Critical illness-associated cerebral microbleeds for patients with severe COVID-19: etiologic hypotheses.
COVID-19
Hypoxemia
Kidney failure
MRI
Microhemorrhages
Journal
Journal of neurology
ISSN: 1432-1459
Titre abrégé: J Neurol
Pays: Germany
ID NLM: 0423161
Informations de publication
Date de publication:
Aug 2021
Aug 2021
Historique:
received:
08
10
2020
accepted:
08
11
2020
revised:
02
11
2020
pubmed:
22
11
2020
medline:
22
7
2021
entrez:
21
11
2020
Statut:
ppublish
Résumé
During the COVID-19 outbreak, the presence of extensive white matter microhemorrhages was detected by brain MRIs. The goal of this study was to investigate the origin of this atypical hemorrhagic complication. Between March 17 and May 18, 2020, 80 patients with severe COVID-19 infections were admitted for acute respiratory distress syndrome to intensive care units at the University Hospitals of Strasbourg for whom a brain MRI for neurologic manifestations was performed. 19 patients (24%) with diffuse microhemorrhages were compared to 18 control patients with COVID-19 and normal brain MRI. The first hypothesis was hypoxemia. The latter seemed very likely since respiratory failure was longer and more pronounced in patients with microhemorrhages (prolonged endotracheal intubation (p = 0.0002), higher FiO Blood-brain barrier dysfunction secondary to hypoxemia and high concentration of uremic toxins seems to be the main mechanism leading to critical illness-associated cerebral microbleeds, and this complication remains to be frequently described in severe COVID-19 patients.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
During the COVID-19 outbreak, the presence of extensive white matter microhemorrhages was detected by brain MRIs. The goal of this study was to investigate the origin of this atypical hemorrhagic complication.
METHODS
METHODS
Between March 17 and May 18, 2020, 80 patients with severe COVID-19 infections were admitted for acute respiratory distress syndrome to intensive care units at the University Hospitals of Strasbourg for whom a brain MRI for neurologic manifestations was performed. 19 patients (24%) with diffuse microhemorrhages were compared to 18 control patients with COVID-19 and normal brain MRI.
RESULTS
RESULTS
The first hypothesis was hypoxemia. The latter seemed very likely since respiratory failure was longer and more pronounced in patients with microhemorrhages (prolonged endotracheal intubation (p = 0.0002), higher FiO
CONCLUSIONS
CONCLUSIONS
Blood-brain barrier dysfunction secondary to hypoxemia and high concentration of uremic toxins seems to be the main mechanism leading to critical illness-associated cerebral microbleeds, and this complication remains to be frequently described in severe COVID-19 patients.
Identifiants
pubmed: 33219827
doi: 10.1007/s00415-020-10313-8
pii: 10.1007/s00415-020-10313-8
pmc: PMC7679237
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2676-2684Informations de copyright
© 2020. Springer-Verlag GmbH Germany, part of Springer Nature.
Références
AJR Am J Roentgenol. 2021 Apr;216(4):1046-1047
pubmed: 32903058
Transl Stroke Res. 2020 Feb;11(1):122-134
pubmed: 31055735
Neurology. 2013 Nov 12;81(20):1776-9
pubmed: 24107867
N Engl J Med. 2020 Jul 9;383(2):120-128
pubmed: 32437596
Radiology. 2020 Oct;297(1):E223-E227
pubmed: 32437314
Thromb Haemost. 2001 Nov;86(5):1327-30
pubmed: 11816725
Eur Radiol. 2020 Sep;30(9):4903-4909
pubmed: 32314058
J Cardiothorac Vasc Anesth. 2017 Oct;31(5):1836-1846
pubmed: 28625752
AJNR Am J Neuroradiol. 2020 Nov;41(11):2001-2008
pubmed: 32819899
J Cereb Blood Flow Metab. 2008 Sep;28(9):1635-42
pubmed: 18523438
Neurol Med Chir (Tokyo). 2005 Nov;45(11):556-60; discussion 560
pubmed: 16308513
Neurology. 2015 Feb 10;84(6):630
pubmed: 25666630
Radiology. 2020 Dec;297(3):E313-E323
pubmed: 32677875
Acta Neuropathol. 2020 Jul;140(1):1-6
pubmed: 32449057
Stroke. 2017 Apr;48(4):1085-1087
pubmed: 28235962
J Neuroimaging. 2020 Sep;30(5):593-597
pubmed: 32639679
Brain. 2020 Oct 1;143(10):3104-3120
pubmed: 32637987
Radiology. 2020 Dec;297(3):E324-E334
pubmed: 32729812
Neuroradiol J. 2020 Oct;33(5):374-376
pubmed: 32757827
Lancet. 2020 Jun 20;395(10241):e109
pubmed: 32505222
Brain. 2004 Oct;127(Pt 10):2265-75
pubmed: 15282216
JAMA. 2012 Jun 20;307(23):2526-33
pubmed: 22797452
Radiology. 2020 Nov;297(2):E242-E251
pubmed: 32544034