LitCovid-sentences  

PMC:7253233 / 2649-15257 JSONTXT 12 Projects

Annnotations TAB TSV DIC JSON TextAE

Id Subject Object Predicate Lexical cue
T26 0-12 Sentence denotes Introduction
T27 13-184 Sentence denotes Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged first in Wuhan, China, in 2019 and spread rapidly worldwide as a pandemic of the twenty-first century.
T28 185-330 Sentence denotes The symptoms and disease manifestations caused by SARS-CoV-2 were named Coronavirus disease 2019 (COVID-19) by the World Health Organization [1].
T29 331-562 Sentence denotes The neurological manifestations of this disease are not well known, and there is growing evidence that the disease has effects on the central nervous system (CNS) as detailed in retrospective reports from several centers worldwide.
T30 563-709 Sentence denotes An initial retrospective case series from Wuhan, China, showed that neurological manifestations are present in patients with COVID-19 disease [2].
T31 710-906 Sentence denotes In that series, 45.5% of patients with COVID-19 disease who had severe systemic disease burden also suffered from acute cerebrovascular disease, acute encephalopathy, and skeletal muscle symptoms.
T32 907-1013 Sentence denotes These patients also had higher levels of inflammatory markers and greater evidence of multi-organ failure.
T33 1014-1147 Sentence denotes However, the study did not elucidate how many patients with encephalopathy were monitored and treated for acute symptomatic seizures.
T34 1148-1287 Sentence denotes Another series of patients were reported in Strasbourg, France, with neurological features of encephalopathy and corticospinal tract signs.
T35 1288-1450 Sentence denotes Only a small proportion of the patients (8 out of 64) had electroencephalography performed, which demonstrated diffuse slowing consistent with encephalopathy [3].
T36 1451-1589 Sentence denotes Seizures have not been directly reported as a part of COVID-19 disease outside of patients with previously known brain injury or epilepsy.
T37 1590-1847 Sentence denotes There are several barriers to electrographically monitoring patients with SARS-CoV-2 infection such as prone positioning for respiratory compromise as well as the contamination risk which obviates a need for minimizing procedures in this patient population.
T38 1848-1972 Sentence denotes Neurointensivists and neurologists are often consulted for severe COVID-19 patients that present with neurological features.
T39 1973-2237 Sentence denotes In this report, we describe two patients who were electrographically monitored for acute encephalopathy and seizure-like activity, in the setting of normal brain imaging and who were found to have acute symptomatic seizures associated with severe COVID-19 disease.
T40 2239-2246 Sentence denotes Case #1
T41 2247-2591 Sentence denotes A 76-year-old male with history of chronic asthma on benralizumab, hypertension, chronic kidney disease, hyperlipidemia, left bundle branch block, diastolic dysfunction, and cervical fusion presented to the emergency department with the chief complaint of severe right lower extremity pain, fever (102.5 °F on presentation), and encephalopathy.
T42 2592-2701 Sentence denotes He was status post recent L3-S1 laminectomy for acute lumbosacral radiculopathy 5 days prior to presentation.
T43 2702-2772 Sentence denotes Laboratory workup showed neutrophilic leukocytosis (17,200 cells/mm3).
T44 2773-2927 Sentence denotes He had a Glasgow coma scale of 14, was oriented to name only, and exhibited exaggerated deep tendon reflexes but had no other focal neurological deficits.
T45 2928-2994 Sentence denotes A computerized tomography (CT) scan of the brain was unremarkable.
T46 2995-3084 Sentence denotes Magnetic resonance imaging (MRI) of the spine revealed an epidural abscess between L4-S1.
T47 3085-3200 Sentence denotes Surgical drainage was performed, and the patient was started empirically on vancomycin and piperacillin–tazobactam.
T48 3201-3244 Sentence denotes Wound cultures grew Pseudomonas aeruginosa.
T49 3245-3441 Sentence denotes Despite antibiotic therapy, and improved leukocytosis, he continued to have high-grade fevers and acute hypoxemic respiratory failure requiring intensive care unit transfer on postoperative day 1.
T50 3442-3640 Sentence denotes He was initially managed conservatively with diuresis, preload, and afterload optimization; however, his chest X-ray rapidly progressed to bilateral interstitial and airspace opacification (Fig. 1).
T51 3641-3727 Sentence denotes Fig. 1 Chest X-ray showing bilateral lung infiltrates (a) compared to his baseline (b)
T52 3728-3970 Sentence denotes On postoperative day two, the patient suffered several episodes of left upper extremity clonic activity and worsening encephalopathy with decline in level of consciousness as evidenced by increased drowsiness and inability to follow commands.
T53 3971-4128 Sentence denotes Continuous electroencephalography (EEG) confirmed three focal seizures lasting approximately 30 s each arising from the right centroparietal region (Fig. 2).
T54 4129-4220 Sentence denotes Levetiracetam was initiated and both clinical and electrographic seizure activity subsided.
T55 4221-4311 Sentence denotes Antibiotic regimen was broadened to Vancomycin, Meropenem, and Acyclovir for CSF coverage.
T56 4312-4560 Sentence denotes MRI of the brain and cervical spine with and without contrast was remarkable only for chronic white matter hyperintensities, without acute intracranial lesions, meningeal enhancement or venous sinus thrombosis, and C5–C6 myelomalacia, respectively.
T57 4561-4647 Sentence denotes Lumbar puncture was not performed due to the risk of seeding infection into neuroaxis.
T58 4648-4972 Sentence denotes Given persistent high-grade fevers, worsening respiratory status requiring intubation, and recent possible exposures, a respiratory viral panel was sent in addition to separate rapid testing for COVID-19 polymerase chain reaction on postoperative day 4 and COVID-19 testing was confirmed as positive twenty-four hours later.
T59 4973-5117 Sentence denotes His fibrinogen level was elevated at 631 mg/dL (normal range 200–400 mg/dL) and continued to increase to over 860 mg/dL over the following days.
T60 5118-5247 Sentence denotes C-reactive protein increased from 1.7 mg/dL on prior admission to 27.3 mg/dL and remained elevated despite antimicrobial therapy.
T61 5248-5350 Sentence denotes White blood cell count steadily improved over his hospitalization, and platelet count remained stable.
T62 5351-5512 Sentence denotes Our patient ultimately received a tracheostomy and after 30 days of ICU stay was discharged to a long-term acute care hospital for further ventilator management.
T63 5513-5543 Sentence denotes Fig. 2 Electroencephalography.
T64 5544-5692 Sentence denotes Rhythmic discharges noted in the right frontocentral/vertex region (red box) corresponding to clonic movements of the left arm (Color figure online)
T65 5694-5701 Sentence denotes Case #2
T66 5702-5986 Sentence denotes An 82-year-old male patient with chronic obstructive pulmonary disease, venous thromboembolic disease, complete heart block, and chronic kidney disease presented to the emergency department with a 10-day history of progressive dyspnea, altered mental status, and generalized weakness.
T67 5987-6040 Sentence denotes He was found to be hypoxic, febrile, and tachycardic.
T68 6041-6170 Sentence denotes He was intubated for acute hypoxemic respiratory failure with a chest X-ray showing lung infiltrates consistent with pneumonitis.
T69 6171-6602 Sentence denotes The patient’s laboratory results were significant for lymphopenia (WBC 3.26 k/μl, absolute lymphocyte count 0.70), coagulopathy (international normalised ratio (INR) 2.5, partial thromboplastin time (PTT) 53.9), elevated D-dimer (590 ng/mL), thrombocytopenia (132 k/μl), acute kidney injury (blood urea nitrogen (BUN) 47 mg/dL, creatinine 3.96 mg/dL), and elevated C-reactive protein initially 12.5 mg/L and increased to 26.2 mg/L.
T70 6603-6725 Sentence denotes A nasopharyngeal swab polymerase chain reaction (PCR) test for COVID-19 was sent on admission and was positive 24 h later.
T71 6726-6896 Sentence denotes Continuous video electroencephalogram (EEG) monitoring was ordered on day 5 of admission after events of right eyelid and facial twitching were observed by the care team.
T72 6897-7067 Sentence denotes Frequent EEG seizures were captured independently from the left more than right frontal–temporal regions (Fig. 3) which eventually progressed to focal status epilepticus.
T73 7068-7113 Sentence denotes The majority of seizures were non-convulsive.
T74 7114-7176 Sentence denotes Seizure frequency improved after treatment with levetiracetam.
T75 7177-7349 Sentence denotes A non-contrast CT-brain demonstrated hypodensities within the supratentorial white matter, consistent with mild microvascular disease but without acute intracranial lesion.
T76 7350-7436 Sentence denotes He was unable to have an MRI brain performed due to an incompatible cardiac pacemaker.
T77 7437-7534 Sentence denotes Further vessel imaging was unable to be performed due to patients acute on chronic kidney injury.
T78 7535-7630 Sentence denotes A lumbar puncture was unable to be performed due to worsening coagulopathy (INR 3.8, PTT 73.5).
T79 7631-7757 Sentence denotes Patient remained on the ventilator, and after 20 days of ICU stay, the family opted for withdrawal of life-sustaining support.
T80 7758-7788 Sentence denotes Fig. 3 Electroencephalography.
T81 7789-7947 Sentence denotes Rhythmic discharges evolving in the left frontotemporal (a) region and spreading anteriorly and posteriorly (b) corresponding to right facial clonic movements
T82 7949-7959 Sentence denotes Discussion
T83 7960-8143 Sentence denotes The SARS-Coronavirus-2 belongs to the β-coronavirus group which includes several human pathogenic viruses including middle east respiratory syndrome (MERS) coronavirus and SARS-CoV-1.
T84 8144-8214 Sentence denotes These group of coronaviruses are associated with respiratory symptoms.
T85 8215-8388 Sentence denotes Additional neurological symptoms including delirium, dizziness, and headaches have also been reported with other coronavirus infections prior to the SARS-CoV-2 outbreak [4].
T86 8389-8620 Sentence denotes The case series of patients from Wuhan, China, with COVID-19 disease, included both central and peripheral neurological manifestations (i.e., headache, dizziness, impaired consciousness, cerebrovascular disease, and neuralgia) [2].
T87 8621-8698 Sentence denotes Seizures were not reported as a direct manifestation of SARS-CoV-2 infection.
T88 8699-8839 Sentence denotes The patients described in our series developed focal seizures and, in the second case, even progressed to non-convulsive status epilepticus.
T89 8840-8896 Sentence denotes Seizures may be a CNS manifestation of COVID-19 disease.
T90 8897-9007 Sentence denotes Further investigations are needed to elucidate the mechanism of neurological symptoms in SARS-CoV-2 infection.
T91 9008-9260 Sentence denotes Human coronaviruses (HCoV) have been established to infect human astrocytes and microglia in neural cell cultures as well as detection of viral RNA in a study of human brain autopsy samples supporting their neurotropic and neuroinvasive properties [5].
T92 9261-9401 Sentence denotes A case report of SARS-CoV-1 infection with CNS symptoms during the SARS epidemic also isolated the virus within a brain tissue specimen [6].
T93 9402-9781 Sentence denotes Although direct evidence of a neurotropic effect of SARS-Cov-2 has not been reported as yet through either cerebrospinal fluid (CSF) or autopsy studies, the presence of neurological symptoms in patients with COVID-19 disease during this current pandemic, and the similarity between the two strains of human coronaviruses (CoV-1 and CoV-2), makes this mechanism highly suggestive.
T94 9782-10009 Sentence denotes Acute symptomatic seizures may be the result of a possible neurotropic effect of the virus or can be a marker of severity of systemic disease itself since CNS symptoms were found mainly in patients with severe COVID-19 disease.
T95 10010-10163 Sentence denotes After penetration of the blood–brain barrier, the virus can slow the cerebral microcirculation, possibly through the creation of a hypercoagulable state.
T96 10164-10277 Sentence denotes This allows increased interaction of SARS-CoV-2 with the endothelial receptors and receptors on glial tissue [7].
T97 10278-10388 Sentence denotes The interaction at the glia may predispose patients to seizures as seen in other neurological diseases [8, 9].
T98 10389-10627 Sentence denotes Previous studies of SARS-coronaviruses have described the proliferation of pro-inflammatory cytokines that are active in promoting blood–barrier breakdown, namely interleukin-8 (IL8) and monocyte chemoattractant protein-1 (MCP1) [10, 11].
T99 10628-10840 Sentence denotes A description of coronavirus infections in a Japanese encephalitis mouse model demonstrated CNS viral infection induced astrocyte and microglia proliferation, leading to increased release of IL-8 in the CSF [10].
T100 10841-10959 Sentence denotes MCP1 is another pro-inflammatory mediator that is expressed in CNS cells including astrocytes, neurons, and microglia.
T101 10960-11155 Sentence denotes MCP1 may be up-regulated in conditions which target and degrade the blood–brain barrier and can recruit additional inflammatory cells as the monocytes migrate across the blood–brain barrier [11].
T102 11156-11329 Sentence denotes We hypothesize that as a result of the accumulation of inflammatory markers, there may be local cortical irritation that precipitates seizures related to COVID-19 infection.
T103 11330-11619 Sentence denotes Although cerebrospinal fluid may contain markers of inflammation, the treatment of this infection is largely supportive, and with the additional risk of coagulopathy precipitated by SARS-CoV-2, a lumbar puncture may not be justifiable unless there is an alternative diagnosis to be sought.
T104 11620-11858 Sentence denotes A limitation of our case series is that cerebrospinal fluid was unable to be obtained due to patient factors that made a lumbar puncture relatively contraindicated and that a CSF-PCR test for SARS-CoV-2 was not yet commercially available.
T105 11859-11971 Sentence denotes As this disease continues to spread, we will continue to learn about its direct and/or indirect epileptogenesis.
T106 11973-11984 Sentence denotes Conclusions
T107 11985-12364 Sentence denotes Although there are concerns regarding decreasing transmission risk by limiting healthcare interventions in COVID-19 disease, patients with severe infection who demonstrate either clinical signs of seizures or severe encephalopathy may benefit from continuous electroencephalography monitoring to diagnose and treat symptomatic seizures and also non-convulsive status epilepticus.
T108 12365-12608 Sentence denotes The mechanism of seizures precipitated by SARS-CoV-2 infection appears to be multifactorial and may involve a possible neurotropism of SARS-CoV-2 in addition to blood–brain barrier breakdown precipitated by pro-inflammatory cytokine reactions.