Cross-sectional case-control studies (Blue)
Twenty patients hospitalized with COVID-19 encephalopathy were included in this retrospective cohort study. The relationship between systemic inflammation, indexed by C-reactive protein (CRP), and brain microstructural changes in normal appearing white matter, measured by apparent diffusion coefficient (ADC), was investigated. The authors restricted their analysis to nine specific brain regions that have been previously known in the literature to be involved in delirium, including the genu and splenium of the corpus callosum, posterior thalamic radiation, anterior corona radiata, cingulum, uncinate fasciculus, hippocampal white matter, external capsule, and middle cerebellar peduncle. They also quantified the severity of the encephalopathy using the Richmond Agitation-Sedation scale (RASS) and recorded the duration of COVID-19 encephalopathy. The authors found that increased CRP was associated with increased ADC in the genu of the corpus callosum (p = 0.0064), anterior corona radiata (p = 0.0089), and external capsule (p = 0.0068). Analyses included age as a covariate and survived multiple comparisons correction. No correlation was found between CRP or ADC with RASS scores or encephalopathy duration. These findings are in keeping with previous findings showing that COVID-19 patients can present with a fronto-subcortical syndrome and show cytokine-induced injury in corpus callosum, corona radiata and external capsule.
Rhally A, Griffa A, Kremer S, Uginet M, Breville G, Stancu P, Assal F, Lalive PH, Lövblad KO, Allali G. C-reactive protein and white matter microstructural changes in COVID-19 patients with encephalopathy. J Neural Transm 128, 1899–1906 (2021). https://doi.org/10.1007/s00702-021-02429-6.