance of the cortical ventricle in the two-sided top resting area (Figure 3), and the skull MRI suggests hemorrhagic reversibility of post-encephalopathy syndrome (Figure 4) The patient was eventually discharged after treatment Figure 3 THE CT SHAFT POSITION FLAT SWEEP SHOWS THAT THE DOUBLE TOP REST AREA VASCULAR SOURCE/CYTOTOXIC EDEMA, SUGGESTS PRES (ARROW) Figure 4 Brain MRI shaft DWI (A), FLAIR (B), Enhanced Pre-T1 Weighted (C), Enhanced T1 Weighted (D) and SWI (E and F) sequence imaging show that the two-sided rear top pillow infarction (white arrow, A), rear top resting area edema (white arrow, B) and contrast-enhanced enhanced stove (hollow white arrow, D) SWI shows a large amount of artifacts on the back of the two-sided top pillow, which corresponds to bleeding in the cortex and subtly cortex (white arrows, E and F), with more pronounced on the right side Conclusion The authors noted that the two patients reported were imaging-diagnosed hemorrhagic post-encephalopathy syndrome, which clinically manifested itself as an acute neurological syndrome characterized by headache, changeof in mental state, seizures or visual impairment, and with fluctuations in blood pressure Under the influence of cytotoxicity and immunosuppression, it is associated with eclampsia and pre-eclampsia, as well as various autoimmune and rheumatism The potential pathophysiological mechanisms of PRES remain controversial and are often considered to be changes in the integrity of the blood-brain barrier (BBB), possibly due to loss of self-regulation function or endothelial dysfunction The main imaging characteristics of PRES are vascular-derived edema at the back of the top pillow lobe, and abnormal changes can be observed in the watershed, frontal lobe, the lower temporal lobe, the base nerve section, the brain stem and the small brain Studies have reported presthestative complications of PRES haemorrhagic disease in 15%-20% of cases, including spot haemorrhage, as well as clinical manifestations commonly known as cytokine release syndrome The imaging signs of two cases of COVID-19 infection reported in this case are consistent with hemorrhagic PRES Therefore, the pathogenesis of PRES in COVID-19 infected persons is a combination effect of cytokine release and direct destruction of BBB mediated by SARS-CoV-2 PRES can occur in patients with COVID-19 infection, especially if blood pressure is unstable After the symptoms associated with COVID-19 subsided, the abnormalbrain also improved significantly and the mental state returned to normal In summary, PRES may be one of the manifestations of neurological damage to COVID-19 infection Copyright Notice The copyright scopyrights published by the God's External Information APP are not limited to the copyrights of the sponsor/original author and outside of God information, and no one may steal any content directly or indirectly by way of adaptation, tailoring, reproduction, reproduction, recording, etc without the express authorization of outside information Works authorized by outside information should be used within the scope of authorization, please indicate the source: Outside God Information In the event of a violation, The Outside Information will reserve the right to further pursue the legal liability of the infringer Outside the God's Information welcomes individuals to forward and share works published under this number