Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy

Antonio Colombo; Filippo Martinelli Boneschi; Sandro Beretta; Nereo Bresolin; Maurizio Versino; Lorenzo Lorusso; Diego Spagnoli; Giulia Nastasi; Davide Vallauri; Stefania Rota; Maria Repaci; Massimo Ferrarini; Mattia Pozzato; Lucia Princiotta Cariddi; Payam Tabaee Damavandi; Federico Carimati; Paola Banfi; Alessandro Clemenzi; Margherita Marelli; Andrea Giorgianni; Gabriele Vinacci; Marco Mauri; Paola Melzi; Maria Di Stefano; Antonio Tetto; Margherita Canesi; Andrea Salmaggi

doi:10.1016/j.ensci.2020.100306

Posterior reversible encephalopathy syndrome and COVID-19: A series of 6 cases from Lombardy, Italy

eNeurologicalSci. 2020 Dec 22:22:100306. doi: 10.1016/j.ensci.2020.100306. eCollection 2021 Mar.

Authors

Antonio Colombo¹, Filippo Martinelli Boneschi², Sandro Beretta³, Nereo Bresolin², Maurizio Versino⁴, Lorenzo Lorusso⁵, Diego Spagnoli⁶, Giulia Nastasi³, Davide Vallauri³, Stefania Rota³, Maria Repaci³, Massimo Ferrarini³, Mattia Pozzato², Lucia Princiotta Cariddi⁴, Payam Tabaee Damavandi⁴, Federico Carimati⁴, Paola Banfi⁴, Alessandro Clemenzi⁴, Margherita Marelli⁴, Andrea Giorgianni⁴, Gabriele Vinacci⁴, Marco Mauri⁴, Paola Melzi⁵, Maria Di Stefano⁵, Antonio Tetto⁵, Margherita Canesi⁶, Andrea Salmaggi⁷

Affiliations

¹ SNO (Society of Hospital Neurosciences, Italy) and Polo Neurologico Brianteo, Seregno, MB, Italy.
² Dino Ferrari Centre, Department of Pathophysiology and Transplantation (DEPT), University of Milan and IRCCS Ca' Granda Foundation Ospedale Maggiore Policlinico, Neurology Unit and MS Center Milan, Italy.
³ Neurology and Stroke Unit, Radiology Unity, ASST Vimercate (MB), Italy.
⁴ University of Insubria, Clinical and Experimental Medicine and Medical Humanitates, Center of Research in Medical Pharmacology, Neurology and Stroke Unit, Neuroradiology, Pneumology ASST Sette Laghi, Varese, Italy.
⁵ Neurology and Stroke Unit Merate Hospital, ASST, Lecco, Italy.
⁶ Neurosurgery and Neurorehabilitation Gravedona Hospital, Como, Italy.
⁷ Neurology and Stroke Unit ASST, Lecco, Italy.

Abstract

Posterior reversible encephalopathy cases are increasingly being reported in patients affected by COVID-19, but the largest series so far only includes 4 patients. We present a series of 6 patients diagnosed with PRES during COVID-19 hospitalized in 5 Centers in Lombardia, Italy. 5 out of the 6 patients required intensive care assistence and seizures developed at weaning from assisted ventilation. 3 out of 6 patients underwent cerebrospinal fluid analysis which was normal in all cases, with negative PCR for Sars-CoV-2 genome search. PRES occurrence may be less rare than supposed in COVID-19 patients and a high suspicion index is warranted for prompt diagnosis and treatment.

Keywords: COVID-19; PRES; Seizures.