{"id":19094,"date":"2020-08-02T05:09:23","date_gmt":"2020-08-01T21:09:23","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=19094"},"modified":"2020-08-05T07:06:35","modified_gmt":"2020-08-04T23:06:35","slug":"icu-management-practice-%e6%96%b0%e5%86%a0%e7%97%85%e6%af%92%e6%84%9f%e6%9f%93%e4%bd%8f%e9%99%a2%e6%82%a3%e8%80%85%e7%a5%9e%e7%bb%8f%e7%b3%bb%e7%bb%9f%e5%bd%b1%e5%83%8f%e5%ad%a6%e8%a1%a8%e7%8e%b0","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=19094","title":{"rendered":"[ICU Management &#038; Practice]: \u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u4f4f\u9662\u60a3\u8005\u795e\u7ecf\u7cfb\u7edf\u5f71\u50cf\u5b66\u8868\u73b0"},"content":{"rendered":"\n<h1 class=\"wp-block-heading\">Imaging in Neurological Disease of Hospitalised COVID-19 Patients<\/h1>\n\n\n\n<p>Originating in Wuhan, China, COVID-19 soon spread throughout the world and has been declared a pandemic by the World Health Organization. Italy was the second country to be hit as hard as China, with a total of 222,104 cases and 31,106 deaths (at time of publication).<\/p>\n\n\n\n<p>A study was conducted to understand the characteristics of neurological symptoms and neuroimaging features of COVID-19 patients admitted to hospitals across Italy. This was a retrospective, multicenter study design. Three major institutions in Italy were included in the study: University of Brescia, Brescia, University of Eastern Piemonte, Novara and University of Sassari, Sassari.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Inclusion Criteria<\/strong><\/h3>\n\n\n\n<ol><li>COVID-19 patients who had tested positive by rRT-PCR (real-time reverse transcriptase polymerase chain reaction) on testing of respiratory secretions obtained from endotracheal aspirates, nasopharyngeal, oropharyngeal swabs, or bronchoalveolar lavage between February 29 to April 4, 2020.<\/li><li>Acute neurological symptoms during stay at the hospital. &nbsp;<\/li><li>Patients who had done any neuroimaging studies such as spine or brain imaging. &nbsp;<\/li><\/ol>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Study Results<\/strong><\/h3>\n\n\n\n<p>Based on the inclusion criteria, 725 patients admitted to hospitals were reviewed, but only 108 patients actually met the criteria to be included in the study.&nbsp;<\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Total patients&nbsp;<\/td><td>108<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>Examined with Non-Contrast Brain CT<\/td><td>107<\/td><td>99%<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>Head &amp; Neck CT angiography<\/td><td>17<\/td><td>16%<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><tr><td>Brain MRI<\/td><td>20<\/td><td>18%<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Most common neurological symptoms&nbsp;<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>&nbsp;<\/td><td>Patients&nbsp;<\/td><td>Percentage<\/td><\/tr><tr><td>Altered mental status&nbsp;<\/td><td>64<\/td><td>59%<\/td><\/tr><tr><td>Ischemic stroke&nbsp;<\/td><td>34<\/td><td>31%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Past medical history of patients&nbsp;<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>Patients with no known past medical history turned out to have the following symptoms&nbsp;Age range (16-62)<\/td><td>31\/108<\/td><td>29%<\/td><td>&nbsp;<\/td><td>Patients with known medical history had at least one of the following symptoms&nbsp;<\/td><td>77\/108&nbsp;<\/td><td>71%<\/td><\/tr><tr><td>Acute ischaemic infarcts&nbsp;<\/td><td>10<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>Coronary artery disease&nbsp;<\/td><td>25<\/td><td>23%<\/td><\/tr><tr><td>Intracranial haemorrhage&nbsp;<\/td><td>2<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>Cerebrovascular disease&nbsp;<\/td><td>15<\/td><td>14%<\/td><\/tr><tr><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>Hypertension<\/td><td>55<\/td><td>51%<\/td><\/tr><tr><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>&nbsp;<\/td><td>Diabetes&nbsp;<\/td><td>30<\/td><td>28%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p><strong>Findings on Brain CT<\/strong><\/p>\n\n\n\n<figure class=\"wp-block-table\"><table><tbody><tr><td>&nbsp;<\/td><td>Patients&nbsp;<\/td><td>Percentage<\/td><\/tr><tr><td>No acute findings&nbsp;<\/td><td>71<\/td><td>66%<\/td><\/tr><tr><td>Acute abnormalities&nbsp;<\/td><td>7<\/td><td>35%<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<p>The association between the age of the patient and the presence of altered mental status was statistically significant.&nbsp;The more aged the patient, the&nbsp;more prone they were to altered mental status.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Summary of Results<\/strong><\/h3>\n\n\n\n<ol><li>The study showed that while there was no discernable pattern of neuroimaging characteristics, there was a predominant presence of acute ischaemic infarcts and intracranial haemorrhages. &nbsp;<\/li><li>Results, when compared to Wuhan, showed a lower occurrence of CNS symptoms (25% Wuhan vs. 15% Italy) but a higher occurrence of ischaemic stroke (31% Wuhan vs. 11% Italy).<\/li><li>It is not clearly understood whether the presence of neurological symptoms is due to the severity of illness or a result of a direct invasion of CNS by SARS-CoV-2. There is some evidence that ischaemic stroke in patients with severe COVID-19 might be triggered by cytokine storm syndrome.<\/li><li>There is evidence to suggest COVID-19 associated occurrence of Guillain-Barr\u00e9 syndrome (GBS) and some variants.<\/li><\/ol>\n\n\n\n<p>There is a strong need for neurologists and neuro-radiologists to better understand COVID-19-associated patterns in neuroimaging for better patient outcomes. &nbsp;<\/p>\n\n\n\n<p>Source:&nbsp;<a href=\"https:\/\/pubs.rsna.org\/doi\/pdf\/10.1148\/radiol.2020201933\" target=\"_blank\" rel=\"noreferrer noopener\">Radiology<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">References:<\/h4>\n\n\n\n<p>Mahammedi A et al. (2020)&nbsp;<a href=\"https:\/\/pubs.rsna.org\/doi\/pdf\/10.1148\/radiol.2020201933\" target=\"_blank\" rel=\"noreferrer noopener\">Imaging in Neurological Disease of Hospitalized COVID-19 Patients: An Italian Multicenter Retrospective Observational Study.<\/a>&nbsp;Radiology.&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Imaging in Neurological Disease of Hospitalised COVID-1 [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[24,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19094"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=19094"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19094\/revisions"}],"predecessor-version":[{"id":19095,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/19094\/revisions\/19095"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=19094"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=19094"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=19094"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}