LitCovid-sentences  

PMC:7546130 / 6606-11824 JSONTXT 11 Projects

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Id Subject Object Predicate Lexical cue
T62 0-10 Sentence denotes Discussion
T63 11-285 Sentence denotes We present a patient with pulmonary COVID-19 infection who developed neurological symptoms characterized by severely impaired consciousness, with multiple DWI areas of restricted diffusion and scattered SWI hypointensities at brain MRI and CSF positivity for SARS-CoV-2 RNA.
T64 286-442 Sentence denotes Neurological complications following COVID-19 infection are not uncommon [2], and various putative mechanisms for brain involvement have been suggested [3].
T65 443-614 Sentence denotes Our patient presented MRI signs of brain vascular injury, characterized by the coexistence of acute ischemic areas and scattered microbleeds or alternatively microthrombi.
T66 615-916 Sentence denotes The underlying mechanisms, which include direct and indirect penetration of the virus to the central nervous system and systemic cardiorespiratory complications [4], are yet to be elucidated, and a direct correlation with SARS-CoV-2 infection remains uncertain, but we tried to make some observations.
T67 917-1123 Sentence denotes First, the multiple supratentorial ischemic lesions seen on DWI, with corpus callosum involvement, do not depict a territorial distribution, inconsistent with COVID-19-associated large vessel occlusion [5].
T68 1124-1203 Sentence denotes Instead, they might reflect diffuse local thrombosis or, less likely, embolism.
T69 1204-1476 Sentence denotes In this setting, high D-dimer values may reflect thrombus formation, but they can also act as acute-phase enhancer of the inflammatory cascade and stimulates monocyte synthesis and release of proinflammatory cytokines, which can contribute to the occurrence of stroke [6].
T70 1477-1580 Sentence denotes We cannot ascertain a specific correlation of the DWI findings with SARS-CoV2 infection in our patient.
T71 1581-1758 Sentence denotes Nevertheless, similar MRI findings of bilateral supratentorial and corpus callosum DWI lesions have been described in COVID-19 patients with similar clinical manifestations [2].
T72 1759-1836 Sentence denotes The SWI hypointense foci in our patient are also of difficult interpretation.
T73 1837-2107 Sentence denotes In fact, SWI hypointensities in the corpus callosum and in the cortical/iuxtacortical regions of COVID-19 patients with neurological impairment have been reported [7], but their pathological correlate is not univocal, as they could represent microbleeds or microthrombi.
T74 2108-2221 Sentence denotes In one pathology study, microhemorrages were detected on brain tissue at the location of SWI hypointensities [8].
T75 2222-2420 Sentence denotes Though a coagulopathic disorder has been reported in COVID-19 patients, diffuse, mostly peripherally distributed brain microbleeds can also be the expression of critical illness in ICU patients [9].
T76 2421-2648 Sentence denotes Acute necrotizing encephalopathy (ANE) [2], with similar bithalamic SWI hypointensities, has been reported in COVID-19 patients, but the MRI picture we describe is different, because no signs of edema and necrosis were evident.
T77 2649-2875 Sentence denotes Our patient did not develop any EEG abnormalities typically related to meningoencephalitis, hypoxic encephalopathy, or renal failure, such as epileptiform focal abnormalities and lateralized or generalized periodic discharges.
T78 2876-3009 Sentence denotes Accordingly, post-contrast MRI showed a lack of parenchymal and meningeal enhancement, and no MRI signs of encephalitis were present.
T79 3010-3088 Sentence denotes The meaning of SARS-CoV-2 RNA positivity in the CSF of our patient is unclear.
T80 3089-3187 Sentence denotes A direct effect of the virus, with normal proteins and no pleocytosis in the CSF, is questionable.
T81 3188-3532 Sentence denotes Viral neurotropism has been largely theorized, and virus particles have been observed to cross the capillary endothelium of the brain blood barrier (BBB) [10], but direct implication of SARS-CoV-2 in neurological manifestations is controversial, and viral RNA in the CSF of patients with neurological complications is only rarely detected [11].
T82 3533-3720 Sentence denotes In a recent study including 31 patients with neurological manifestations, none had CSF viral positivity, but many had signs of disturbance of the blood brain barrier (BBB) integrity [12].
T83 3721-3891 Sentence denotes Our patient showed signs of mild damage of the BBB as well, which might also be a possible consequence of systemic inflammation, in a patient with multiple organ failure.
T84 3892-4049 Sentence denotes Therefore, an indirect mechanism of neurovascular unit breakdown, resulting in a passage of the virus in the CSF through the damaged BBB, cannot be excluded.
T85 4050-4109 Sentence denotes Contamination or artifact could also be a possibility [11].
T86 4110-4358 Sentence denotes In COVID-19 pneumonia, the extensive microvascular damage seems to be related to a macrophage activation syndrome (MAS)-like mechanism [13], which induces a coagulopathic cascade with subsequent local microthrombosis and microbleeding in the lungs.
T87 4359-4474 Sentence denotes A similar mechanism could be responsible for central nervous system manifestations, but supporting data are scarce.
T88 4475-4639 Sentence denotes We consider this case an example of neurological manifestations possibly related to COVID-19, characterized by vascular damage predominantly involving microvessels.
T89 4640-4827 Sentence denotes The absence of pathological confirmation represents a major limitation, but similar MRI patterns [2] and recent pathological correlations seem to support a microangiopathic substrate [8].
T90 4828-5070 Sentence denotes Different mechanisms including a systemic procoagulative status and systemic and local inflammatory processes involving the endothelium, most likely via the ACE2 receptor, and eventual immune-mediated vascular injury could be considered [11].
T91 5071-5218 Sentence denotes Clinicians should be aware of the possible severe neurological complications in COVID-19 patients and of the role of MRI in their characterization.