Focal EEG changes indicating critical illness associated cerebral microbleeds in a Covid-19 patient

Pia De Stefano; Umberto Nencha; Ludovico De Stefano; Pierre Mégevand; Margitta Seeck

doi:10.1016/j.cnp.2020.05.004

Focal EEG changes indicating critical illness associated cerebral microbleeds in a Covid-19 patient

Clin Neurophysiol Pract. 2020 Jun 10:5:125-129. doi: 10.1016/j.cnp.2020.05.004. eCollection 2020.

Authors

Pia De Stefano¹, Umberto Nencha¹, Ludovico De Stefano², Pierre Mégevand^{1

3}, Margitta Seeck¹

Affiliations

¹ EEG and Epilepsy Unit, Division of Neurology, Geneva University Hospitals, Switzerland.
² Rheumatology Unit, IRCCS Policlinico, S. Matteo Foundation, University of Pavia, Italy.
³ Department of Basic Neuroscience, Faculty of Medicine, University of Geneva, Switzerland.

Abstract

Objectives: We describe a patient suffering from Covid19-related acute respiratory distress syndrome (ARDS), highlighting the diagnostic role of the EEG in ICU.

History: A Covid-19 patient undergoing mechanical ventilation due to related acute respiratory distress syndrome (ARDS), presented altered mental status in the ICU. Video-EEG revealed a focal monomorphic theta slowing in bilateral frontal-central regions. Concordant with the EEG localization, MRI showed abundant microbleeds located in bilateral white matter junction, various regions of corpus callosum and internal capsule, suggestive of Critical Illness-Associated Cerebral Microbleeds. CSF analysis excluded the presence of encephalitis, SARS-Cov2 RNA-PCR in CSF was negative. Clinical and biological picture was suggestive of cytokine release syndrome.

Conclusion: This is the first reported case of Critical Illness-Associated Cerebral Microbleeds in the context of Covid-19. Knowledge of Covid-19 is still partial and acute neurological complications should be explored systematically. In our case, EEG helped to rule out non-convulsive status epilepticus, but revealed focal dysfunction, justifying further investigations.EEG plays a crucial role in these patients, allowing investigating the presence of focal or diffuse cerebral dysfunction. This is particularly helpful for Covid-19 patients in the ICU, where the neurological examination is challenging by the severity of the respiratory illness.

Keywords: Brain; Coma; Covid-19; Cytokine; EEG; ICU; Inflammation; Microbleeds; SARS-CoV2.

Publication types

Case Reports