Reader response: Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry
DeryaKaya, Neurologist, Dokuz Eylul University Faculty of Medicine,Unit for Brain Aging and Dementia, Department of Geriatric Medicine
NuriKarabay, Radiologist, Dokuz Eylul University Faculty of Medicine, Department of Radiology
Ahmet TuranIsik, Geriatrician, Dokuz Eylul University Faculty of Medicine,Unit for Brain Aging and Dementia, Department of Geriatric Medicine
Submitted July 07, 2020
We read with great interest the article by Romero-Sánchez et al.1 on their experience with neurologic manifestations in hospitalized patients with the coronavirus disease 2019 (COVID-19). The authors have presented two interesting patients’ brain images. We have 2 concerns regarding those images.
In one of them, multiple brain hemorrhages resembling posterior reversible encephalopathy syndrome (PRES) were shown on brain MRI (Figure 1 in the article). We think that it is not enough to make the diagnosis of PRES with the present form of the case. For instance, the image seems to also be compatible with cerebral amyloid angiopathy-related inflammation. Therefore, considering that our knowledge on COVID-19 and the related conditions is still in its incipient stage, it would be better if the authors avoid strict expressions, although they stated that pandemic context prevented them performing full neurologic evaluation and complete diagnostic workup as limitations in the article.
Additionally, the other patient with sudden language dysfunction who had bilateral temporal hyperintensity in the brain image (Figure 2 in the article), was diagnosed as “encephalitis.” As encephalitis has a wide spectrum that could include conditions such as limbic encephalitis or herpes simplex encephalitis in the presence of language dysfunction and bitemporal hyperintensity, the authors could have given some clinical and laboratory information, at least, of this very interesting patient.
Finally, we may have a chance to gain new insights into the special patients, as in here, in the ongoing pandemic context.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
Reference
Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology 2020 Epub Jun 1.
We read with great interest the article by Romero-Sánchez et al.1 on their experience with neurologic manifestations in hospitalized patients with the coronavirus disease 2019 (COVID-19). The authors have presented two interesting patients’ brain images. We have 2 concerns regarding those images.
In one of them, multiple brain hemorrhages resembling posterior reversible encephalopathy syndrome (PRES) were shown on brain MRI (Figure 1 in the article). We think that it is not enough to make the diagnosis of PRES with the present form of the case. For instance, the image seems to also be compatible with cerebral amyloid angiopathy-related inflammation. Therefore, considering that our knowledge on COVID-19 and the related conditions is still in its incipient stage, it would be better if the authors avoid strict expressions, although they stated that pandemic context prevented them performing full neurologic evaluation and complete diagnostic workup as limitations in the article.
Additionally, the other patient with sudden language dysfunction who had bilateral temporal hyperintensity in the brain image (Figure 2 in the article), was diagnosed as “encephalitis.” As encephalitis has a wide spectrum that could include conditions such as limbic encephalitis or herpes simplex encephalitis in the presence of language dysfunction and bitemporal hyperintensity, the authors could have given some clinical and laboratory information, at least, of this very interesting patient.
Finally, we may have a chance to gain new insights into the special patients, as in here, in the ongoing pandemic context.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
Reference