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Persistent visual dysfunction following posterior reversible encephalopathy syndrome due to COVID‐19: Case series and literature review
Author(s) -
Hixon Alison M.,
Thaker Ashesh A.,
Pelak Victoria S.
Publication year - 2021
Publication title -
european journal of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.881
H-Index - 124
eISSN - 1468-1331
pISSN - 1351-5101
DOI - 10.1111/ene.14965
Subject(s) - medicine , context (archaeology) , posterior reversible encephalopathy syndrome , encephalopathy , covid-19 , altered mental status , pediatrics , intervention (counseling) , hypertensive encephalopathy , intensive care medicine , psychiatry , magnetic resonance imaging , disease , paleontology , biology , blood pressure , infectious disease (medical specialty) , radiology
Background and purpose The full spectrum of neurological sequelae in COVID‐19 is beginning to emerge. SARS‐CoV‐2 has the potential to cause both direct and indirect brain vascular endothelial damage through infection and inflammation that may result in long‐term neurological signs and symptoms. We sought to illuminate persistent neuro‐ophthalmological deficits that may be seen following posterior reversible encephalopathy syndrome (PRES) due to COVID‐19. Methods We identified three individuals with PRES due to COVID‐19 in our hospital system. One patient was identified on presentation to our neuro‐ophthalmology clinic. The other patients were identified through internal records search. These cases were compared to published reports of PRES in COVID‐19 identified through systematic literature search of PubMed/LitCOVID. Results All three patients were hospitalized with severe COVID‐19 and developed altered mental status with new onset seizures that led to the recognition of PRES through diagnostic imaging. During recovery, two patients had persistent visual dysfunction including visual field deficits. One patient also experienced hallucinatory palinopsia and visual hallucinations. Literature search identified 32 other cases of PRES in the context of COVID‐19. Visual disturbances were described in 14 cases (40%), with only seven cases (50%) reporting full recovery by the time of publication. Conclusions As we learn about enduring neurological complications of COVID‐19, it is possible that complications may be underrecognized and underreported. Understanding the range of complications can help in postcare evaluation and management changes in the critical care setting to potentially allow intervention before persistent deficits occur due to COVID‐19.