MRI of Cerebrovascular Injury Associated With COVID-19 and Non-COVID-19 Acute Respiratory Distress Syndrome: A Matched Case-Control Study.

Autor:	Shoskes A; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH., Huang M; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH., Gedansky A; Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH., Hassett C; Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH., Buletko AB; Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH., Duggal A; Department of Critical Care, Respiratory Institute, Cleveland Clinic, Cleveland, OH., Uchino K; Cerebrovascular Center, Department of Neurology, Neurological Institute, Cleveland Clinic, Cleveland, OH., Cho SM; Division of Neuroscience Critical Care, Division of Cardiac Surgery, Departments of Neurology, Cardiac Surgery, Neurosurgery, Anesthesiology, and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2022 Nov 01; Vol. 50 (11), pp. 1638-1643. Date of Electronic Publication: 2022 Sep 12.
DOI:	10.1097/CCM.0000000000005658
Abstrakt:	Objectives: Cerebrovascular injury associated with COVID-19 has been recognized, but the mechanisms remain uncertain. Acute respiratory distress syndrome (ARDS) is a severe pulmonary injury, which is associated with both ischemic and hemorrhagic stroke. It remains unclear if cerebrovascular injuries associated with severe COVID-19 are unique to COVID-19 or a consequence of severe respiratory disease or its treatment. The frequency and patterns of cerebrovascular injury on brain MRI were compared among patients with COVID-19 ARDS and non-COVID-19 ARDS. Design: A case-control study. Setting: A tertiary academic hospital system. Patients: Adult patients (>18 yr) with COVID-19 ARDS (March 2020 to July 2021) and non-COVID-19 ARDS (January 2010-October 2018) who underwent brain MRI during their index hospitalization. Interventions: None. Measurements and Main Results: Cerebrovascular injury on MRI included cerebral ischemia (ischemic infarct or hypoxic ischemic brain injury) and intracranial hemorrhage (intraparenchymal, subarachnoid, or subdural, and cerebral microbleed [CMB]).Twenty-six patients with COVID-19 ARDS and sixty-six patients with non-COVID ARDS underwent brain MRI during the index hospitalization, resulting in 23 age- and sex-matched pairs. The frequency of overall cerebrovascular injury (57% vs 61%), cerebral ischemia (35% vs 43%), intracranial hemorrhage (43% vs 48%), and CMB (52% vs 41%) between COVID-19 ARDS and non-COVID-19 ARDS patients was similar (all p values >0.05). However, four of 26 patients (15%) with COVID-19 and no patients with non-COVID-19 ARDS had disseminated leukoencephalopathy with underlying CMBs, an imaging pattern that has previously been reported in patients with COVID-19. Conclusions: In a case-control study of selected ARDS patients with brain MRI, the frequencies of ischemic and hemorrhagic cerebrovascular injuries were similar between COVID-19 versus non-COVID-19 ARDS patients. However, the MRI pattern of disseminated hemorrhagic leukoencephalopathy was unique to the COVID-19 ARDS patients in this cohort. Competing Interests: Dr. Duggal’s institution received funding from the National Heart, Lung, and Blood Institute and the Centers for Disease Control and Prevention; he received funding from On Steering committee for Alung Technologies. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2022 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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