Evidence of brain metabolism redistribution from neocortex to primitive brain structures in early acute COVID-19 respiratory syndrome.

Autor: Souza SPM; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Colet N; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Fujiwara M; Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Fernandes AP; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Tobar N; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Dertkigil SSJ; Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Takahashi MES; Gleb Wataghin Institute of Physics, University of Campinas, Campinas, Brazil., Amorim BJ; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Silva LS; Department of Neurology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Yasuda CL; Department of Neurology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Cendes F; Department of Neurology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., de Souza TF; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Rodrigues JT; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Zantut-Wittmann DE; Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil., Ramos CD; Nuclear Medicine Division, Department of Radiology, Faculty of Medical Sciences, University of Campinas, Campinas, São Paulo, Brazil. cdramos@unicamp.br.
Jazyk: angličtina
Zdroj: EJNMMI research [EJNMMI Res] 2024 Mar 12; Vol. 14 (1), pp. 28. Date of Electronic Publication: 2024 Mar 12.
DOI: 10.1186/s13550-024-01089-3
Abstrakt: Background: Neuropsychiatric sequelae of COVID-19 have been widely documented in patients with severe neurological symptoms during the chronic or subacute phase of the disease. However, it remains unclear whether subclinical changes in brain metabolism can occur early in the acute phase of the disease. The aim of this study was to identify and quantify changes in brain metabolism in patients hospitalized for acute respiratory syndrome due to COVID-19 with no or mild neurological symptoms.
Results: Twenty-three non-intubated patients (13 women; mean age 55.5 ± 12.1 years) hospitalized with positive nasopharyngeal swab test (RT-PCR) for COVID-19, requiring supplemental oxygen and no or mild neurological symptoms were studied. Serum C-reactive protein measured at admission ranged from 6.43 to 189.0 mg/L (mean: 96.9 ± 54.2 mg/L). The mean supplemental oxygen demand was 2.9 ± 1.4 L/min. [ 18 F]FDG PET/CT images were acquired with a median of 12 (4-20) days of symptoms. After visual interpretation of the images, semiquantitative analysis of [ 18 F]FDG uptake in multiple brain regions was evaluated using dedicated software and the standard deviation (SD) of brain uptake in each region was automatically calculated in comparison with reference values of a normal database. Evolutionarily ancient structures showed positive SD mean values of [ 18 F]FDG uptake. Lenticular nuclei were bilaterally hypermetabolic (> 2 SD) in 21/23 (91.3%) patients, and thalamus in 16/23 (69.6%), bilaterally in 11/23 (47.8%). About half of patients showed hypermetabolism in brainstems, 40% in hippocampi, and 30% in cerebellums. In contrast, neocortical regions (frontal, parietal, temporal and occipital lobes) presented negative SD mean values of [ 18 F]FDG uptake and hypometabolism (< 2 SD) was observed in up to a third of patients. Associations were found between hypoxia, inflammation, coagulation markers, and [ 18 F]FDG uptake in various brain structures.
Conclusions: Brain metabolism is clearly affected during the acute phase of COVID-19 respiratory syndrome in neurologically asymptomatic or oligosymptomatic patients. The most frequent finding is marked hypermetabolism in evolutionary ancient structures such as lenticular nucleus and thalami. Neocortical metabolism was reduced in up to one third of patients, suggesting a redistribution of brain metabolism from the neocortex to evolutionary ancient brain structures in these patients.
(© 2024. The Author(s).)
Databáze: MEDLINE
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