Focal EEG changes indicating critical illness associated cerebral microbleeds in a Covid-19 patient

Pia De Stefano, Umberto Nencha, Ludovico De Stefano, Pierre Mégevand, Margitta Seeck

Research output: Contribution to journalArticle

Abstract

Objectives: We describe a patient suffering from Covid19-related acute respiratory distress syndrome (ARDS), highlighting the diagnostic role of the EEG in ICU. History: A Covid-19 patient undergoing mechanical ventilation due to related acute respiratory distress syndrome (ARDS), presented altered mental status in the ICU. Video-EEG revealed a focal monomorphic theta slowing in bilateral frontal-central regions. Concordant with the EEG localization, MRI showed abundant microbleeds located in bilateral white matter junction, various regions of corpus callosum and internal capsule, suggestive of Critical Illness-Associated Cerebral Microbleeds. CSF analysis excluded the presence of encephalitis, SARS-Cov2 RNA-PCR in CSF was negative. Clinical and biological picture was suggestive of cytokine release syndrome. Conclusion: This is the first reported case of Critical Illness-Associated Cerebral Microbleeds in the context of Covid-19. Knowledge of Covid-19 is still partial and acute neurological complications should be explored systematically. In our case, EEG helped to rule out non-convulsive status epilepticus, but revealed focal dysfunction, justifying further investigations. EEG plays a crucial role in these patients, allowing investigating the presence of focal or diffuse cerebral dysfunction. This is particularly helpful for Covid-19 patients in the ICU, where the neurological examination is challenging by the severity of the respiratory illness.

Original languageEnglish
Pages (from-to)125-129
Number of pages5
JournalClinical Neurophysiology Practice
Volume5
DOIs
Publication statusPublished - 2020
Externally publishedYes

Keywords

  • Brain
  • Coma
  • Covid-19
  • Cytokine
  • EEG
  • ICU
  • Inflammation
  • Microbleeds
  • SARS-CoV2

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Physiology (medical)

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