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Non-severe COVID-19 complicated by cytotoxic lesions of the corpus callosum (mild encephalitis/encephalopathy with a reversible splenial lesion): a case report and literature review
Department of Emergency Medicine, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, JapanDepartment of Infectious Diseases, Japanese Red Cross Wakayama Medical Center, 4–20 Komatsubara-dori, Wakayama, 640-8558, Japan
Coronavirus disease 2019- (COVID-19-) associated cytotoxic lesions of the corpus callosum (CLOCCs) have been reported as a rare neurological abnormality in severe cases. Here, a case of CLOCCs in the early stages of mild COVID-19 infection during the Omicron BA.1 epidemic is reported along with a literature review.
Case report
A Japanese woman with COVID-19 presented to the emergency department with altered consciousness and cerebellar symptoms a day after fever onset. Magnetic resonance imaging (MRI) revealed a lesion with restricted diffusion in the corpus callosum. She exhibited no complications of pneumonia, her neurological symptoms resolved after two days, and after 10 days, the brain lesion was not detected on MRI.
Literature review
The PubMed database was searched for case reports that met the CLOCC definition proposed by Starkey et al. The search yielded 15 COVID-19-associated cases reported as CLOCCs and 13 cases described under former terms, including mild encephalitis/encephalopathy with a reversible splenial lesion. Adult cases with a documented course were accompanied by pneumonia or hypoxemia, whereas pediatric cases were mostly accompanied by a multisystem inflammatory syndrome.
Conclusion
COVID-19-associated CLOCCs can occur, even at an early, non-severe stage. Therefore, this condition may be underdiagnosed if MRI is not performed.
COVID-19 (novel COronaVIrus Disease-2019) is a respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been reported to be complicated by various neurological abnormalities at various times (
Global Incidence of Neurological Manifestations among Patients Hospitalized with COVID-19 - A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium.
). COVID-19-associated cytotoxic lesions of the corpus callosum (CLOCCs) have been reported as a rare neurological abnormality in severe cases due to pneumonia (
A 23-year-old man with SARS-CoV-2 infection who presented with auditory hallucinations and imaging findings of cytotoxic lesions of the corpus callosum (CLOCC).
). Retrospective studies of patients with COVID-19 who underwent neuroimaging showed CLOCC-like findings on magnetic resonance imaging (MRI), three out of 73 adults in France and one out of 47 adults in Sweden. However, these studies did not provide details on the severity of the disease (
CLOCCs are nonspecific secondary lesions of the corpus callosum that occur as a result of many triggers and are characterized by the following neuroradiological feature: reduced diffusion (low apparent diffusion coefficient [ADC] value) on MRI (
), this condition has been recently termed “CLOCCs” (Supplementary Table 1). CLOCCs are associated with various conditions including infection, seizures/status epilepticus, drug therapy, alcohol, metabolic disturbance, subarachnoid hemorrhage, trauma, and malignancy, among others. This clinical entity was frequently reported as MERS in Asian children during the pre-COVID-19 era; Hoshino et al. reported that MERS was the second most common cause of acute encephalopathy in children (15.6% of 983 cases, median age 5 years, 90.2% fully recovered), while preceding causes were influenza virus in 53 cases (34.4%) as well as rotavirus, mumps virus, HHV-6, and bacterial infections in other patients (
The clinical characteristics and severity of CLOCCs in cases of coronavirus infection, including infection with mild COVID-19, are not fully understood. Therefore, we report a new uncomplicated case of CLOCC in a patient with mild COVID-19 with no concurrent pneumonia and reviewed previous cases of CLOCCs associated with coronaviruses.
2. Case report
A 61-year-old Japanese woman presented to the emergency department with acute stroke-like symptoms in January 2022 (Day 1), the predominant phase of SARS-CoV-2 Omicron sublineage BA.1.1 (Omicron BA 1.1 or Nextstrain clade 21K: 91%; Delta or Nextstrain clade 21J: 9% in Japan(
)). She had a history of asthma with no treatment except during attacks. She was allergic to pyrine. She had received two doses of Comirnaty® (COVID-19 vaccine, mRNA) six months earlier. She experienced generalized pain, and her family physician performed a PCR test for SARS-CoV-2. She had fever at night on Day 1, vomited in the morning on Day 2, and was lying in bed unable to move. In the afternoon, she was informed that the PCR test was positive, at which time she experienced dysarthria and was transported to our ER. Upon arrival, she had a Glasgow Coma Scale score of E3V5M6, a pulse of 80 beats/min, a respiratory rate of 24 breaths/min, an SpO2 of 98% (room air), and a body temperature of 37.5°C. She complained of general weakness, dysarthria, and numbness in her hands and fingers but denied headache and dizziness. Physical examination revealed tetany-like stiffness of fingers and intention tremor in both hands. On neurological examination, she exhibited dysarthria with slight drooping of the left side of the mouth but no obvious facial palsy. She experienced difficulty remaining in a seated position and gait disturbance, but no obvious paralysis was noted. Further detailed neurological examination was not possible due to her altered state of consciousness. Laboratory tests revealed a white blood cell count of 3,800/µL and a C-reactive protein level of 75.9 mg/L.
Brain MRI performed at admission revealed a round diffusion-restricted lesion in the splenium of the corpus callosum on diffusion-weighted imaging and a slight decrease in ADC value in the same lesion on an ADC map (Figure 1). As no other intracranial signal changes were observed, CLOCCs were suspected, and additional investigative tests, such as cerebrospinal fluid examination, were withheld and follow-up was selected. A chest-computed tomography (CT) scan revealed no pneumonia or other abnormal findings.
Figure 1Brain magnetic resonance imaging on day 2 (A and B) and day 12 (C and D)
After admission, the patient was treated with 1000 mL/day of intravenous fluids and 800 mg of molnupiravir orally twice a day for 5 days, and the fever resolved after the third day. On Day 4, her neurological symptoms resolved, she was able to walk, and oral ingestion became possible. After admission, she developed cough, but her oxygenation capability did not deteriorate, and she was discharged after a 10-day isolation. On Day 12, the patient was reexamined, and a brain MRI revealed that the lesion in the splenium of the corpus callosum had completely disappeared (Figure 1). Based on the clinical course and imaging changes, a diagnosis of CLOCCs associated with COVID-19 was confirmed.
3. Literature review
This case shows that CLOCCs can occur even in non-severe COVID-19 cases in the very early phase. An article that reviewed nine case reports of COVID-19-associated CLOCCs found no similar cases of this type (
COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2.
). The clinical characteristics and severity of CLOCCs in cases of coronavirus infection, including COVID-19, are not fully understood. Therefore, a literature review was performed using PubMed. This is currently the most complete review of case reports and case series on CLOCCs associated with coronaviruses.
3.1 Methods
We searched the PubMed electronic database with no language restrictions from inception through March 2022 to identify cases of patients with coronavirus infection complicated by isolated CLOCCs. The inclusion criteria were cases of solitary lesions that met the definition proposed by Starky et al., regardless of which terms, such as CLOCCs/MERS/RESLES/transient splenic lesions, were used to describe the lesions (
). Cases of intracranial lesions in addition to corpus callosum lesions were excluded. The detailed search terms are shown in Supplementary Table 2.
We included case reports, case series, and other descriptive studies in which patient background and/or clinical course could be extracted, even partially, in addition to MRI findings. Reviews of previously published cases were excluded to avoid duplication of cases. Letters to the editor were included. In addition, the references cited in previously published reports were also reviewed.
3.2 Search results
No reports associated with the previously known four human coronaviruses (229E, OC43, NL63, and HKU1), severe acute respiratory syndrome coronavirus (SARS-CoV or SARS-CoV-1), or Middle East respiratory syndrome coronavirus (MERS-CoV) were found through the literature search. In contrast, we identified 29 cases of CLOCCs (15 case reports and 11 case series) associated with COVID-19 (Supplementary Table 3). Details of the 30 cases, including our report, are summarized in Table 1 and are described below.
Table 1A Summary of individual cases reporting COVID-19-associated CLOCCs/MERS/RESLES in order of patient age.
First author
Article type
Country
Patient age/gender
Risk
Diagnosis
SARS-CoV-2 PCR
SARS-CoV-2 serology
Time between reported COVID-19 symptoms and onset of CLOCCs (days)
Hypoxemia (oxygen saturation ≤ 94% on room air)
Pneumonia
CRP (mg/L)
Na (mmol/L)
Overall outcome
ID 1
Hayashi M
CR
Japan
75/M
Alzheimer's disease
C
Positive for oropharyngeal swab
NR
A few
+
+
53.2
Normal
Died due to respiratory failure
ID 2
Kakadia B
CR
United States
69/M
Hypertension
C
Negative for nasopharyngeal swab
Positive IgA/IgG
NR
NR
NR
503.2
NR
Resloved
(our case)
Kubo M
CR
Japan
61/F
Asthma
C
Positive for nasopharyngeal swab
NR
1
-
-
75.9
129
Resloved, discharged
ID 3
El Aoud S
CR
France
60/M
Dyslipidemia
C
Negative for oropharyngeal swab
Positive IgG
9
-
+
50
NR
Improved
ID 4
Usta NC
CS
Turkey
57/M
Hypertension, diabetes
C
NR
NR
NR
NR
+
NR
NR
Recovered
ID 5
Forestier G
CR
France
55/M
None
C
Positive for nasopharyngeal swab
NR
NR
NR
+
8.1
Normal
NR
ID 6
Edjlali M
CS
France
51/M
NR
C
Positive for nasopharyngeal swab
NR
NR
NR
NR
NR
NR
NR
ID 7
Esra Demir
CR
Turkey
50/M
None
C
Positive for nasopharyngeal and oropharyngeal swab
NR
0
-
+
170
NR
Resolved, discharged
ID 8
Klironomos S
CS
Sweden
late 40s/F
NR
C
NR
NR
NR
NR
NR
NR
NR
NR
ID 9
Edjlali M
CS
France
49/M
NR
C
Positive for nasopharyngeal swab
NR
NR
NR
NR
NR
NR
NR
ID 10
Eren F
CR
Turkey
47/M
None
C
Positive for nasopharyngeal swab
NR
5
-
+
14.2
NR
Recovered completely, discharged
ID 11
Chauffier J
CR
France
47/M
None
C
Positive for nasopharyngeal swab
NR
13
+
+
171
Hyponatremia
Improved, discharged
ID 12
Micci L
CR
United States
45/M
None
C
Positive
NR
4
+
+
NR
NR
Discharged
ID 13
Chevalier K
CR
France
45/M
None
C
NR
NR
3
NR
NR
NR
NR
Recovered, discharged
ID 14
Arıkan FA
CR
Turkey
43/M
None
C
Positive for nasopharyngeal swab
NR
5
NR
+
94
NR
Recovered
ID 15
DE Oliveira FAA
CR
Brazil
40/M
NR
C
Positive for nasal swab
NR
4
NR
NR
NR
NR
Improved
ID 16
Usta NC
CS
Turkey
38/M
None
C
Positive
NR
3≦
NR
+
NR
NR
NR
ID 17
Benameur K
CS
United States
34/M
Hypertension
C
NR
Positive IgM/IgG
8
+
+
NR
NR
NR
ID 18
Sen M
CR
Turkey
33/F
NR
C
Negative
Positive IgM
NR
NR
+
123
Normal
Improved, discharged
ID 19
Moreau A
CR
Belgium
26/M
None
C
Negative for nasopharyngeal swab
Positive IgG
2
-
+
200
NR
Improved
ID 20
Elkhaled W
CR
Qatar
23/M
None
C
Positive for nasopharyngeal swab
NR
0
+
ARDS
379.8
137
Died due to multiple organ failure
ID 21
Aksu Uzunhan T
CS
Turkey
16/M
None
C
Positive
NR
NR
NR
NR
45
138
NR
ID 22
Elmas B
CS
Brazil
15/M
NR
C
Positive
Positive IgM/IgG
2
NR
-
7.64
NR
Recovered
ID 23
Abdel-Mannan O
CS
United Kingdom
15/F
NR
MIS-C
Positive for nasopharyngeal swab
Positive IgG
5
NR
NR
328
Normal
Resolved, fully ambulant
ID 24
Çetin H
CS
Turkey
14/M
NR
C
Positive
NR
NR
NR
NR
NR
NR
Recovered
ID 25
Ucan B
CS
Turkey
14/M
None
MIS-C
NR
NR
NR
NR
NR
NR
NR
NR
ID 26
Lin J
CR
United States
13/M
None
MIS-C
Positive
NR
3
-
-
109
128
Recovering
ID 27
Gaur P
CS
United Kingdom
12/M
NR
MIS-C
Negative for 2 nasopharyngeal swabs
Positive IgG
5
+
NR
Elevated
NR
Recovered, discharged
ID 28
Çelebi Y
CR
Turkey
11/M
None
MIS-C
Negative for 2 nasal swab
Positive IgG
2
NR
-
Elevated
Hyponatremia
Recovered
ID 29
Bektaş G
CS
Turkey
10/M
None
MIS-C
Negative
Positive IgM/IgG
2
-
-
392
133
Recovered completely, discharged
First author
Neurological symptoms
Olfactory and taste dysfunction
CT
MRI DWI Findings (days since first neurological symptoms)
CSF
Neurological symptoms (days since CLOCCs occurred)
MRI (days since first imaging)
Neuroradiological terms
ID 1
Hayashi M
Alerted consciousness, ataxia, kinetic tremor in his hands, walking instability, urinary incontinence
Normal
NR
(a) (a few days)
Not performed
Partially improved (neurological deficit and cerebellar ataxia had resolved on admission day 2), but died due to respiratory failure
NR
MERS
ID 2
Kakadia B
Disorientation, inattention, and bradyphrenia without focal deficits.
3.3 Geographic location, age, sex, and underlying conditions
The reporting countries were in Europe and the Middle East (22 cases), North and South America (6 cases), and Asia (2 cases), with the largest number of cases in Turkey (11 cases). Of interest, a literature search of MERS case reports from the pre-COVID-19 era showed that most reports originated in Asia, while fewer were from Western countries, but the reasons for this difference are unclear (
The median age of the patients was 40 (range, 10-75) years: of 26 males and 4 females, 22 were ≥16 years and 8 were <16 years. Fifteen of the 21 cases in which past medical or psychiatric history was mentioned were healthy subjects with no specific history.
3.4 Neuroradiological characteristics
Neurological symptoms (including duplication) in 30 cases included altered consciousness (including cognitive impairment, confusion, delirium, lethargy, coma, or personality changes) in 20 cases, ataxia in 5 cases, hallucinations (auditory or visual, etc.) in 3 cases, dysarthria in 2 cases, and suicidal ideation in 1 case; none had seizures and one case was asymptomatic. A case was reported as a psychiatric emergency in which the initial diagnosis was mania, which was later found to be COVID-19-associated CLOCCs (
). Brain CT findings were reported in four cases and were normal. Cerebrospinal fluid analyses were reported in 12 cases and were normal in 11 cases.
MRI findings revealed a small round or oval lesion in the middle of the corpus callosum (image pattern (a) from the article by Starkey et al.) in 28 of 30 patients, and a lesion extending laterally via callosal fibers into the adjacent white matter in addition to the above-mentioned lesion (image pattern (b) from the article by Starkey et al.) in two patients (
The course of neurological symptoms improved in 18 cases and partially improved in two cases (one died of respiratory failure), but the symptom course was not described for eight cases. In most cases that experienced improvement, symptoms resolved within a few days up to a week. Another patient died of multi-organ failure before an assessment was performed, while the other had symptoms that were unchanged. A repeat MRI revealed that the lesion completely disappeared in 17 cases. These findings are consistent with reports that most patients improved within a week in the pre-COVID-19 era, although reversibility is not necessary for a diagnosis of CLOCCs (
The neuroradiological diagnosis terms (with duplicates) referred to in the 30 case reports varied from CLOCCs in 16 cases to MERS in 13 cases, RESLES in 3 cases, and other in 7 cases. Only one case other than ours mentioned all three terms (
). This requires caution when reviewing previous publications. Sriwastava et al. reviewed nine cases of CLOCCs in their literature search up to March 2021, but we found eight more cases reported under terms other than CLOCCs published during the same period (
COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2.
Lesions of the corpus callosum associated with COVID-19 have been reported to be caused by acute disseminated encephalomyelitis, reversible posterior leukoencephalopathy syndrome, parts of other cerebral infarction lesions, and micro-bleeding (
Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19).
). The first three are usually accompanied by CNS lesions other than those in the corpus callosum, while the latter microhemorrhages could occur in critically-ill patients who undergo mechanical ventilation and/or extracorporeal membrane oxygenation (
Distinct pattern of microsusceptibility changes on brain magnetic resonance imaging (MRI) in critically ill patients on mechanical ventilation/oxygenation.
); however, all these lesions can be differentiated by integrated clinical judgment in context and imaging findings.
Ischemic stroke is a common complication of COVID-19, which raises the issue of differential diagnosis of ischemic stroke in patients presenting with CLOCC-like MRI patterns. As life-long antiplatelet therapy is considered in ischemic stroke, it is important to recognize CLOCCs from the clinical management point of view. While it is difficult to differentiate between hyperacute stroke and CLOCCs based solely on MRI findings of the corpus callosum within the first 24 hours of onset, it can be helpful to focus on whether there are lesions other than the corpus callosum that are suggestive of cerebral infarction. This is due to the anatomical characteristics that the corpus callosum has multiple perfusion systems and a solitary lesion in the corpus callosum is exceedingly rarely caused by ischemia (
Dhillon, P. S., & Lenthall, R. (2020). Letter by Dhillon and Lenthall Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032156
Sparr, S. A., & Bieri, P. (2020). Response by Sparr and Bieri to Letter Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032521
). The blood supply of the corpus callosum comes from both the anterior and posterior circulation and has developed collateral circulation. If a corpus callosum lesion is caused by ischemia, ischemic lesions are often present in other parts of the brain. It is also important to note that cerebral infarction of the corpus callosum is a condition that occurs in the elderly with vascular risk factors. A study of 127 cases of cerebral infarction of the corpus callosum, including 21 cases of pure corpus callosum infarction, found that >90% of patients had stenosis or occlusion of large cerebral arteries and most of them had lesions in more than two vessels (
). In our case, the clinical decision was made not to commence antiplatelet therapy at the time of the initial presentation, as cerebral infarction was not suspected based on the patient's little vascular risk factors and the distribution of lesions. Furthermore, if it is difficult to differentiate in the early stages of onset, a repeat MRI is useful to detect changes over time consistent with cerebral infarction. Some reports have suggested that CLOCCs were suspected based on an observed low density in the corpus callosum on brain CT, but we do not believe that this finding is sufficient or characteristic enough to confirm a diagnosis of CLOCCs (
Dhillon, P. S., & Lenthall, R. (2020). Letter by Dhillon and Lenthall Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032156
). In contrast, the four cases reported as ischemic infarction of the corpus callosum with COVID-19 in the early phase of the pandemic were subsequently followed by multiple letters raising questions as to whether they were truly ischemic strokes (
Dhillon, P. S., & Lenthall, R. (2020). Letter by Dhillon and Lenthall Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032156
Sparr, S. A., & Bieri, P. (2020). Response by Sparr and Bieri to Letter Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032521
). Therefore, caution is advised when diagnosing a solitary lesion of the corpus callosum associated with COVID-19 as cerebral infarction.
In our review, we sought to clarify the typical clinico-radiological features of COVID-19-associated CLOCCs by excluding reported cases in which the diagnosis was uncertain or that did not meet Starkey's definition even if the authors had reported the case as CLOCCs (
). Abdel-Mannan et al. reported a case series of four children with COVID-19 and multisystem inflammatory syndrome in children (MIS-C); these patients showed lesions in the splenium of the corpus callosum, three of whom did not exhibit findings consistent with CLOCCs, as the lesions were either not diffusion-restricted on MRI or they were present in areas in addition to the corpus callosum (
). We are unsure whether these cases are of similar or different pathophysiology to CLOCCs, but they may provide clues for further research.
3.5 COVID-19 status/severity and CLOCCs
COVID-19 diagnosis was based on PCR positive result in 18 cases and serodiagnosis in 8 cases but was unreported in 4 cases.
Of the 30 cases, 22 patients aged 16 years and older had developed CLOCCs during the course of COVID-19. In the 15 cases where the course was reported, the median time between the onset of COVID-19 and that of CLOCCs was 3 days (range, 0–13 days). Of the 15 cases, 14 were complicated by pneumonia or hypoxemia, and five received ventilation or critical care. Only our case was not complicated by pneumonia or hypoxemia.
Moreover, of eight cases under 16 years of age, six were complicated by COVID-19-associated MIS-C. The median time between the onset of MIS-C and the onset of CLOCCs was 3 days (range, 2–5 days). CLOCCs developed during the course of COVID-19 in the remaining two cases.
Thus, CLOCCs associated with COVID-19 were primarily reported in adults with pneumonia and in children with MIS-C, which occurred at a relatively early phase of the disease (median, 3 days). This is consistent with the assumption that the pathogenesis of CLOCCs involves nonspecific cytokines independent of triggers such as influenza (
Our case did not have pneumonia but presented with typical CLOCCs only one day after the onset of COVID-19. To our knowledge, this is the first report of CLOCCs in an adult with mild COVID-19. This suggests that COVID-19-associated CLOCCs can occur even at an early, non-severe stage.
This case was reported during the Omicron predominance period. The severity of COVID-19 has been reported to be much lower during this period (
Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods — United States, December 2020–January 2022.
). Thus, this case might reflect Omicron features. Meanwhile, sufficient information on the SARS-CoV-2 sublineage was unavailable from our literature review, with 28 cases submitted or published online by December 2021 and one published online in February 2022. As the first case of Omicron was reported from South Africa to the World Health Organisation on November 24, 2021, it is presumed that these cases were reported before its emergence.
This study has some limitations. This is a single-case report, and we could not examine the sublineage in this case. Furthermore, the literature review of case reports and case series inevitably contains reporting biases and missing information. Therefore, it is unclear whether this case represented a rare phenotype of the broad spectrum of COVID-19-associated CLOCCs or whether it could be more common in the relatively less severe Omicron or future prevalent strains. Thus, further studies are needed to fully understand the pathophysiology and severity of COVID-19-associated CLOCCs, including those of mild cases.
4. Summary
We reported a case in which the diagnosis of CLOCCs was reached by MRI performed to differentiate cerebellar infarction when the patient presented to the emergency department the day after a fever. In patients with COVID-19, CLOCCs may easily be underdiagnosed if MRI scans are not performed, given that most mild cases are treated at home, the need for infection control raises the threshold for MRI scans, and CLOCCs have the characteristic of neurological symptoms that improve within several days. Appropriate diagnosis could prevent unnecessary further invasive testing, such as cerebrospinal fluid testing, and lead to the initiation of infection control measures in undiagnosed COVID-19 cases. During the COVID-19 pandemic, clinicians should be mindful of COVID-19-associated CLOCCs as a differential diagnosis in patients presenting with altered consciousness/personality or ataxia, even in cases of mild illness.
Global Incidence of Neurological Manifestations among Patients Hospitalized with COVID-19 - A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium.
Dhillon, P. S., & Lenthall, R. (2020). Letter by Dhillon and Lenthall Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032156
A 23-year-old man with SARS-CoV-2 infection who presented with auditory hallucinations and imaging findings of cytotoxic lesions of the corpus callosum (CLOCC).
Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19).
Trends in Disease Severity and Health Care Utilization During the Early Omicron Variant Period Compared with Previous SARS-CoV-2 High Transmission Periods — United States, December 2020–January 2022.
Sparr, S. A., & Bieri, P. (2020). Response by Sparr and Bieri to Letter Regarding Article, “infarction of the Splenium of the Corpus Callosum in the Age of COVID-19: A Snapshot in Time.” In Stroke. https://doi.org/10.1161/STROKEAHA.120.032521
COVID-19 and neuroinflammation: a literature review of relevant neuroimaging and CSF markers in central nervous system inflammatory disorders from SARS-COV2.
Distinct pattern of microsusceptibility changes on brain magnetic resonance imaging (MRI) in critically ill patients on mechanical ventilation/oxygenation.
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