Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Division of Neurology, Department of Clinical Neurosciences, Faculty of Medicine, Geneva University Hospitals, University of Geneva, Geneva, Switzerland.
J Neural Transm (Vienna). 2024 Apr;131(4):377-384. doi: 10.1007/s00702-024-02751-9. Epub 2024 Feb 16.
Acute encephalopathy (AE) has been described as a severe complication of COVID-19. Inflammation has been suggested as a pathogenic mechanism, with high-dose glucocorticoids (GC) showing a beneficial effect. Here, we retrospectively analyzed the clinical and radiological features in a group of COVID-19 AE patients who received GC treatment (GT) and in a non-treated (NT) group.
Thirty-six patients with COVID-19 AE (mean age 72.6 11 years; 86.11% men) were evaluated for GC treatment. Twelve patients (mean age 73.6 4.5 years; 66.67% men) received GC, whereas 24 patients who showed signs of spontaneous remission were not treated with GC (mean age 70.1 8.6 years; 95.83% men). Differences in clinical characteristics and correlations with imaging features were explored.
The GT group showed signs of vulnerability, with a longer hospitalization (p = 0.009) and AE duration (p = 0.012) and a higher hypertensive arteriopathy (HTNA) score (p = 0.022), when compared to NT group. At hospital discharge, the two groups were comparable in terms of clinical outcome (modified Rankin scale; p = 0.666) or mortality (p = 0.607). In our whole group analyses, AE severity was positively correlated with periventricular white matter hyperintensities (p = 0.011), deep enlarged perivascular spaces (p = 0.039) and HTNA score (p = 0.014).
This study suggests that, despite signs of radiological vulnerability and AE severity, patients treated by high-dose GC showed similar outcome at discharge, with respect to NT patients. Imaging features of cerebral small vessel disease correlated with AE severity, supporting the hypothesis that brain structural vulnerability can impact AE in COVID-19.
急性脑病（AE）已被描述为 COVID-19 的一种严重并发症。炎症被认为是一种发病机制，大剂量糖皮质激素（GC）显示出有益的效果。在这里，我们回顾性分析了一组接受 GC 治疗（GT）和未治疗（NT）的 COVID-19 AE 患者的临床和影像学特征。
评估了 36 例 COVID-19 AE 患者（平均年龄 72.6 11 岁；86.11%为男性）的 GC 治疗。12 例患者（平均年龄 73.6 4.5 岁；66.67%为男性）接受了 GC 治疗，而 24 例出现自发缓解迹象的患者未接受 GC 治疗（平均年龄 70.1 8.6 岁；95.83%为男性）。探讨了临床特征的差异及其与影像学特征的相关性。
GT 组表现出脆弱性迹象，住院时间（p=0.009）和 AE 持续时间（p=0.012）更长，高血压性小血管病（HTNA）评分更高（p=0.022），与 NT 组相比。出院时，两组在临床结局（改良 Rankin 量表；p=0.666）或死亡率（p=0.607）方面无差异。在我们的全组分析中，AE 严重程度与脑室周围白质高信号（p=0.011）、深部扩大的血管周围间隙（p=0.039）和 HTNA 评分（p=0.014）呈正相关。
本研究表明，尽管存在影像学脆弱性和 AE 严重程度的迹象，但接受大剂量 GC 治疗的患者在出院时与 NT 患者相比，结局相似。脑小血管疾病的影像学特征与 AE 严重程度相关，支持脑结构脆弱性可能影响 COVID-19 中 AE 的假说。
