RESUMEN
OBJECTIVE: To assess FDG cerebral PET in patients suffering from cognitive impairment linked to Long COVID. The COVID pandemic has affected dozens of millions of people around the world and has resulted in the deaths of more than 3 million people. Following the acute forms, it has been reported sometimes long forms of COVID, with involvements of several organs including the brain. Neurological complications can include cognitive disturbances (brain fog) that are very common and can seriously disturb the life of patients. METHODS: Fluorodeoxyglucose PETs were performed in 3 patients with cognitive decline following COVID infection. RESULTS: We report here 3 cases of brain fog with major hypometabolic areas of the pons revealed by the cerebral FDG PET. CONCLUSION: The dysfunction of the locus coeruleus in these patients could partly explain the cognitive disorders observed. Further studies involving larger cohorts of patients suffering from cognitive dysfunction will be needed to determine if the brainstem is frequently affected in these patients.
Asunto(s)
COVID-19 , Disfunción Cognitiva , Encéfalo/diagnóstico por imagen , Tronco Encefálico/diagnóstico por imagen , COVID-19/complicaciones , COVID-19/diagnóstico por imagen , Disfunción Cognitiva/diagnóstico por imagen , Disfunción Cognitiva/etiología , Fluorodesoxiglucosa F18 , Humanos , Tomografía de Emisión de Positrones , Radiofármacos , Síndrome Post Agudo de COVID-19RESUMEN
In the context of delayed autoimmune encephalitis antibody results, functional imaging can support the diagnosis of limbic encephalitis associated with anti-voltage-gated potassium channel complex (VGKCC) antibodies. Here we present a typical case of VGKCC encephalitis in a 69-year-old woman whose symptoms responded to plasmapheresis. A cerebral 18F-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET) scan performed prior to commencing treatment revealed striatal hypermetabolism assessed qualitatively and semi-quantitatively, with normal uptake in the cortex and cerebellum when analysed semi-quantitatively. Repeat FDG-PET imaging performed three months later revealed normalisation of striatal hypermetabolism. Previous case reports have described striatal hypermetabolism and/or cortical hypometabolism in patients with VGKCC encephalitis. However, most of these descriptions were based on qualitative analyses only and may represent the relative change in cortical metabolism compared with striatal metabolism. We recommend semi-quantitative analysis of cerebral FDG-PET, in addition to reporting the qualitative FDG-PET images.
Asunto(s)
Cuerpo Estriado/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Encefalitis Límbica , Tomografía de Emisión de Positrones , Anciano , Anticuerpos/sangre , Corteza Cerebral/diagnóstico por imagen , Femenino , Humanos , Encefalitis Límbica/diagnóstico por imagen , Encefalitis Límbica/inmunología , Encefalitis Límbica/patología , Canales de Potasio con Entrada de Voltaje/inmunologíaRESUMEN
BACKGROUND: Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is a frequent and severe cause of encephalitis in children with potential efficient treatment (immunotherapy). Suggestive clinical features are behavioural troubles, seizures and movement disorders. Prompt diagnosis and treatment initiation are needed to guarantee favourable outcome. Nevertheless, diagnosis may be challenging because of the classical ancillary test (magnetic resonance imaging (MRI), electroencephalogram, standard cerebro-spinal fluid analysis) have limited sensitivity. Currently, immunological analyses are needed for the diagnostic confirmation. In adult patients, some studies suggested a potential role of cerebral (18)FluoroDeoxy-Glucose Positron Emission Tomography (FDG-PET) in the evaluation of anti-NMDAR encephalitis. Nevertheless, almost no data exist in paediatric population. METHOD: We report retrospectively clinical, ancillary tests and cerebral FDG-PET data in 6 young patients (median age=10.5 years, 4 girls) with immunologically confirmed anti-NMDAR encephalitis. RESULTS: Our patients presented classical clinical features of anti-NMDAR encephalitis with severe course (notably four patients had normal MRI). Our series shows the feasibility and the good sensitivity of cerebral FDG-PET (6/6 patients with brain metabolism alteration) in paediatric population. We report some particular features in this population: extensive, symmetric cortical hypometabolism especially in posterior areas; asymmetric anterior focus of hypermetabolism; and basal ganglia hypermetabolism. We found also a good correlation between the clinical severity and the cerebral metabolism changes. Moreover, serial cerebral FDG-PET showed parallel brain metabolism and clinical improvement. CONCLUSION: Our study reveals the existence of specific patterns of brain metabolism alteration in anti-NMDAR encephalitis in paediatric population.