Médecine Intensive-Réanimation, Hôpitaux Universitaires, Strasbourg, France.
Nuclear Medicine and Molecular Imaging, ICANS, Strasbourg, France.
Eur J Neurol. 2021 Oct;28(10):3443-3447. doi: 10.1111/ene.14776. Epub 2021 Mar 26.
COVID-19 affects the brain in various ways, amongst which delirium is worrying. An assessment was made of whether a specific, long-lasting, COVID-19-related brain injury develops in acute respiratory distress syndrome patients after life-saving re-oxygenation.
Ten COVID+ patients (COVID+) with unusual delirium associated with neuroimaging suggestive of diffuse brain injury and seven controls with non-COVID encephalopathy were studied. The assessment took place when the intractable delirium started at weaning off ventilation support. Brain magnetic resonance imaging (MRI) was performed followed by standard cerebrospinal fluid (CSF) analyses and assessment of CSF erythropoietin concentrations (as a marker for the assessment of tissue repair), and of non-targeted CSF metabolomics using liquid chromatography high resolution mass spectrometry.
Patients were similar as regards severity scores, but COVID+ were hospitalized longer (25 [11.75; 25] vs. 9 [4.5; 12.5] days, p = 0.03). On admission, but not at MRI and lumbar puncture performance, COVID+ were more hypoxic (p = 0.002). On MRI, there were leptomeningeal enhancement and diffuse white matter haemorrhages only in COVID+. In the latter, CSF erythropoietin concentration was lower (1.73 [1.6; 2.06] vs. 3.04 [2.9; 3.91] mIU/ml, p = 0.01), and CSF metabolomics indicated (a) increased compounds such as foodborne molecules (sesquiterpenes), molecules from industrialized beverages and micro-pollutants (diethanolamine); and (b) decreased molecules such as incomplete breakdown products of protein catabolism and foodborne molecules (glabridin). At 3-month discharge, fatigue, anxiety and depression as well as MRI lesions persisted in COVID+.
Some COVID+ are at risk of a specific delirium. Imperfect brain repair after re-oxygenation and lifestyle factors might influence long-lasting brain injuries in a context of foodborne micro-pollutants.
COVID-19 以多种方式影响大脑，其中谵妄令人担忧。本研究评估了急性呼吸窘迫综合征患者在挽救生命的再氧合后是否会发展出与 COVID-19 相关的特定、持久的脑损伤。
研究了 10 例 COVID+患者（COVID+），这些患者出现不寻常的谵妄，神经影像学提示弥漫性脑损伤，7 例对照患者患有非 COVID 性脑病。评估是在脱机通气支持时开始出现顽固性谵妄时进行的。进行脑磁共振成像（MRI）检查，随后进行标准脑脊液（CSF）分析和 CSF 促红细胞生成素浓度评估（作为组织修复评估的标志物），以及使用液相色谱高分辨率质谱进行非靶向 CSF 代谢组学分析。
患者的严重程度评分相似，但 COVID+的住院时间更长（25[11.75；25]天 vs. 9[4.5；12.5]天，p=0.03）。入院时，但不是在 MRI 和腰椎穿刺时，COVID+的缺氧程度更严重（p=0.002）。在 MRI 上，仅 COVID+患者出现软脑膜增强和弥漫性脑白质出血。在后者中，CSF 促红细胞生成素浓度较低（1.73[1.6；2.06] vs. 3.04[2.9；3.91] mIU/ml，p=0.01），CSF 代谢组学表明（a）增加了食物源分子（倍半萜）、工业化饮料和微污染物（二乙醇胺）等化合物；（b）减少了蛋白质分解代谢不完全产物和食物源分子（甘草素）等化合物。在 3 个月出院时，COVID+患者仍存在疲劳、焦虑和抑郁以及 MRI 病变。
一些 COVID+患者有发生特定谵妄的风险。再氧合后不完全的脑修复以及生活方式因素可能会在食物源微污染物的背景下影响持久的脑损伤。
