Query: coved 19 brain

title: The three frontlines against COVID 19: Brain, Behavior, and Immunity
abstract: The pandemic outbreak of coronavirus disease 2019 (COVID 19) is raising global anxiety and fear of both real and perceived health threat from the virus. Overwhelming evidence shows infected patients experiencing neuropsychiatric complications, suggesting that the "psychoneuroimmunity" model might be beneficial in understanding the impact of the virus. Therefore, this Special Issue on "Immunopsychiatry of COVID 19 Pandemic" was launched immediately after the pandemic was declared, with the first paper accepted on the March 25th, 2020. A total of ninety three papers were accepted, the last one was on the July 10th, 2020 when the initial acute phase started declining. The papers of this Special Issue have illuminated the social impact, psychopathology, neurological manifestation, immunity responses, and potential treatments and prevention on COVID 19. For example, anxiety disorders, mood disorders, and suicidal ideation are most common psychiatric manifestations. COVID 19 infection can have central and/or peripheral nervous system symptoms, including headache, sleep disorders, encephalopathy, and loss of taste and smell. A "three steps" Neuro COVID infection model (neuro invasion, clearance and immune response) was established. The current therapeutic interventions for COVID 19 include supportive intervention, immunomodulatory agents, antiviral therapy, and plasma transfusion. Psychological support should be implemented, improving the psychological wellbeing, as well as to enhance psychoneuroimmunity against COVID 19.

title: Letter to editor: Severe brain haemorrhage and concomitant COVID 19 Infection: A neurovascular complication of COVID 19
abstract: Beyond pulmonary infection, SARS CoV can cause dysfunction of multiple other organs and systems. Cardiovascular complications after COVID 19 have now been reported very often but the knowledge on neurovascular complications especially brain haemorrhage is scars. Here, we report the first case of COVID 19 positive patient presenting with a concomitant subarachnoid haemorrhage from an intracranial aneurysm. A 60 year old woman was admitted to our emergency department due to loss of consciousness. The patient was intubated due to reduced Glasgow Coma Scale (GCS) and respiratory insufficiency. A computer tomography (CT) with CT angiography revealed left frontal haemorrhage with ventricle bleeding  from a ruptured pericallosal artery aneurysm around 5 mm in size (Fig. 1C, F) Oropharyngeal swab with PCR based testing was COVID 19 positive. A chest CT confirmed pneumonia predominantly of left lung  On admission laboratory diagnostic showed elevated troponin 45 ng/ ml (normal 14 ng/ ml) and creatine kinase 4920 U/l (normal 145 U/l) Elevated CRP 1.1 mg /dl and leukocytes 14.2X1000 ml. Slightly elevated lactate dehydrogenase 360 U/l (normal 247 U/l) and elevated liver enzyme GOT 103 U/I (normal 31 U/l) The aneurysm was clipped microsurgically immediately after admission. After clipping of the aneurysm, due to positive COVID 19 PCR, the patient was transferred to a COVID 19 specialized ward for the treatment of infection and for the further intensive medical care. Cerebrospinal fluid (CSF) diagnostic revealed no viral genome in the CSF. Initially elevated troponin was normalized in the further course and no cardiac complication occurred. CT perfusion studies on day 3, 6, 9 and 12 showed no signs of cerebral vasospasm. Until last imaging on day 12 post ictus no delayed cerebral ischemia was detected. Patient still needs the treatment of pneumonia. Due to poor grade subarachnoid haemorrhage (WFNS grad 4) the patient is completely cured from COVID 19 and now transferred for rehabilitation. Involvement of other organs especially the brain and the cardiovascular system increase additional morbidity and mortality in COVID19 infected patients. The elderly patients with chronic medical conditions are particularly at risk to develop neurological complications including olfactory and gustatory disturbances (Vavougios, 2020) and in some cases an encephalitis (Ye et al. 2020) showing the possible accessibility of the virus to the brain and involvement of central nervous system (Duong et al. 2020) Moreover, COVID 19 infection can pose emotional and psychological stress in affected patients (Chew et al. 2020) This is the first case of COVID19 infection and concomitant aneurysmal subarachnoid haemorrhage from a ruptured pericallosal artery aneurysm. Whether COVID 19 infection led to aneurysm formation or rupture of an already existing aneurysm is still unexplored. There are however, multiple mechanisms, how an intracranial aneurysm can possibly lead to vascular wall instability during systemic inflammation due to viral infection. Viral infections including influenza A and COVID19 are known to induce cytokine storm (hypercytokinemia) leading to elevated systemic inflammation with high levels of IL 6, IL 1b and TNFa (Muhammad et al. 2011; Qin et al. 2020) Systemic inflammation is known to cause vascular injury including breakdown of collagen and permeability of blood brain barrier. Influenza A virus infection for example disturbs BBB through involvement of systemic elevated MMP 9 that breaks collagen present in the basal membrane of every arterial wall and a high collagen turnover in the systemic circulation is a sign of instability of existing intracranial aneurysm (Hackenberg et al. 2020) in patients with unruptured intracranial aneurysms. Moreover, COVID19 infection has been reported to increase systemic inflammation through dysbalance of T helper cells with exaggerated Th1 response (Huang et al. 2020) Similar kind of alterations in T helper cells populations have been found in patients with intracranial aneurysms (Zhang et al. 2016) Moreover, a disturbed balance of macrophages and other inflammatory markers has been found in the wall of ruptured intracranial aneurysms (Hasan et al. 2012) showing that inflammation is an important component of instable aneurysms. In our patient, we found elevated systemic leukoctyes as a sign of systemic inflammation that is probably due to both infection and SAH. We however could not analyse subpopulations of different leukocytes in systemic circulation that might be altered. Another possibility could be a direct invasion of virus in the brain as previously reported (Duong et al. 2020) However, we did not find virus genome in the cerebrospinal fluid and consequently it is highly unlikely that virus had any direct influence. Taken together, aneurysm instability partially due to systemic inflammation after virus infection might be one possible reason leading to SAH. This is however a single case report with concomitant SAH and COVID 19. Therefore, further epidemiological/clinical studies are needed to confirm the relationship and animal experiments in controlled conditions are required to find out exact mechanism.

title: The impact of COVID 19 on mental health: The interactive roles of brain biotypes and human connection
abstract: COVID 19 along with the mitigation strategies being used to address the virus pose significant threats to our individual and collective mental health. As the crisis evolves and persists, it will be increasingly important for the research community to conduct investigations that address the mental health consequences of COVID 19. The causes of mental health effects in the context of COVID 19 are multifactorial and likely include biological, behavioral, and environmental determinants. We argue that the COVID 19 crisis significantly threatens our basic human need for human connection, which might serve as a crucial environmental factor that could underlie the overall insult to our mental health. Furthermore, "brain styles," which we have previously conceptualized as "biotypes" that are informed by a neural taxonomy, might interact with the universal threat to our need for human connection to explain the mental health consequences of COVID 19 from a precision psychiatry perspective. The goal of this commentary is to inspire research on the mental health consequences of COVID 19 from an individualized, brain based perspective that honors the profound threat that the virus poses to our basic human motivations.

title: Brain abnormalities in COVID 19 acute/subacute phase: A rapid systematic review
abstract: This systematic review aimed to synthesize early data on typology and topography of brain abnormalities in adults with COVID 19 in acute/subacute phase.  We performed systematic literature search via PubMed, Google Scholar and ScienceDirect on articles published between January 1 and July 05, 2020, using the following strategy and key words: ( OR (sars cov 2[Title/Abstract] OR (coronavirus[Title/Abstract] AND ( A total of 286 non duplicate matches were screened for original contributions reporting brain imaging data related to SARS Cov 2 presentation in adults.  The selection criteria were met by 26 articles (including 21 case reports, and 5 cohort studies) The data analysis in a total of 361 patients revealed that brain abnormalities were noted in 124/361 (34% reviewed cases. Neurologic symptoms were the primary reason for referral for neuroimaging across the studies. Modalities included CT angiogram, perfusion, venogram) EEG, MRI angiogram, functional) and PET. The most frequently reported brain abnormalities were brain white matter (WM) hyperintensities on MRI 66/124 (53% affected cases) and hypodensities on CT (additional 23% affected cases) followed by microhemorrhages, hemorrhages and infarcts, while other types were found in <5% affected cases. WM abnormalities were most frequently noted in bilateral anterior and posterior cerebral WM (50% affected cases) Conclusion About a third of acute/subacute COVID 19 patients referred for neuroimaging show brain abnormalities suggestive of COVID 19 related etiology. The predominant neuroimaging features were diffuse cerebral WM hypodensities hyperintensities attributable to leukoencephalopathy, leukoaraiosis or rarefield WM.

title: Brain ischemic injury in COVID 19 infected patients: a series of 10 post mortem cases
abstract: The coronavirus disease 2019 (COVID 19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) COVID 19 symptoms are not limited to the respiratory tract, but complications have been described involving other organs including brain. At present, data on SARS CoV 2 neuropathological features are limited [4, 5, 8, 10] and most frequently focused on cases presenting neurological symptoms.

title: Deep brain stimulation telemedicine for psychiatric patients during the COVID 19 pandemic
abstract: We read with great interest the recent paper by Caulfield and George  in which they discuss how at home neurotherapeutics, including self administered repetitive transcranial magnetic stimulation and transcranial direct current stimulation, could assist to manage some of the potential mental health problems, particularly depression, caused by self isolation during the COVID 19 pandemic. We concur with their view, but the authors did not discuss another neurotherapeutic technique that could be translated into a home setting, namely deep brain stimulation (DBS) Here, we briefly describe our experiences with the application of DBS telemedicine to maintain the delivery of DBS treatment and care to psychiatric patients who needed to remain at home during the COVID 19 outbreak and lockdown of the city of Wuhan (from 23rd January to 8th April 2020) DBS is an implantable neurosurgical treatment that has been approved for the management of intractable obsessivecompulsive disorder (OCD) in many countries since 2009  Over the past three decades, the clinical utility of DBS has also been explored for other treatment resistant psychiatric disorders, including major depressive disorder (MDD)  Tourette's syndrome [4] anorexia nervosa  and substance use disorders [6] Usually, carefully selected patients receive DBS surgery at a specialized center and are advised to attend regular face to face clinical follow ups and personalized DBS parameter (e.g. stimulation frequency, pulse width or voltage) adjustments at a DBS outpatient clinic to achieve the optimal DBS therapeutic effects. In China, new DBS systems incorporating information communication technology have been developed and utilized to deliver DBS treatment and care to patients with movement disorders at home [7] The use of DBS telemedicine enables clinicians not only to remotely make therapeutic DBS parameter adjustments and battery checks, but also to offer medical consults and psychological support while patients are within their own home setting, regardless of whether they live in urban or rural areas.

title: Strategies to mitigate impacts of the COVID 19 pandemic on patients treated with deep brain stimulation
abstract: In the wake of the COVID 19 crisis, 160,000 patients worldwide who have undergone deep brain stimulation (DBS) are now experiencing critical treatment disruptions. These include patients treated for Parkinson's disease, dystonia, epilepsy and essential tremor as well as for psychiatric disorders, like treatmentresistant obsessive compulsive disorder and Tourette syndrome. With many hospitals overburdened  and the potential for community based infection still high (and increasing) shifting to various forms of telemedicine DBS care has become part of a necessary "natural experiment" to mitigate risk for infection and continue care throughout the pandemic. However, the impacts of COVID 19 on patient outcomes and well being remain unknown. Some potential risks of and practical considerations for implementing remote DBS carewere outlined by Gross et al.  who discussed whether and when to implant new patients with DBS, how to avoid and what to do in case of internal pulse generator (IPG) depletion, and how to address hardware infection or malfunction. Gross et al. provide effective recommendations for addressing potential neurosurgical risks during the pandemic; however, a gap remains in understanding how best to address potential ethical issues that can impact patient well being in the context of remote DBS care. Our group of DBS clinicians and researchers e currently treating patients using conventional DBS and engaged in research on ethical issues arising in next generation DBS care, respectively, highlight some of these ethical considerations here. In the absence of remote programming technology for DBS systems, the shift to telemedicine for patients who wish to continue DBS treatment inevitably entails a greater level of involvement and participation from patients in managing their own care. Whereas before the pandemic, physicians and other healthcare professionals were able to conduct routine observations of motor function, assess changes in cognition, mood, behavior or quality of life, modify or titrate stimulation parameters and assess battery life in person, now most of these critical aspects of care are occurring remotely, resulting in greater patient control and autonomy over their treatment (particularly stimulation) Physicians may widen stimulation parameters within a safe margin to allow patients to "tweak" their stimulation and experiment with minimum thresholds on their own. This key shift toward greater patient control over stimulation is part of a larger strategy to balance battery conservationwith symptom management. Many patients without rechargeable batteries face the possibility of battery depletion during the course of the pandemic; thus, conserving battery life is of high priority.

title: Long Term Brain Disorders in Post Covid 19 Neurological Syndrome (PCNS) Patient
abstract: In the recent pandemic disease, called COVID 19, the role of neurologists and neurobiologists represents a chance to study key features of brain infection and deepen neurological manifestations of COVID 19 and other coronavirus infections. In fact, many studies suggest brain damage during infection and persistent neurological symptoms after COVID 19 infection. Reverse transcription PCR test, antibody tests, Computed Tomography (CT) of the lung, and Magnetic Resonance (MR) of the brain of the patient were periodically performed during this case report for eight months after infection. The aim of this article is to describe the prolonged neurological clinical consequences related to COVID 19. We believe it is clinically clear that we can define a post acute COVID 19 neurological syndrome. Therefore, in patients after a severe clinical condition of COVID 19, a deepening of persistent neurological signs is necessary.

title: Nervous system involvement after infection with COVID 19 and other coronaviruses
abstract: Viral infections have detrimental impacts on neurological functions, and even to cause severe neurological damage. Very recently, coronaviruses (CoV) especially severe acute respiratory syndrome CoV 2 (SARS CoV 2) exhibit neurotropic properties and may also cause neurological diseases. It is reported that CoV can be found in the brain or cerebrospinal fluid. The pathobiology of these neuroinvasive viruses is still incompletely known, and it is therefore important to explore the impact of CoV infections on the nervous system. Here, we review the research into neurological complications in CoV infections and the possible mechanisms of damage to the nervous system.

title: Brain Imaging Findings in COVID 19 Positive Newborns
abstract: Only limited data regarding COVID 19 infection in paediatric and neonatal population are available yet: COVID 19 tends to spare newborns and risk of severe disease in infected patients appears low