Query: covid 19 brain disease

title: Brain Imaging Use and Findings in COVID 19: A Single Academic Center Experience in the Epicenter of Disease in the United States
abstract: Coronavirus disease 2019 (COVID 19) is a serious public health crisis and can have neurologic manifestations. This is a retrospective observational case series performed March 1 31, 2020, at New York University Langone Medical Center campuses. Clinical and imaging data were extracted, reviewed, and analyzed. Two hundred forty two patients with COVID 19 underwent CT or MRI of the brain within 2 weeks after the positive result of viral testing (mean age, 68.7 16.5 years; 150 men/92 women [62.0%/38.0% The 3 most common indications for imaging were altered mental status (42.1% syncope/fall (32.6% and focal neurologic deficit (12.4% The most common imaging findings were nonspecific white matter microangiopathy (134/55.4% chronic infarct (47/19.4% acute or subacute ischemic infarct (13/5.4% and acute hemorrhage (11/4.5% No patients imaged for altered mental status demonstrated acute ischemic infarct or acute hemorrhage. White matter microangiopathy was associated with higher 2 week mortality (P .001) Our data suggest that in the absence of a focal neurologic deficit, brain imaging in patients with early COVID 19 with altered mental status may not be revealing.

title: Neurological Complications of Coronavirus Disease (COVID 19) Encephalopathy, MRI Brain and Cerebrospinal Fluid Findings: Case 2
abstract: The neurological complications of coronavirus disease 2019 (COVID 19) are being better understood as the pandemic progresses. We report a second case of a patient who presented with COVID 19 infection and encephalopathy to our institution. In addition, we report MRI brain and cerebrospinal fluid data. COVID 19 does not seem to cross the blood brain barrier. The exact mechanisms of encephalopathy and pathological response of COVID 19 are unknown.

title: Magnetic Resonance Imaging Alteration of the Brain in a Patient With Coronavirus Disease 2019 (COVID 19) and Anosmia.

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: The Need for Digital Health Solutions in Deep Brain Stimulation for Parkinson's Disease in the Time of COVID 19 and Beyond
abstract: Deep brain stimulation (DBS) is a well established therapy for the management of patients with advanced Parkinson's disease and other movement disorders. Patients implanted with DBS require life long management of the medical device as well as medications. Patients are often challenged to frequently visit the specialized DBS centers and such challenges are aggravated depending on geography, socioeconomic factors, and support systems. We discuss the need for digital health solutions to overcome these barriers to better and safely take care of patients, especially in the current COVID 19 pandemic.

title: Organisational changes and challenges for inflammatory bowel disease services in the UK during the COVID 19 pandemic
abstract: To determine the challenges in diagnosis, monitoring, support provision in the management of inflammatory bowel disease (IBD) patients and explore the adaptations of IBD services.  Internet based survey by invitation of IBD services across the UK from 8 to 14 April 2020.  Respondents from 125 IBD services completed the survey. The number of whole time equivalent gastroenterologists and IBD nurses providing elective outpatient care decreased significantly between baseline (median 4, IQR 4 7.5 and median 3, IQR 2 4) to the point of survey (median 2, IQR 1 4.8 and median 2, IQR 1 3) in the 6 week period following the onset of the COVID 19 pandemic (p<0.001 for both comparisons) Almost all (94% 112/119) services reported an increase in IBD helpline activity. Face to face clinics were substituted for telephone consultation by 86% and video consultation by 11% of services. A variation in the provision of laboratory faecal calprotectin testing was noted with 27% of services reporting no access to faecal calprotectin, and a further 32% reduced access. There was also significant curtailment of IBD specific endoscopy and elective surgery.  IBD services in the UK have implemented several adaptive strategies in order to continue to provide safe and high quality care for patients. National Health Service organisations will need to consider the impact of these changes in current service delivery models and staffing levels when planning exit strategies for post pandemic IBD care. Careful planning to manage the increased workload and to maintain IBD services is essential to ensure patient safety.

title: Brain Disease Network Analysis to Elucidate the Neurological Manifestations of COVID 19
abstract: Although COVID 19 largely causes respiratory complications, it can also lead to various extrapulmonary manifestations resulting in higher mortality and these comorbidities are posing a challenge to the health care system. Reports indicate that 30 60% of patients with COVID 19 suffer from neurological symptoms. To understand the molecular basis of the neurologic comorbidity in COVID 19 patients, we have investigated the genetic association between COVID 19 and various brain disorders through a systems biology based network approach and observed a remarkable resemblance. Our results showed 123 brain related disorders associated with COVID 19 and form a high density disease disease network. The brain disease gene network revealed five highly clustered modules demonstrating a greater complexity of COVID 19 infection. Moreover, we have identified 35 hub proteins of the network which were largely involved in the protein catabolic process, cell cycle, RNA metabolic process, and nuclear transport. Perturbing these hub proteins by drug repurposing will improve the clinical conditions in comorbidity. In the near future, we assumed that in COVID 19 patients, many other neurological manifestations will likely surface. Thus, understanding the infection mechanisms of SARS CoV 2 and associated comorbidity is a high priority to contain its short and long term effects on human health. Our network based analysis strengthens the understanding of the molecular basis of the neurological manifestations observed in COVID 19 and also suggests drug for repurposing.

title: Intracranial hemorrhage related to brain vascular disease and COVID 19 containment: Where are the patients?

title: Cerebrovascular disease in patients with COVID 19: neuroimaging, histological and clinical description
abstract: Since the appearance of the first case of coronavirus disease 2019 (COVID 19) a pandemic has emerged affecting millions of people worldwide. Although the main clinical manifestations are respiratory, an increase in neurological conditions, specifically acute cerebrovascular disease, has been detected. We present cerebrovascular disease case incidence in hospitalized patients with SARS CoV 2 infection. Patients were confirmed by microbiological/serological testing, or on chest CT semiology. Available data on comorbidity, laboratory parameters, treatment administered, neuroimaging, neuropathological studies and clinical evolution during hospitalization, measured by the modified Rankin scale, were analysed. A bivariate study was also designed to identify differences between ischaemic and haemorrhagic subtypes. A statistical model of binary logistic regression and sensitivity analysis was designed to study the influence of independent variables over prognosis. In our centre, there were 1683 admissions of patients with COVID 19 over 50 days, of which 23 (1.4% developed cerebrovascular disease. Within this group of patients, cerebral and chest CT scans were performed in all cases, and MRI in six (26.1% Histological samples were obtained in 6/23 cases (two brain biopsies, and four arterial thrombi) Seventeen patients were classified as cerebral ischaemia (73.9% with two arterial dissections) five as intracerebral haemorrhage (21.7% and one leukoencephalopathy of posterior reversible encephalopathy type. Haemorrhagic patients had higher ferritin levels at the time of stroke (1554.3 versus 519.2, P 0.004) Ischaemic strokes were unexpectedly frequent in the vertebrobasilar territory (6/17, 35.3% In the haemorrhagic group, a characteristic radiological pattern was identified showing subarachnoid haemorrhage, parieto occipital leukoencephalopathy, microbleeds and single or multiple focal haematomas. Brain biopsies performed showed signs of thrombotic microangiopathy and endothelial injury, with no evidence of vasculitis or necrotizing encephalitis. The functional prognosis during the hospital period was unfavourable in 73.9% (17/23 modified Rankin scale 4 6) and age was the main predictive variable (odds ratio 1.5; 95% confidence interval 1.012 2.225; P 0.043) Our series shows cerebrovascular disease incidence of 1.4% in patients with COVID 19 with high morbidity and mortality. We describe pathological and radiological data consistent with thrombotic microangiopathy caused by endotheliopathy with a haemorrhagic predisposition.

title: Neurological manifestations of patients with COVID 19: potential routes of SARS CoV 2 neuroinvasion from the periphery to the brain
abstract: Coronavirus disease 2019 (COVID 19) caused by severe acute respiratory syndrome Coronavirus 2 (SARS CoV 2) has caused a global pandemic in only 3 months. In addition to major respiratory distress, characteristic neurological manifestations are also described, indicating that SARS CoV 2 may be an underestimated opportunistic pathogen of the brain. Based on previous studies of neuroinvasive human respiratory coronaviruses, it is proposed that after physical contact with the nasal mucosa, laryngopharynx, trachea, lower respiratory tract, alveoli epithelium, or gastrointestinal mucosa, SARS CoV 2 can induce intrinsic and innate immune responses in the host involving increased cytokine release, tissue damage, and high neurosusceptibility to COVID 19, especially in the hypoxic conditions caused by lung injury. In some immune compromised individuals, the virus may invade the brain through multiple routes, such as the vasculature and peripheral nerves. Therefore, in addition to drug treatments, such as pharmaceuticals and traditional Chinese medicine, non pharmaceutical precautions, including facemasks and hand hygiene, are critically important.