背景:在2019年冠状病毒病(COVID-19)大流行的过去3年中,COVID-19已被认为会导致各种神经系统并发症,包括罕见的可逆性后部脑病综合征(PRES)。在先前报道的与COVID-19相关的PRES病例中,大多数患者患有严重的COVID-19感染和已知的PRES诱发因素,比如不受控制的高血压,肾功能不全,使用免疫抑制剂。尚不清楚这些危险因素或严重急性呼吸综合征冠状病毒2(SARS-CoV-2)的感染是否有助于这些患者的PRES的发展。在这里,我们报告了与COVID-19相关的PRES的特殊病例,没有任何已知的PRES危险因素,表明SARS-CoV-2在与COVID-19相关的PRES发病机理中的直接作用。
方法:一名18岁女性患者因腹痛被送往急诊科就诊。初步调查显示没有异常,除了使用口咽拭子的新型冠状病毒核酸检测结果呈阳性。然而,患者随后出现强直阵挛性癫痫发作,头痛,第二天呕吐。进行了广泛的调查,包括脑部MRI和腰椎穿刺.脑MRI显示双侧枕骨低信号T1加权和高信号T2加权病变,额叶,和顶骨皮质无增强作用。血液和脑脊液分析结果为阴性。病人没有高血压,肾功能不全,自身免疫性疾病,或使用免疫抑制剂或细胞毒性药物。
方法:根据PRES的临床特征和典型MRI表现诊断PRES。
方法:对患者进行对症治疗,如抗惊厥药。
结果:患者在1周内完全康复。最初的MRI异常在11天后进行的第二次MR检查中也完全消失。支持PRES的诊断。患者随访6个月,保持正常状态。
结论:当前病例没有典型的PRES危险因素,这表明尽管COVID-19患者PRES的原因可能是多因素的,SARS-CoV-2的感染可能在COVID-19相关PRES的发病中起直接作用。
BACKGROUND: During the past 3 years of the corona virus disease 2019 (COVID-19) pandemic, COVID-19 has been recognized to cause various neurological complications, including rare posterior reversible encephalopathy syndrome (PRES). In previously reported cases of PRES associated with COVID-19, the majority of patients had severe COVID-19 infection and known predisposing factors for PRES, such as uncontrolled hypertension, renal dysfunction, and use of immunosuppressants. It remains unclear whether these risk factors or infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) contributes to the development of PRES in these patients. Here we report a special case of PRES associated with COVID-19 without any known risk factors for PRES, indicating the SARS-CoV-2\'s direct role in the pathogenesis of PRES associated with COVID-19.
METHODS: An 18-year-old female patient presented to the emergency department with abdominal pain. Preliminary investigations showed no abnormalities, except for positive results in novel coronavirus nucleic acid tests using oropharyngeal swabs. However, the patient subsequently developed tonic-clonic seizures, headaches, and vomiting on the second day. Extensive investigations have been performed, including brain MRI and lumbar puncture. Brain MRI showed hypointense T1-weighted and hyperintense T2-weighted lesions in the bilateral occipital, frontal, and parietal cortices without enhancement effect. Blood and cerebrospinal fluid analyses yielded negative results. The patient had no hypertension, renal insufficiency, autoimmune disease, or the use of immunosuppressants or cytotoxic drugs.
METHODS: PRES was diagnosed based on the clinical features and typical MRI findings of PRES.
METHODS: Symptomatic treatments such as anticonvulsants were administered to the patients.
RESULTS: The patient fully recovered within 1 week. The initial MRI abnormalities also disappeared completely on a second MR examination performed 11 days later, supporting the diagnosis of PRES. The patient was followed up for 6 months and remained in a normal state.
CONCLUSIONS: The current case had no classical risk factors for PRES, indicating that although the cause of PRES in COVID-19 patients may be multifactorial, the infection of SARS-CoV-2 may play a direct role in the pathogenesis of PRES associated with COVID-19.