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01-12-2021 | SARS-CoV-2 | Review

Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature

Authors: Francesco Motolese, Mario Ferrante, Mariagrazia Rossi, Alessandro Magliozzi, Martina Sbarra, Francesca Ursini, Massimo Marano, Fioravante Capone, Francesco Travaglino, Raffaele Antonelli Incalzi, Vincenzo Di Lazzaro, Fabio Pilato

Published in: Journal of Neurology | Issue 12/2021

Abstract

Background

SARS-CoV-2 infection has been associated with various neurological manifestations. Since patients affected by SARS-CoV-2 infection present coagulation and immune system dysregulation, ischemic or haemorragic stroke is not uncommon, irrespective of respiratory distress. However, the occurrence of focal neurological deficits together with other symptoms like headache, cortical blindness, seizure and altered mental status should prompt the diagnosis of Posterior Reversible Encephalopathy Syndrome (PRES). Antithrombotic treatment, the alteration of endothelial function, and coagulopathy due to COVID-19 and PRES leading to the breakdown of blood–brain barrier may then contribute to the occurrence of a brain haemorrhage.

Methods

We describe the case of a COVID-19 patient who developed bilateral occipital lobe haemorrhages suggestive of haemorrhagic PRES. We then reviewed the available literature about haemorrhagic evolution of PRES in COVID-19.

Results

We describe the clinical and radiological features of five COVID-19 patients who developed haemorrhagic PRES.

Conclusions

Coagulopathy and endothelial dysfunction resulting from the massive release of cytokines during the host immune response may be key factors in the pathogenesis of COVID-19-related PRES. Antithrombotic therapy and the leakage of the blood–brain barrier can subsequently increase the risk of haemorrhagic transformation of the lesioned brain tissue. A prompt diagnosis of PRES is mandatory, since the timely interruption/reversal of antithrombotic therapy may be a key determinant for a good prognosis.

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Title: Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature
Authors: Francesco Motolese
Mario Ferrante
Mariagrazia Rossi
Alessandro Magliozzi
Martina Sbarra
Francesca Ursini
Massimo Marano
Fioravante Capone
Francesco Travaglino
Raffaele Antonelli Incalzi
Vincenzo Di Lazzaro
Fabio Pilato
Publication date: 01-12-2021
Publisher: Springer Berlin Heidelberg
Keywords: SARS-CoV-2
COVID-19
Posterior Reversible Encephalopathy Syndrome
Published in: Journal of Neurology / Issue 12/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI: https://doi.org/10.1007/s00415-021-10709-0

At a glance: The STEP trials

Springer Medicine

Posterior Reversible Encephalopathy Syndrome and brain haemorrhage as COVID-19 complication: a review of the available literature

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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