Coronavirus Disease in the Brain - PowerPoint Presentation

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Coronavirus Disease in the BrainIncidence of Neurologic Complications of COVID-19 and Its Supportive Treatments

Colbey W. Freeman, MD; Jonathan Masur, MD;

Mougnyan

Cox, MD;

Suyash

Mohan, MD

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Background

Coronavirus disease 2019 (COVID-19) is most known for causing pneumonia

We are learning more about the effects of COVID-19 in the brain

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Research Question: How common are critical results on brain scans (CT and MRI) in patients in the hospital with COVID-19?

Purpose

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Methods

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Methods

“Critical”

results were:Bleeding in the brain (intracranial hemorrhage)Stroke without brain bleed (ischemic infarct)

Blocked blood vessels in the brain (vascular occlusion)Brain injury from low oxygen (hypoxic-ischemic injury)Movement of the brain from its normal position that puts pressure on the brain (herniation)

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Methods

Laboratory values

near the time of the brain CT or MRI were recordedOxygen-carrying protein in the blood (hemoglobin)Levels showing kidney function (creatinine)

Markers of inflammation (D-dimer, fibrinogen)Levels showing ability of blood to clot (PT, PTT, INR, platelets)

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1357 patients with COVID-19 admitted

January 1-April 27, 2020

81 with brain scans

73 CT, 1 MR, 7 both

18 with

critical results

Results

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COVID-19 patients with brain scans

COVID-19 patients

with critical results

on brain scansAverage age in years

66.3

60.5

Females/Males

36/45

9/9

Results

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Younger patients also had critical results on their brain scans

While average age of patients with critical results was 60.5 years, 7 of those 18 patients were less than 55 years old and 3 of 18 patients were in their 40s

Results

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African-American patients may be more likely to have critical results on brain scans

Results

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Results

The use of life support machines (machine to help patients breathe - ventilator, machine to help blood circulation and increase oxygen in blood - ECMO) was common in patients who had brain scans

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High blood pressure and diabetes were common in people who had brain scans and who had critical results on those brain scans

Results

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Results

6 examples of bleeding in the brain in 5 patients

2 patients had herniation caused by bleeding12 patients with strokes without brain bleeds1 patient with injury from overall low oxygen

4 patients had large blocked arteries in the brain

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Of the 81 patients with brain scans, 18 (22.2%) died during the study

Of the 18 patients with critical results on brain scans, 3 (16.7%) died, all of whom had bleeds in their brains

Results

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In patients with

critical results

…

Patients were anemic with low hemoglobin

Kidney function was below normal

Results

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Results

In patients with

critical results

…

Blood markers of inflammation were high

Lab values suggested patients had lost some ability to clot

Platelet levels were normal

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Neurologic symptoms are common in patients with COVID-19, such as headache, changes in senses, confusion, or dizziness

Discussion

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Only

6%

of hospitalized COVID-19 patients during the study had brain scans, but critical results and death were common in those that did

1.3% of all COVID-19 patients in our health system met our criteria for critical brain results

22.2%

of patients with brain scans had critical results

Discussion

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High blood pressure and type 2 diabetes mellitus were common in COVID-19 patients who had brain scans

COVID-19 is likely more severe in patients with diabetes

Critical brain scan results may be more common in African-American patients

Important for heath care providers to be vigilant and aware that some patients may be at greater risk for these complications

Discussion

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Many patients with brain scans and critical results were on life support at some time in the hospital

ECMO (pump system used to circulate and replenish oxygen in blood) use was overrepresented in patients with critical results

Discussion

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The death rate was slightly lower in our group of patients with brain imaging (22.2%) and patients with critical brain findings (16.7%) than some other studies looking at COVID-19 patients overall

While the death rate was not higher in patients with critical results, our study did not look at long-term health problems from those critical results in surviving patients, and some patients died months later

Discussion

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Patients with critical results had high levels of inflammatory markers in their blood, which may represent a whole-body inflammatory state triggered by COVID-19

Could this be contributing to the critical outcomes?

Discussion

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Expanding the study to include patients at multiple health systems

Is the rate of each type of critical result increased over pre-COVID-19 years?

Future Directions

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Critical results on brain scans in COVID-19 patients were uncommon overall, but in patients who had brain scans, they were present in many (22.2%) patients

High blood pressure and type 2 diabetes were common in COVID-19 patients undergoing brain scans and those with critical results on those brain scans

Some life support treatments have their own risks, and patients, their families, and health care providers should be aware of benefits and risks to using them

Conclusion