Journal article
Focal EEG changes indicating critical illness associated cerebral microbleeds in a Covid-19 patient.
- De Stefano P EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, Switzerland.
- Nencha U EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, Switzerland.
- De Stefano L Rheumatology Unit, IRCCS Policlinico, S. Matteo Foundation, University of Pavia, Italy.
- Mégevand P EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, Switzerland.
- Seeck M EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, Switzerland.
- 2020-07-02
Published in:
- Clinical neurophysiology practice. - 2020
English
Objectives
We describe a patient suffering from Covid19-related acute respiratory distress syndrome (ARDS), highlighting the diagnostic role of the EEG in ICU.
History
A Covid-19 patient undergoing mechanical ventilation due to related acute respiratory distress syndrome (ARDS), presented altered mental status in the ICU. Video-EEG revealed a focal monomorphic theta slowing in bilateral frontal-central regions. Concordant with the EEG localization, MRI showed abundant microbleeds located in bilateral white matter junction, various regions of corpus callosum and internal capsule, suggestive of Critical Illness-Associated Cerebral Microbleeds. CSF analysis excluded the presence of encephalitis, SARS-Cov2 RNA-PCR in CSF was negative. Clinical and biological picture was suggestive of cytokine release syndrome.
Conclusion
This is the first reported case of Critical Illness-Associated Cerebral Microbleeds in the context of Covid-19. Knowledge of Covid-19 is still partial and acute neurological complications should be explored systematically. In our case, EEG helped to rule out non-convulsive status epilepticus, but revealed focal dysfunction, justifying further investigations.EEG plays a crucial role in these patients, allowing investigating the presence of focal or diffuse cerebral dysfunction. This is particularly helpful for Covid-19 patients in the ICU, where the neurological examination is challenging by the severity of the respiratory illness.
We describe a patient suffering from Covid19-related acute respiratory distress syndrome (ARDS), highlighting the diagnostic role of the EEG in ICU.
History
A Covid-19 patient undergoing mechanical ventilation due to related acute respiratory distress syndrome (ARDS), presented altered mental status in the ICU. Video-EEG revealed a focal monomorphic theta slowing in bilateral frontal-central regions. Concordant with the EEG localization, MRI showed abundant microbleeds located in bilateral white matter junction, various regions of corpus callosum and internal capsule, suggestive of Critical Illness-Associated Cerebral Microbleeds. CSF analysis excluded the presence of encephalitis, SARS-Cov2 RNA-PCR in CSF was negative. Clinical and biological picture was suggestive of cytokine release syndrome.
Conclusion
This is the first reported case of Critical Illness-Associated Cerebral Microbleeds in the context of Covid-19. Knowledge of Covid-19 is still partial and acute neurological complications should be explored systematically. In our case, EEG helped to rule out non-convulsive status epilepticus, but revealed focal dysfunction, justifying further investigations.EEG plays a crucial role in these patients, allowing investigating the presence of focal or diffuse cerebral dysfunction. This is particularly helpful for Covid-19 patients in the ICU, where the neurological examination is challenging by the severity of the respiratory illness.
- Language
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- English
- Open access status
- gold
- Identifiers
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- DOI 10.1016/j.cnp.2020.05.004
- PMID 32607454
- Persistent URL
- https://sonar.ch/global/documents/46773
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