coved 19 MRI
2952636
Absence of Pathognomonic or Inflammatory Patterns in Cardiac Biopsies From Patients With Brugada Syndrome
Background Brugada syndrome (BrS) is characterized by the presence of coved ST segment elevations in the right precordial leads (so called type I ECG) and additional clinical features. Caused by cardiac ion channel gene mutations, BrS may be associated with ventricular and atrial conduction disturbances as well as ventricular fibrillation. Recent studies have discussed whether BrS is merely a primary electric disorder or whether inflammatory or other histopathologic abnormalities in the right ventricle (RV) underlie the ECG phenotype. Methods and Results We retrospectively analyzed BrS biopsy samples from 21 unrelated patients for histopathologic abnormalities (hypertrophy, fibrosis, inflammation, fatty tissue) together with the patients' clinical, genetic, and imaging data. Eleven patients (52% had normal RV imaging (by angiography, echocardiography, or cardiac MRI) Results of myocardial biopsies were normal in 3 patients (14% and revealed mostly moderate abnormalities in the others. Four patients (19% had predominant fatty tissue in the RV myocardium. Using immunohistochemistry and conventional tissue staining, we could not detect inflammatory tissue changes, an observation compatible with the clinical absence of signs for myocarditis. Conclusions Imaging and histopathologic evaluation may detect moderate but uncharacteristic cardiac abnormalities in patients with BrS. None of the patients had arrhythmogenic RV cardiomyopathy or overt myocarditis. Only in a small subset did predominant histopathologic abnormalities in the biopsy samples of the RV outflow tract occur that could provide a link to the ECG phenotype. A variety of mechanisms, including genetic and structural RV alterations, may underlie the Brugada ECG phenotype.
Circulation. Arrhythmia and electrophysiology
Sven Zumhagen Tilmann Spieker Julia Rolinck Hideo Andreas Baba Gunter Breithardt Werner Bocker Lars Eckardt Matthias Paul Thomas Wichter Eric Schulze-Bahr
214751464
COVID 19 associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features
Since its introduction to the human population in December 2019, the coronavirus disease 2019 (COVID 19) pandemic has spread across the world with over 330,000 reported cases in 190 countries (1) While patients typically present with fever, shortness of breath, and cough, neurologic manifestations have been reported, although to a much lesser extent (2) We report the first presumptive case of COVID 19 associated acute necrotizing hemorrhagic encephalopathy, a rare encephalopathy that has been associated with other viral infections but has yet to be demonstrated as a result of COVID 19 infection.
Radiology
Neo Poyiadji Gassan Shahin Daniel Noujaim Michael Stone Suresh Patel Brent Griffith
219725739
Brain MRI Findings in Severe COVID 19: A Retrospective Observational Study
Background Brain MRI parenchymal signal abnormalities have been in association with SARS CoV 2. Purpose Describe the neuroimaging findings (excluding ischemic infarcts) in patients with severe COVID 19 infection. Methods This was a retrospective study of patients evaluated from March 23th, 2020 to April 27th, 2020 at 16 hospitals. Inclusion criteria were: (i) positive nasopharyngeal or lower respiratory tract reverse transcriptase polymerase chain reaction assays; (ii) severe COVID infection defined as requirement for hospitalization and oxygen therapy; (iii) neurologic manifestations; (iv) abnormal brain MRI. Exclusion criteria were patients with missing or non contributory data regarding brain MRI or a brain MRI showing ischemic infarcts, cerebral venous thrombosis, or chronic lesions unrelated to the current event. Categorical data were compared using Fisher exact test. Quantitative data were compared using Student's t test or Wilcoxon test. A p value lower than 0.05 was considered significant. Results Thirty men (81% and 7 women (19% met inclusion criteria, with a mean age of 61+ 12 years (range: 8 78) The most common neurologic manifestations were alteration of consciousness (27/37, 73% pathological wakefulness when the sedation was stopped (15/37, 41% confusion (12/37, 32% and agitation (7/37, 19% The most frequent MRI findings were: signal abnormalities located in the medial temporal lobe in 16/37 (43% 95% CI 27 59% patients, non confluent multifocal white matter hyperintense lesions on FLAIR and diffusion sequences, with variable enhancement, with associated hemorrhagic lesions in 11/37 patients (30% 95% CI 15 45% and extensive and isolated white matter microhemorrhages in 9/37 patients (24% 95% CI 10 38% A majority of patients (20/37, 54% had intracerebral hemorrhagic lesions with a more severe clinical presentation: higher admission rate in intensive care units, 20/20 patients, 100% versus 12/17 patients, 71% p=0.01; development of the acute respiratory distress syndrome in 20/20 patients, 100% versus 11/17 patients, 65% p=0.005. Only one patient was positive for SARS CoV 2 RNA in the cerebrospinal fluid. Conclusion Patients with severe COVID 19 and without ischemic infarcts had a wide range of neurologic manifestations that were be associated with abnormal brain MRIs. Eight distinctive neuroradiological patterns were described.
Radiology
Stephane Kremer Francois Lersy Jerome de Seze J C Ferre Adel Maamar Beatrice Carsin-Nicol Olivier Collange Fabrice Bonneville Gilles Adam Guillaume Martin-Blondel Marie Rafiq Thomas Geeraerts Louis Delamarre Sylvie Grand Alexandre Krainik Sophie Caillard Jean Marc Constans Serge Metanbou A Heintz Julie Helms Maleka Schenck Nicolas Lefebvre Claire Boutet Xavier Fabre Geraud Forestier Isaure de Beaurepaire Gregoire Bornet Audrey Lacalm Helene Oesterle Federico Bolognini Julien Messie Ghazi Hmeydia Joseph Benzakoun Catherine Oppenheim Blanche Bapst Imen Megdiche Marie-Cecile Henri-Feugeas Antoine Khalil Augustin Gaudemer Lavinia Jager Patrick Nesser Yannick Talla Mba Celine Hemmert Philippe Feuerstein Nathan Sebag Sophie Carre Manel Alleg Claire Lecocq Emmanuelle Schmitt Rene Anxionnat Francois Zhu Pierre-Olivier Comby Frederic Ricolfi Pierre Thouant Hubert Desal Gregoire Boulouis Jerome Berge Apolline Kazemi Nadya Pyatigorskaya Augustin Lecler Suzana Saleme Myriam Edjlali-Goujon Basile Kerleroux Pierre-Emmanuel Zorn Muriel Mathieu Seyyid Baloglu Francois-Daniel Ardellier Thibault Willaume Jean-Christophe Brisset Clotilde Boulay Veronique Mutschler Yves Hansmann Paul Michel Mertes Francis Schneider Samira Fafi-Kremer Mickael Ohana Ferhat Meziani J-S David Nicolas Meyer Mathieu Anheim Pr Francois Cotton
218532964
Epidemiology and clinical features of emergency department patients with suspected COVID 19: Initial results from the COVID 19 Emergency Department Quality Improvement Project (COVED 1)
The COVID 19 Emergency Department (COVED) Quality Improvement Project aims to provide regular and real time clinical information to ED clinicians caring for patients with suspected and confirmed COVID 19. The present study summarises data from the first 2 weeks of the study.
Emergency medicine Australasia EMA
Gerard M O'Reilly Rob D Mitchell P Rajiv J Wu H Brennecke Lisa Brichko Michael Noonan R Hiller Biswadev Mitra Carl Luckhoff Andrew Paton De Villiers Smit M J Santamaria P A Cameron
218538799
Early postmortem brain MRI findings in COVID 19 non survivors
Importance: The severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is considered to have potential neuro invasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID 19) Brain magnetic resonance imaging (MRI) data in COVID 19 patients are scarce due to difficulties to obtain such examination in infected unstable patients during the COVID 19 outbreak. Objective: To investigate the occurrence of structural brain abnormalities in non survivors of COVID 19 in a virtopsy framework. Design: Prospective, case series study with postmortem brain MRI obtained early <24h) after death. Setting: Monocentric study. Participants: From 31/03/2020 to 24/04/2020, consecutive decedents who fulfilled the following inclusion criteria were included: death <24 hours, SARS CoV 2 detection on nasopharyngeal swab specimen, chest computerized tomographic (CT) scan suggestive of COVID 19, absence of known focal brain lesion, and MRI compatibility. Main Outcome(s) and Measure(s) Signs of acute brain injury and MRI signal abnormalities along the olfactory tract and brainstem were searched independently by 3 neuroradiologists, then reviewed with neurologists and clinicians. Results: Among the 62 patients who died from COVID 19 during the inclusion period, 19 decedents fulfilled inclusion criteria. Subcortical micro and macro bleeds (2 decedents) cortico subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES, one decedent) and nonspecific deep white matter changes (one decedent) were observed. Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality. Conclusions and Relevance: Postmortem brain MRI demonstrates hemorrhagic and PRES related brain lesions in non survivors of COVID 19 that might be triggered by the virus induced endothelial disturbances. SARS CoV 2 related olfactory impairment seems to be limited to olfactory bulbs. The absence of brainstem MRI abnormalities does not support a brain related contribution to respiratory distress in COVID 19.
medRxiv
Tim Coolen Valentina Lolli Niloufar Sadeghi Antonin Rovai Nicola Trotta Fabio Silvio Taccone Jacques Creteur Sophie Henrard Jean-Christophe Goffard Olivier Dewitte Gilles Naeije Serge Goldman Xavier De Tiege
219549512
Cardiac MRI of Children with Multisystem Inflammatory Syndrome (MIS C) Associated with COVID 19: Case Series
This case series examines cardiac MRI findings in four children and adolescents admitted to intensive care in April 2020 for multisystem inflammatory syndrome and Kawasaki disease like features related to COVID 19. Acute myocarditis occurred less than 1 week after onset of fever and gastrointestinal symptoms. Physical examination showed rash and cheilitis/conjunctivitis. All patients recovered after intravenous immunoglobulin therapy. SARS CoV 2 RT PCR was negative on nasopharyngeal, stool, and respiratory samples and was positive on serology. Cardiac MRI showed diffuse myocardial edema on T2 STIR sequences and native T1 mapping, with no evidence of late gadolinium enhancement suggestive of replacement fibrosis or focal necrosis. These findings favor post infectious myocarditis in children and adolescents with COVID 19.
Radiology
Eleonore Blondiaux Pauline Parisot Alban Redheuil Lucile Tzaroukian Yael Levy Chiara Sileo Aurelie Schnuriger Mathie Lorrot Romain Guedj Hubert Ducou le Pointe
218562332
Brain MRI Findings in Patients in the Intensive Care Unit with COVID 19 Infection
Online supplemental material is available for this article.
Radiology
Sedat Giray Kandemirli Lerzan Dogan Zeynep T Sarikaya Simay Kara Canan Akinci Dilaver Kaya Yildiz Kaya Duzgun Yildirim Filiz Tuzuner Mustafa S Yildirim Enes Ozluk Bulent Gucyetmez Ercan Karaarslan Isil Koyluoglu Hande S Demirel Kaya Orkhan Mammadov Ilkay Kisa Ozdemir Nazire Afsar Beyza Citci Yalcinkaya Sevdinaz Rasimoglu Duygu E Guduk Ararso Kedir Jima Aylin Ilksoz Vildan Ersoz Meltem Yonca Eren Nilufer Celtik Serdar Arslan Bora Korkmazer Saban S Dincer Elif Gulek Ibrahim Dikmen Murathan Yazici Serkan Unsal Taner Ljama Ismail Demirel Aykut Ayyildiz Isil Kesimci Sahika Bolsoy Deveci Melih Tutuncu Osman Kizilkilic Lutfi Telci Rehile Zengin Alp Dincer Ibrahim O Akinci Naci Kocer
219328217
Acute myelitis as a neurological complication of Covid 19: A case report and MRI findings
Abstract During the recent outbreak of COVID 19 caused by SARS CoV 2 coronavirus, there is rising concerns about neurological complications of COVID 19. Fever, headache and anosmia may occur early during the disease course. Other neurological sequalae such as encephalitis may occur in later phases. We report a case of acute myelitis in a 32 year old male Covid 19 positive patient who presented with a two day history of flu like symptoms then sudden onset paraplegia and urinary retention. The incidence is not known and the pathogenesis of the disease behind this manifestation is still not fully understood. Nevertheless considering the broad differential diagnosis of acute myelitis, prompt clinical and diagnostic work up was crucial to exclude other causes. Patients presenting with neurological symptoms such as loss of consciousness, ataxia, convulsions, status epilepticus, encephalitis, myelitis or neuritis should raise concerns for Covid 19 infection during this pandemic prompting early diagnosis and initiation of proper management.
Radiology Case Reports
Reem AlKetbi Dana AlNuaimi Muna Almulla N Altalai Mohammed Samir Navin Kumar Usama M Albastaki
219725304
Early postmortem brain MRI findings in COVID 19 non survivors
Objectives The severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) is considered to have potential neuroinvasiveness that might lead to acute brain disorders or contribute to respiratory distress in patients with coronavirus disease 2019 (COVID 19) This study investigates the occurrence of structural brain abnormalities in non survivors of COVID 19 in a virtopsy framework. Methods In this prospective, monocentric, case series study, consecutive patients who fulfilled the following inclusion criteria benefited from an early postmortem structural brain MRI: death <24 hours, SARS CoV 2 detection on nasopharyngeal swab specimen, chest CT scan suggestive of COVID 19, absence of known focal brain lesion, and MRI compatibility. Results Among the 62 patients who died of COVID 19 from March 31, 2020, to April 24, 2020, at our institution, 19 decedents fulfilled the inclusion criteria. Parenchymal brain abnormalities were observed in 4 decedents: subcortical microbleeds and macrobleeds (2 decedents) cortico subcortical edematous changes evocative of posterior reversible encephalopathy syndrome (PRES; 1 decedent) and nonspecific deep white matter changes (1 decedent) Asymmetric olfactory bulbs were found in 4 other decedents without downstream olfactory tract abnormalities. No brainstem MRI signal abnormality was observed. Conclusions Postmortem brain MRI demonstrates hemorrhagic and PRES related brain lesions in non survivors of COVID 19. SARS CoV 2 related olfactory impairment seems to be limited to olfactory bulbs. Brainstem MRI findings do not support a brain related contribution to respiratory distress in COVID 19.
Neurology
Tim Coolen Valentina Lolli Niloufar Sadeghi Antonin Rovai Nicola Trotta Fabio Silvio Taccone Jacques Creteur Sophie Henrard Jean-Christophe Goffard Olivier Dewitte Gilles Naeije Serge Goldman Xavier De Tiege
67770769
Monitoring of intracerebellarly administered natural killer cells with fluorine 19 MRI
PurposeMedulloblastoma (MB) is the most common malignant brain tumor in children. Recent studies have shown the ability of natural killer (NK) cells to lyse MB cell lines in vitro, but in vivo successes remain elusive and the efficacy and fate of NK cells in vivo remain unknown.MethodsTo address these questions, we injected MB cells into the cerebellum of immunodeficient mice and examined tumor growth at various days after tumor establishment via bioluminescence imaging. NK cells were labeled with a fluorine 19 (19F) MRI probe and subsequently injected either intratumorally or contralaterally to the tumor in the cerebellum and effect on tumor growth was monitored.ResultsThe 19F probe efficiently labeled the NK cells and exhibited little cytotoxicity. Fluorine 19 MRI confirmed the successful and accurate delivery of the labeled NK cells to the cerebellum of the mice. Administration of 19F labeled NK cells suppressed MB growth, with the same efficacy as unlabeled cells. Immunohistochemistry confirmed the presence of NK cells within the tumor, which was associated with induction of apoptosis in tumor cells. NK cell migration to the tumor from a distal location as well as activation of apoptosis was also demonstrated by immunohstochemistry.ConclusionsOur results show that NK cells present a novel opportunity for new strategies in MB treatment. Further, 19F labeled NK cells can suppress MB growth while enabling 19F MRI to provide imaging feedback that can facilitate study and optimization of therapeutic paradigms.
Journal of Neuro Oncology
Bridget A Kennis Keith A Michel William Benjamin Brugmann Alvaro Macedo Laureano Rong-Hua Tao Srinivas S Somanchi Samuel A Einstein Javiera Bravo-Alegria Shinji Maegawa Andrew Wahba Simin Kiany Nancy Beatriz Gordon Lucia Silla Dawid Schellingerhout Soumen Khatua Wafik Tharwat Zaky David I Sandberg Laurence James Neil Cooper Dean Anthony Lee James A Bankson Vidya Gopalakrishnan