Acutely altered mental status as the main clinical presentation of multiple strokes in critically ill patients with COVID-19.
Identifieur interne : 000956 ( Main/Exploration ); précédent : 000955; suivant : 000957Acutely altered mental status as the main clinical presentation of multiple strokes in critically ill patients with COVID-19.
Auteurs : Carolina Díaz-Pérez [Espagne] ; Carmen Ramos [Espagne] ; Alberto L Pez-Cruz [Espagne] ; José Mu Oz Olmedo [Espagne] ; Jimena Lázaro González [Espagne] ; Enrique De Vega-Ríos [Espagne] ; Carmen González-Ávila [Espagne] ; Carlos Hervás [Espagne] ; Santiago Trillo [Espagne] ; José Vivancos [Espagne]Source :
- Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology [ 1590-3478 ] ; 2020.
Descripteurs français
- KwdFr :
- Adulte d'âge moyen (MeSH), Betacoronavirus (MeSH), Confusion (imagerie diagnostique), Confusion (psychologie), Confusion (étiologie), Humains (MeSH), Infections à coronavirus (complications), Infections à coronavirus (imagerie diagnostique), Infections à coronavirus (psychologie), Maladie aigüe (MeSH), Maladie grave (psychologie), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (complications), Pneumopathie virale (imagerie diagnostique), Pneumopathie virale (psychologie), Sujet âgé (MeSH).
- MESH :
- imagerie diagnostique : Confusion, Infections à coronavirus, Pneumopathie virale.
- psychologie : Confusion, Infections à coronavirus, Maladie grave, Pneumopathie virale.
- étiologie : Confusion.
- complications : Adulte d'âge moyen, Betacoronavirus, Humains, Infections à coronavirus, Maladie aigüe, Mâle, Pandémies, Pneumopathie virale, Sujet âgé.
English descriptors
- KwdEn :
- Acute Disease (MeSH), Aged (MeSH), Betacoronavirus (MeSH), Confusion (diagnostic imaging), Confusion (etiology), Confusion (psychology), Coronavirus Infections (complications), Coronavirus Infections (diagnostic imaging), Coronavirus Infections (psychology), Critical Illness (psychology), Humans (MeSH), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (complications), Pneumonia, Viral (diagnostic imaging), Pneumonia, Viral (psychology).
- MESH :
- complications : Coronavirus Infections, Pneumonia, Viral.
- diagnostic imaging : Confusion, Coronavirus Infections, Pneumonia, Viral.
- etiology : Confusion.
- psychology : Confusion, Coronavirus Infections, Critical Illness, Pneumonia, Viral.
- Acute Disease, Aged, Betacoronavirus, Humans, Male, Middle Aged, Pandemics.
Abstract
BACKGROUND AND AIMS
Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes.
METHODS
Clinical presentation and diagnostic work-up of the patients.
RESULTS
Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (case 1: affecting the left frontal and temporal lobes and both occipital lobes; case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes.
CONCLUSION
Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.
DOI: 10.1007/s10072-020-04679-w
PubMed: 32808174
PubMed Central: PMC7431112
Affiliations:
Links toward previous steps (curation, corpus...)
Le document en format XML
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uniqKey="Diaz Perez C" first="Carolina" last="Díaz-Pérez">Carolina Díaz-Pérez</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain. carodipez@gmail.com.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Neurology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Ramos, Carmen" sort="Ramos, Carmen" uniqKey="Ramos C" first="Carmen" last="Ramos">Carmen Ramos</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Neurology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="L Pez Cruz, Alberto" sort="L Pez Cruz, Alberto" uniqKey="L Pez Cruz A" first="Alberto" last="L Pez-Cruz">Alberto L Pez-Cruz</name><affiliation wicri:level="3"><nlm:affiliation>Department of Psychiatry, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Psychiatry, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Mu Oz Olmedo, Jose" sort="Mu Oz Olmedo, Jose" uniqKey="Mu Oz Olmedo J" first="José" last="Mu Oz Olmedo">José Mu Oz Olmedo</name><affiliation wicri:level="3"><nlm:affiliation>Neuroradiology Unit, Department of Radiology, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Neuroradiology Unit, Department of Radiology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Lazaro Gonzalez, Jimena" sort="Lazaro Gonzalez, Jimena" uniqKey="Lazaro Gonzalez J" first="Jimena" last="Lázaro González">Jimena Lázaro González</name><affiliation wicri:level="3"><nlm:affiliation>Intensive Care Unit, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Intensive Care Unit, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="De Vega Rios, Enrique" sort="De Vega Rios, Enrique" uniqKey="De Vega Rios E" first="Enrique" last="De Vega-Ríos">Enrique De Vega-Ríos</name><affiliation wicri:level="3"><nlm:affiliation>Department of Internal Medicine, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Internal Medicine, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Gonzalez Vila, Carmen" sort="Gonzalez Vila, Carmen" uniqKey="Gonzalez Vila C" first="Carmen" last="González-Ávila">Carmen González-Ávila</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Neurology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Hervas, Carlos" sort="Hervas, Carlos" uniqKey="Hervas C" first="Carlos" last="Hervás">Carlos Hervás</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Neurology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Trillo, Santiago" sort="Trillo, Santiago" uniqKey="Trillo S" first="Santiago" last="Trillo">Santiago Trillo</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Neurology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Vivancos, Jose" sort="Vivancos, Jose" uniqKey="Vivancos J" first="José" last="Vivancos">José Vivancos</name><affiliation wicri:level="3"><nlm:affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Department of Neurology, La Princesa University Hospital, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author></analytic><series><title level="j">Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology</title><idno type="eISSN">1590-3478</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Acute Disease (MeSH)</term><term>Aged (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Confusion (diagnostic imaging)</term><term>Confusion (etiology)</term><term>Confusion (psychology)</term><term>Coronavirus Infections (complications)</term><term>Coronavirus Infections (diagnostic imaging)</term><term>Coronavirus Infections (psychology)</term><term>Critical Illness (psychology)</term><term>Humans (MeSH)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>Pandemics (MeSH)</term><term>Pneumonia, Viral (complications)</term><term>Pneumonia, Viral (diagnostic imaging)</term><term>Pneumonia, Viral (psychology)</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte d'âge moyen (MeSH)</term><term>Betacoronavirus (MeSH)</term><term>Confusion (imagerie diagnostique)</term><term>Confusion (psychologie)</term><term>Confusion (étiologie)</term><term>Humains (MeSH)</term><term>Infections à coronavirus (complications)</term><term>Infections à coronavirus (imagerie diagnostique)</term><term>Infections à coronavirus (psychologie)</term><term>Maladie aigüe (MeSH)</term><term>Maladie grave (psychologie)</term><term>Mâle (MeSH)</term><term>Pandémies (MeSH)</term><term>Pneumopathie virale (complications)</term><term>Pneumopathie virale (imagerie diagnostique)</term><term>Pneumopathie virale (psychologie)</term><term>Sujet âgé (MeSH)</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="en"><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="diagnostic imaging" xml:lang="en"><term>Confusion</term><term>Coronavirus Infections</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="etiology" xml:lang="en"><term>Confusion</term></keywords><keywords scheme="MESH" qualifier="imagerie diagnostique" xml:lang="fr"><term>Confusion</term><term>Infections à coronavirus</term><term>Pneumopathie virale</term></keywords><keywords scheme="MESH" qualifier="psychologie" xml:lang="fr"><term>Confusion</term><term>Infections à coronavirus</term><term>Maladie grave</term><term>Pneumopathie virale</term></keywords><keywords scheme="MESH" qualifier="psychology" xml:lang="en"><term>Confusion</term><term>Coronavirus Infections</term><term>Critical Illness</term><term>Pneumonia, Viral</term></keywords><keywords scheme="MESH" qualifier="étiologie" xml:lang="fr"><term>Confusion</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Acute Disease</term><term>Aged</term><term>Betacoronavirus</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Pandemics</term></keywords><keywords scheme="MESH" qualifier="complications" xml:lang="fr"><term>Adulte d'âge moyen</term><term>Betacoronavirus</term><term>Humains</term><term>Infections à coronavirus</term><term>Maladie aigüe</term><term>Mâle</term><term>Pandémies</term><term>Pneumopathie virale</term><term>Sujet âgé</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>BACKGROUND AND AIMS</b></p><p>Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>Clinical presentation and diagnostic work-up of the patients.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (case 1: affecting the left frontal and temporal lobes and both occipital lobes; case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSION</b></p><p>Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32808174</PMID><DateCompleted><Year>2020</Year><Month>09</Month><Day>15</Day></DateCompleted><DateRevised><Year>2020</Year><Month>09</Month><Day>15</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1590-3478</ISSN><JournalIssue CitedMedium="Internet"><Volume>41</Volume><Issue>10</Issue><PubDate><Year>2020</Year><Month>Oct</Month></PubDate></JournalIssue><Title>Neurological sciences : official journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology</Title><ISOAbbreviation>Neurol Sci</ISOAbbreviation></Journal><ArticleTitle>Acutely altered mental status as the main clinical presentation of multiple strokes in critically ill patients with COVID-19.</ArticleTitle><Pagination><MedlinePgn>2681-2684</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1007/s10072-020-04679-w</ELocationID><Abstract><AbstractText Label="BACKGROUND AND AIMS" NlmCategory="OBJECTIVE">Cerebral infarction in COVID-19 patients might be associated with a hypercoagulable state related to a systemic inflammatory response. Its diagnosis might be challenging. We present two critically ill patients with COVID-19 who presented acutely altered mental status as the main manifestation of multiple strokes.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">Clinical presentation and diagnostic work-up of the patients.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">Two patients in their sixties were hospitalized with a bilateral pneumonia COVID-19. They developed respiratory failure and were admitted to ICU for mechanical ventilation and intense medical treatment. They were started on low-molecular-weight heparin since admission. Their laboratory results showed lymphopenia and increased levels of C-reactive protein and D-dimer. Case 1 developed hypofibrinogenemia and presented several cutaneous lesions with biopsy features of thrombotic vasculopathy. Case 2 was performed a CT pulmonary angiogram at ICU showing a bilateral pulmonary embolism. When waking up, both patients were conscious but with a remarkable global altered mental status without focal neurological deficits. A brain MRI revealed multiple acute bilateral ischemic lesions with areas of hemorrhagic transformation in both patients (case 1: affecting the left frontal and temporal lobes and both occipital lobes; case 2: affecting both frontal and left occipital lobes). Cardioembolic source and acquired antiphospholipid syndrome were ruled out. COVID-19-associated coagulopathy was suspected as the possible main etiology of the strokes.</AbstractText><AbstractText Label="CONCLUSION" NlmCategory="CONCLUSIONS">Acutely altered mental status might be the main manifestation of multiple brain infarctions in critically ill COVID-19 patients. It should be specially considered in those with suspected COVID-19-associated coagulopathy. Full-dose anticoagulation and clinical-radiological monitoring might reduce their neurological consequences.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Díaz-Pérez</LastName><ForeName>Carolina</ForeName><Initials>C</Initials><Identifier Source="ORCID">http://orcid.org/0000-0003-3661-5368</Identifier><AffiliationInfo><Affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain. carodipez@gmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Ramos</LastName><ForeName>Carmen</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>López-Cruz</LastName><ForeName>Alberto</ForeName><Initials>A</Initials><AffiliationInfo><Affiliation>Department of Psychiatry, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Muñoz Olmedo</LastName><ForeName>José</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Neuroradiology Unit, Department of Radiology, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Lázaro González</LastName><ForeName>Jimena</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Intensive Care Unit, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>De Vega-Ríos</LastName><ForeName>Enrique</ForeName><Initials>E</Initials><AffiliationInfo><Affiliation>Department of Internal Medicine, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>González-Ávila</LastName><ForeName>Carmen</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Hervás</LastName><ForeName>Carlos</ForeName><Initials>C</Initials><AffiliationInfo><Affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Trillo</LastName><ForeName>Santiago</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Vivancos</LastName><ForeName>José</ForeName><Initials>J</Initials><AffiliationInfo><Affiliation>Department of Neurology, La Princesa University Hospital, Madrid, Spain.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D002363">Case Reports</PublicationType><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2020</Year><Month>08</Month><Day>17</Day></ArticleDate></Article><MedlineJournalInfo><Country>Italy</Country><MedlineTA>Neurol Sci</MedlineTA><NlmUniqueID>100959175</NlmUniqueID><ISSNLinking>1590-1874</ISSNLinking></MedlineJournalInfo><SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName><SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName></SupplMeshList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000208" MajorTopicYN="N">Acute Disease</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D003221" MajorTopicYN="N">Confusion</DescriptorName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000209" MajorTopicYN="N">etiology</QualifierName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016638" MajorTopicYN="N">Critical Illness</DescriptorName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName><QualifierName UI="Q000150" MajorTopicYN="N">complications</QualifierName><QualifierName UI="Q000000981" MajorTopicYN="N">diagnostic imaging</QualifierName><QualifierName UI="Q000523" MajorTopicYN="Y">psychology</QualifierName></MeshHeading></MeshHeadingList><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">Acutely altered mental status</Keyword><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">Multiple strokes</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year><Month>05</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="accepted"><Year>2020</Year><Month>08</Month><Day>07</Day></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2020</Year><Month>8</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2020</Year><Month>9</Month><Day>17</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="entrez"><Year>2020</Year><Month>8</Month><Day>19</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>ppublish</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">32808174</ArticleId><ArticleId IdType="doi">10.1007/s10072-020-04679-w</ArticleId><ArticleId IdType="pii">10.1007/s10072-020-04679-w</ArticleId><ArticleId IdType="pmc">PMC7431112</ArticleId></ArticleIdList><ReferenceList><Reference><Citation>Thromb Haemost. 2020 Jun;120(6):998-1000</Citation><ArticleIdList><ArticleId IdType="pubmed">32316063</ArticleId></ArticleIdList></Reference><Reference><Citation>J Infect Public Health. 2020 May;13(5):667-673</Citation><ArticleIdList><ArticleId IdType="pubmed">32340833</ArticleId></ArticleIdList></Reference><Reference><Citation>Cerebrovasc Dis. 2020 Jul 20;:1-8</Citation><ArticleIdList><ArticleId IdType="pubmed">32690850</ArticleId></ArticleIdList></Reference><Reference><Citation>Br J Haematol. 2009 Apr;145(1):24-33</Citation><ArticleIdList><ArticleId IdType="pubmed">19222477</ArticleId></ArticleIdList></Reference><Reference><Citation>Curr Opin Neurol. 2002 Feb;15(1):51-5</Citation><ArticleIdList><ArticleId IdType="pubmed">11796951</ArticleId></ArticleIdList></Reference><Reference><Citation>Int J Stroke. 2020 Jul;15(5):540-554</Citation><ArticleIdList><ArticleId IdType="pubmed">32362244</ArticleId></ArticleIdList></Reference><Reference><Citation>J Thromb Haemost. 2020 May;18(5):1094-1099</Citation><ArticleIdList><ArticleId IdType="pubmed">32220112</ArticleId></ArticleIdList></Reference><Reference><Citation>JAMA Neurol. 2020 Apr 10;:</Citation><ArticleIdList><ArticleId IdType="pubmed">32275288</ArticleId></ArticleIdList></Reference><Reference><Citation>N Engl J Med. 2020 Jun 4;382(23):2268-2270</Citation><ArticleIdList><ArticleId IdType="pubmed">32294339</ArticleId></ArticleIdList></Reference><Reference><Citation>J Stroke Cerebrovasc Dis. 2020 Aug;29(8):104941</Citation><ArticleIdList><ArticleId IdType="pubmed">32689643</ArticleId></ArticleIdList></Reference></ReferenceList></PubmedData></pubmed><affiliations><list><country><li>Espagne</li></country><region><li>Communauté de Madrid</li></region><settlement><li>Madrid</li></settlement></list><tree><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Diaz Perez, Carolina" sort="Diaz Perez, Carolina" uniqKey="Diaz Perez C" first="Carolina" last="Díaz-Pérez">Carolina Díaz-Pérez</name></region><name sortKey="De Vega Rios, Enrique" sort="De Vega Rios, Enrique" uniqKey="De Vega Rios E" first="Enrique" last="De Vega-Ríos">Enrique De Vega-Ríos</name><name sortKey="Gonzalez Vila, Carmen" sort="Gonzalez Vila, Carmen" uniqKey="Gonzalez Vila C" first="Carmen" last="González-Ávila">Carmen González-Ávila</name><name sortKey="Hervas, Carlos" sort="Hervas, Carlos" uniqKey="Hervas C" first="Carlos" last="Hervás">Carlos Hervás</name><name sortKey="L Pez Cruz, Alberto" sort="L Pez Cruz, Alberto" uniqKey="L Pez Cruz A" first="Alberto" last="L Pez-Cruz">Alberto L Pez-Cruz</name><name sortKey="Lazaro Gonzalez, Jimena" sort="Lazaro Gonzalez, Jimena" uniqKey="Lazaro Gonzalez J" first="Jimena" last="Lázaro González">Jimena Lázaro González</name><name sortKey="Mu Oz Olmedo, Jose" sort="Mu Oz Olmedo, Jose" uniqKey="Mu Oz Olmedo J" first="José" last="Mu Oz Olmedo">José Mu Oz Olmedo</name><name sortKey="Ramos, Carmen" sort="Ramos, Carmen" uniqKey="Ramos C" first="Carmen" last="Ramos">Carmen Ramos</name><name sortKey="Trillo, Santiago" sort="Trillo, Santiago" uniqKey="Trillo S" first="Santiago" last="Trillo">Santiago Trillo</name><name sortKey="Vivancos, Jose" sort="Vivancos, Jose" uniqKey="Vivancos J" first="José" last="Vivancos">José Vivancos</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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