Posterior reversible encephalopathy syndrome in patients with COVID-19

Sarah C. Parauda, Virginia Gao, Alexandra N. Gewirtz, Neal S. Parikh, Alexander E. Merkler, Joshua Lantos, Halina White, Dana Leifer, Babak B. Navi, Alan Z. Segal

Research output: Contribution to journalArticlepeer-review

70 Scopus citations

Abstract

Objective: To report four patients with coronavirus disease 2019 (COVID-19) who developed posterior reversible encephalopathy syndrome (PRES). Methods: Patient data was abstracted from medical records at Weill Cornell Medical Center. Results: Four patients with SARS-CoV-2 infection and PRES were identified. The patients' ages ranged from 64 to 74 years, and two were women. All four patients were admitted to the hospital with acute respiratory distress syndrome requiring intensive care unit admission and mechanical ventilation. PRES was diagnosed after persistent confusion, lethargy, new focal neurological deficits, or seizures were noted, with evidence of seizures on electroencephalogram for two of the patients. Imaging confirmed the presence of cerebral vasogenic edema. All four patients had elevated blood pressure and renal injury in the days preceding PRES diagnosis, as well as evidence of systemic inflammation and systemic hypercoagulability. Symptoms of PRES improved with blood pressure control. Conclusions: Our four cases demonstrate the occurrence of PRES in critically-ill patients with COVID-19. PRES should be considered in the differential for acute neurological deficits and seizures in this setting.

Original languageEnglish
Article number117019
JournalJournal of the Neurological Sciences
Volume416
DOIs
StatePublished - 15 Sep 2020
Externally publishedYes

Keywords

  • COVID-19
  • Posterior reversible encephalopathy syndrome
  • SARS-CoV-2

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