Introduction

Encephalopathy is a common complication of coronavirus disease 2019. Although the encephalopathy is idiopathic in many cases, there are several published reports of patients with posterior reversible encephalopathy syndrome in the setting of coronavirus disease 2019.

Objective

To describe the diverse presentations, risk factors, and outcomes of posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019.

Methods

We assessed patients with coronavirus disease 2019 and a diagnosis of posterior reversible encephalopathy syndrome at our institution from April 1 to June 24, 2020. We performed a literature search to capture all known published cases of posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019.

Results

There were 2 cases of posterior reversible encephalopathy syndrome in the setting of coronavirus 2019 at our institution during a 3-month period. One patient was treated with anakinra, an interleukin-1 inhibitor that may disrupt endothelial function. The second patient had an underlying human immunodeficiency virus infection. We found 13 total cases in our literature search, which reported modest blood pressure fluctuations and a range of risk factors for posterior reversible encephalopathy syndrome. One patient was treated with tocilizumab, an interleukin-6 inhibitor that may have effects on endothelial function. All patients had an improvement in their neurological symptoms. Interval imaging, when available, showed radiographic improvement of brain lesions.

Conclusions

Risk factors for posterior reversible encephalopathy syndrome in patients with coronavirus disease 2019 may include underlying infection or immunomodulatory agents with endothelial effects in conjunction with modest blood pressure fluctuations. We found that the neurological prognosis for posterior reversible encephalopathy syndrome in the setting of coronavirus disease 2019 infection is favorable. Recognition of posterior reversible encephalopathy syndrome in this patient population is critical for prognostication and initiation of treatment, which may include cessation of potential offending agents and tight blood pressure control.

中文翻译：

---

2019冠状病毒病患者可逆性后部脑病综合征：2例及文献复习

 介绍

脑病是 2019 年冠状病毒病的常见并发症。尽管在许多情况下脑病是特发性的，但有几份已发表的关于 2019 年冠状病毒病背景下可逆性后部脑病综合征患者的报告。

 客观的

描述 2019 年冠状病毒病患者可逆性后部脑病综合征的不同表现、危险因素和结果。

 方法

我们对2020年4月1日至6月24日在我们机构诊断为2019冠状病毒病和可逆性后部可逆性脑病综合征的患者进行了评估。我们进行了文献检索，以获取所有已知已发表的2019冠状病毒病患者中可逆性后部可逆性脑病综合征病例。

 结果

3 个月内，我们机构在 2019 年冠状病毒背景下出现了 2 例可逆性后部脑病综合征病例。一名患者接受了阿那白滞素（anakinra）治疗，阿那白滞素是一种白细胞介素 1 抑制剂，可能会破坏内皮功能。第二名患者患有潜在的人类免疫缺陷病毒感染。我们在文献检索中总共发现了 13 例病例，其中报告了适度的血压波动和一系列可逆性后部脑病综合征的危险因素。一名患者接受托珠单抗治疗，托珠单抗是一种白细胞介素 6 抑制剂，可能会影响内皮功能。所有患者的神经症状均有所改善。间隔成像（如果可用）显示脑部病变的放射学改善。

 结论

2019 年冠状病毒病患者发生可逆性后部脑病综合征的危险因素可能包括潜在感染或具有内皮效应的免疫调节剂以及适度的血压波动。我们发现，在 2019 年冠状病毒病感染的情况下，可逆性后部脑病综合征的神经学预后良好。识别该患者群体中的可逆性后部脑病综合征对于预测和开始治疗至关重要，其中可能包括停止潜在的致病药物和严格控制血压。