COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings
COVID-19-related encephalopathy: a case series with brain FDG-positron-emission tomography/computed tomography findings
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DOI：
10.1111/ene.14478
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发表时间：
2020-09-22
影响因子：
5.1
通讯作者：
Pourcher, V.
中科院分区：
文献类型：
--
作者：
Delorme, C.;Paccoud, O.;Pourcher, V.
目的本文的目的是使用脑2-脱氧-2-氟-D-葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）成像描述COVID-19相关脑病的临床特征及其代谢相关性。背景和目的已报告了与COVID-19相关的各种神经系统表现。COVID-19相关脑病很少被报道和研究。方法我们报告了4例COVID-19相关脑病。诊断是在确诊的COVID-19患者中做出的，这些患者表现为新发认知障碍、中枢局灶性神经系统体征或癫痫发作。所有患者均接受认知筛查、脑磁共振成像（MRI）、腰椎穿刺和脑2-脱氧-2-氟-D-葡萄糖（FDG）-正电子发射断层扫描（PET）/计算机断层扫描（CT）（FDG-PET/CT）。结果4例患者年龄均在60岁以上，均有不同程度的认知功能损害，以额叶损害为主。2例患者出现小脑综合征，1例患者出现肌阵挛，1例患者出现精神症状，1例患者出现癫痫持续状态。首次COVID-19症状和神经系统症状发作之间的延迟为0至12天。所有患者均无脑炎的MRI特征，也无明显的脑脊液（CSF）异常。所有患者脑脊液SARS-CoV-2 RT-PCR均为阴性。所有患者均表现出一致的脑部FDG-PET/CT异常模式，即额叶低代谢和小脑高代谢。所有患者在免疫治疗后均有所改善。结论尽管临床表现各异，但所有患者的FDG-PET表现一致，这可能反映了免疫机制。
Aim The aim of this paper is to describe the clinical features of COVID-19-related encephalopathy and their metabolic correlates using brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) imaging. Background and purpose A variety of neurological manifestations have been reported in association with COVID-19. COVID-19-related encephalopathy has seldom been reported and studied. Methods We report four cases of COVID-19-related encephalopathy. The diagnosis was made in patients with confirmed COVID-19 who presented with new-onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) (FDG-PET/CT). Results The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID-19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG-PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy. Conclusions Despite varied clinical presentations, all patients presented with a consistent FDG-PET pattern, which may reflect an immune mechanism.