Department of Neurology, Boston University School of Medicine, Boston, MA USA.
Department of Radiology, Boston University School of Medicine, Boston, MA USA.
J Stroke Cerebrovasc Dis. 2020 Nov;29(11):105212. doi: 10.1016/j.jstrokecerebrovasdis.2020.105212. Epub 2020 Jul 30.
Encephalopathy is a common complication of coronavirus disease 2019. Although the encephalopathy is idiopathic in many cases, there are several published reports of patients with posterior reversible encephalopathy syndrome in the setting of coronavirus disease 2019.
To describe the diverse presentations, risk factors, and outcomes of posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019.
We assessed patients with coronavirus disease 2019 and a diagnosis of posterior reversible encephalopathy syndrome at our institution from April 1 to June 24, 2020. We performed a literature search to capture all known published cases of posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019.
There were 2 cases of posterior reversible encephalopathy syndrome in the setting of coronavirus 2019 at our institution during a 3-month period. One patient was treated with anakinra, an interleukin-1 inhibitor that may disrupt endothelial function. The second patient had an underlying human immunodeficiency virus infection. We found 13 total cases in our literature search, which reported modest blood pressure fluctuations and a range of risk factors for posterior reversible encephalopathy syndrome. One patient was treated with tocilizumab, an interleukin-6 inhibitor that may have effects on endothelial function. All patients had an improvement in their neurological symptoms. Interval imaging, when available, showed radiographic improvement of brain lesions.
Risk factors for posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019 may include underlying infection or immunomodulatory agents with endothelial effects in conjunction with modest blood pressure fluctuations. We found that the neurological prognosis for posterior reversible encephalopathy syndrome in the setting of coronavirus disease 2019 infection is favorable. Recognition of posterior reversible encephalopathy syndrome in this patient population is critical for prognostication and initiation of treatment, which may include cessation of potential offending agents and tight blood pressure control.
脑病是 2019 年冠状病毒病的常见并发症。尽管在许多情况下脑病是特发性的，但有几篇关于 2019 年冠状病毒病患者出现后部可逆性脑病综合征的报道。
描述 2019 年冠状病毒病患者后部可逆性脑病综合征的不同表现、危险因素和结局。
我们评估了我院从 2020 年 4 月 1 日至 6 月 24 日期间患有 2019 年冠状病毒病和后部可逆性脑病综合征诊断的患者。我们进行了文献检索，以捕获所有已知的 2019 年冠状病毒病患者后部可逆性脑病综合征的病例。
在 3 个月的时间里，我们医院有 2 例 2019 年冠状病毒病合并后部可逆性脑病综合征的病例。一名患者接受了白细胞介素-1 抑制剂阿那白滞素治疗，该抑制剂可能破坏内皮功能。第二例患者患有人类免疫缺陷病毒感染。我们在文献检索中发现了总共 13 例病例，报告了血压波动和一系列后部可逆性脑病综合征的危险因素。一名患者接受了白细胞介素-6 抑制剂托珠单抗治疗，该抑制剂可能对内皮功能有影响。所有患者的神经症状均有所改善。有间隔成像时，显示脑部病变的放射学改善。
2019 年冠状病毒病患者后部可逆性脑病综合征的危险因素可能包括潜在感染或免疫调节药物与内皮效应，同时伴有血压适度波动。我们发现 2019 年冠状病毒病感染后部可逆性脑病综合征的神经预后良好。在该患者人群中识别后部可逆性脑病综合征对于预后和治疗的启动至关重要，这可能包括停止潜在的致病药物和严格控制血压。
