Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV)
Identifieur interne : 000074 ( Pmc/Curation ); précédent : 000073; suivant : 000075Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV)
Auteurs : Y. M. Arabi ; A. Harthi [Arabie saoudite] ; J. Hussein [Arabie saoudite] ; A. Bouchama [Arabie saoudite] ; S. Johani [Arabie saoudite] ; A. H. Hajeer [Arabie saoudite] ; B. T. Saeed [Arabie saoudite] ; A. Wahbi [Arabie saoudite] ; A. Saedy [Arabie saoudite] ; T. Aldabbagh [Arabie saoudite] ; R. Okaili [Arabie saoudite] ; M. Sadat [Arabie saoudite] ; H. Balkhy [Arabie saoudite]Source :
- Infection [ 0300-8126 ] ; 2015.
Abstract
Since the identification of the first case of infection with the Middle East respiratory syndrome corona virus (MERS-CoV) in Saudi Arabia in June 2012, the number of laboratory-confirmed cases has exceeded 941 cases globally, of which 347 died. The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. These are so far the first reported cases of neurologic injury associated with MERS-CoV infection.
Data was retrospectively collected from three patients admitted with MERS-CoV infection to Intensive Care unit (ICU) at King Abdulaziz Medical City, Riyadh. They were managed separately in three different wards prior to their admission to ICU.
The three patients presented with severe neurologic syndrome which included altered level of consciousness ranging from confusion to coma, ataxia, and focal motor deficit. Brain MRI revealed striking changes characterized by widespread, bilateral hyperintense lesions on T2-weighted imaging within the white matter and subcortical areas of the frontal, temporal, and parietal lobes, the basal ganglia, and corpus callosum. None of the lesions showed gadolinium enhancement.
CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed.
The online version of this article (doi:10.1007/s15010-015-0720-y) contains supplementary material, which is available to authorized users.
Url:
DOI: 10.1007/s15010-015-0720-y
PubMed: 25600929
PubMed Central: 4521086
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Y. M. Arabi<affiliation><nlm:aff id="Aff1">Intensive Care Department, MC-1425, Respiratory Services, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia</nlm:aff><wicri:noCountry code="subfield">11426 Kingdom of Saudi Arabia</wicri:noCountry></affiliation>Le document en format XML
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Harthi</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Neuro Physiology Services, Neurology Division, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Neuro Physiology Services, Neurology Division, Department of Medicine, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Hussein, J" sort="Hussein, J" uniqKey="Hussein J" first="J." last="Hussein">J. Hussein</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Neuro Radiology Section, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Neuro Radiology Section, Medical Imaging Department, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Bouchama, A" sort="Bouchama, A" uniqKey="Bouchama A" first="A." last="Bouchama">A. Bouchama</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Intensive Care Unit, Experimental Medicine Department, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Intensive Care Unit, Experimental Medicine Department, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Johani, S" sort="Johani, S" uniqKey="Johani S" first="S." last="Johani">S. Johani</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Microbiology, Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Microbiology, Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Hajeer, A H" sort="Hajeer, A H" uniqKey="Hajeer A" first="A. H." last="Hajeer">A. H. Hajeer</name><affiliation wicri:level="1"><nlm:aff id="Aff6">Basic Medical Sciences, Microbiology, Pathology and Laboratory Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Basic Medical Sciences, Microbiology, Pathology and Laboratory Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Saeed, B T" sort="Saeed, B T" uniqKey="Saeed B" first="B. T." last="Saeed">B. T. Saeed</name><affiliation wicri:level="1"><nlm:aff id="Aff7">Cardiac Sciences Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Cardiac Sciences Department, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Wahbi, A" sort="Wahbi, A" uniqKey="Wahbi A" first="A." last="Wahbi">A. Wahbi</name><affiliation wicri:level="1"><nlm:aff id="Aff8">Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Saedy, A" sort="Saedy, A" uniqKey="Saedy A" first="A." last="Saedy">A. Saedy</name><affiliation wicri:level="1"><nlm:aff id="Aff9">Infectious Disease Section, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Infectious Disease Section, Department of Medicine, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Aldabbagh, T" sort="Aldabbagh, T" uniqKey="Aldabbagh T" first="T." last="Aldabbagh">T. Aldabbagh</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Intensive Care Unit, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Okaili, R" sort="Okaili, R" uniqKey="Okaili R" first="R." last="Okaili">R. Okaili</name><affiliation wicri:level="1"><nlm:aff id="Aff11">Neuro Radiology, Nuero Interventionalist, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Neuro Radiology, Nuero Interventionalist, Medical Imaging Department, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Sadat, M" sort="Sadat, M" uniqKey="Sadat M" first="M." last="Sadat">M. Sadat</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Intensive Care Unit, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Balkhy, H" sort="Balkhy, H" uniqKey="Balkhy H" first="H." last="Balkhy">H. Balkhy</name><affiliation wicri:level="1"><nlm:aff id="Aff12">Infection Prevention and Control Program, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Infection Prevention and Control Program, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">25600929</idno><idno type="pmc">4521086</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4521086</idno><idno type="RBID">PMC:4521086</idno><idno type="doi">10.1007/s15010-015-0720-y</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000074</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000074</idno><idno type="wicri:Area/Pmc/Curation">000074</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000074</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV)</title><author><name sortKey="Arabi, Y M" sort="Arabi, Y M" uniqKey="Arabi Y" first="Y. M." last="Arabi">Y. M. Arabi</name><affiliation><nlm:aff id="Aff1">Intensive Care Department, MC-1425, Respiratory Services, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia</nlm:aff><wicri:noCountry code="subfield">11426 Kingdom of Saudi Arabia</wicri:noCountry></affiliation></author><author><name sortKey="Harthi, A" sort="Harthi, A" uniqKey="Harthi A" first="A." last="Harthi">A. Harthi</name><affiliation wicri:level="1"><nlm:aff id="Aff2">Neuro Physiology Services, Neurology Division, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Neuro Physiology Services, Neurology Division, Department of Medicine, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Hussein, J" sort="Hussein, J" uniqKey="Hussein J" first="J." last="Hussein">J. Hussein</name><affiliation wicri:level="1"><nlm:aff id="Aff3">Neuro Radiology Section, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Neuro Radiology Section, Medical Imaging Department, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Bouchama, A" sort="Bouchama, A" uniqKey="Bouchama A" first="A." last="Bouchama">A. Bouchama</name><affiliation wicri:level="1"><nlm:aff id="Aff4">Intensive Care Unit, Experimental Medicine Department, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Intensive Care Unit, Experimental Medicine Department, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Johani, S" sort="Johani, S" uniqKey="Johani S" first="S." last="Johani">S. Johani</name><affiliation wicri:level="1"><nlm:aff id="Aff5">Microbiology, Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Microbiology, Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Hajeer, A H" sort="Hajeer, A H" uniqKey="Hajeer A" first="A. H." last="Hajeer">A. H. Hajeer</name><affiliation wicri:level="1"><nlm:aff id="Aff6">Basic Medical Sciences, Microbiology, Pathology and Laboratory Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Basic Medical Sciences, Microbiology, Pathology and Laboratory Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Saeed, B T" sort="Saeed, B T" uniqKey="Saeed B" first="B. T." last="Saeed">B. T. Saeed</name><affiliation wicri:level="1"><nlm:aff id="Aff7">Cardiac Sciences Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Cardiac Sciences Department, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Wahbi, A" sort="Wahbi, A" uniqKey="Wahbi A" first="A." last="Wahbi">A. Wahbi</name><affiliation wicri:level="1"><nlm:aff id="Aff8">Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Saedy, A" sort="Saedy, A" uniqKey="Saedy A" first="A." last="Saedy">A. Saedy</name><affiliation wicri:level="1"><nlm:aff id="Aff9">Infectious Disease Section, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Infectious Disease Section, Department of Medicine, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Aldabbagh, T" sort="Aldabbagh, T" uniqKey="Aldabbagh T" first="T." last="Aldabbagh">T. Aldabbagh</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Intensive Care Unit, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Okaili, R" sort="Okaili, R" uniqKey="Okaili R" first="R." last="Okaili">R. Okaili</name><affiliation wicri:level="1"><nlm:aff id="Aff11">Neuro Radiology, Nuero Interventionalist, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Neuro Radiology, Nuero Interventionalist, Medical Imaging Department, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Sadat, M" sort="Sadat, M" uniqKey="Sadat M" first="M." last="Sadat">M. Sadat</name><affiliation wicri:level="1"><nlm:aff id="Aff10">Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Intensive Care Unit, King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author><author><name sortKey="Balkhy, H" sort="Balkhy, H" uniqKey="Balkhy H" first="H." last="Balkhy">H. Balkhy</name><affiliation wicri:level="1"><nlm:aff id="Aff12">Infection Prevention and Control Program, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</nlm:aff><country xml:lang="fr">Arabie saoudite</country><wicri:regionArea>Infection Prevention and Control Program, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh</wicri:regionArea></affiliation></author></analytic><series><title level="j">Infection</title><idno type="ISSN">0300-8126</idno><idno type="eISSN">1439-0973</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>Since the identification of the first case of infection with the Middle East respiratory syndrome corona virus (MERS-CoV) in Saudi Arabia in June 2012, the number of laboratory-confirmed cases has exceeded 941 cases globally, of which 347 died. The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. These are so far the first reported cases of neurologic injury associated with MERS-CoV infection.</p></sec><sec><title>Methods</title><p>Data was retrospectively collected from three patients admitted with MERS-CoV infection to Intensive Care unit (ICU) at King Abdulaziz Medical City, Riyadh. They were managed separately in three different wards prior to their admission to ICU.</p></sec><sec><title>Finding</title><p>The three patients presented with severe neurologic syndrome which included altered level of consciousness ranging from confusion to coma, ataxia, and focal motor deficit. Brain MRI revealed striking changes characterized by widespread, bilateral hyperintense lesions on T2-weighted imaging within the white matter and subcortical areas of the frontal, temporal, and parietal lobes, the basal ganglia, and corpus callosum. None of the lesions showed gadolinium enhancement.</p></sec><sec><title>Interpretation</title><p>CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1007/s15010-015-0720-y) contains supplementary material, which is available to authorized users.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Ad" uniqKey="Osterhaus A">AD Osterhaus</name></author><author><name sortKey="Fouchier, Ra" uniqKey="Fouchier R">RA 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<front><journal-meta><journal-id journal-id-type="nlm-ta">Infection</journal-id><journal-id journal-id-type="iso-abbrev">Infection</journal-id><journal-title-group><journal-title>Infection</journal-title></journal-title-group><issn pub-type="ppub">0300-8126</issn><issn pub-type="epub">1439-0973</issn><publisher><publisher-name>Springer Berlin Heidelberg</publisher-name><publisher-loc>Berlin/Heidelberg</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">25600929</article-id><article-id pub-id-type="pmc">4521086</article-id><article-id pub-id-type="publisher-id">720</article-id><article-id pub-id-type="doi">10.1007/s15010-015-0720-y</article-id><article-categories><subj-group subj-group-type="heading"><subject>Case Report</subject></subj-group></article-categories><title-group><article-title>Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV)</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Arabi</surname><given-names>Y. M.</given-names></name><address><phone>+966-11-8011111</phone><email>yaseenarabi@yahoo.com</email><email>icu1@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Harthi</surname><given-names>A.</given-names></name><address><email>HarthiA@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Hussein</surname><given-names>J.</given-names></name><address><email>jawadH@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Bouchama</surname><given-names>A.</given-names></name><address><email>BouchamaAb@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Johani</surname><given-names>S.</given-names></name><address><email>JohaniS@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Hajeer</surname><given-names>A. H.</given-names></name><address><email>Hajeera@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff6"></xref></contrib><contrib contrib-type="author"><name><surname>Saeed</surname><given-names>B. T.</given-names></name><address><email>saeedba@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff7"></xref></contrib><contrib contrib-type="author"><name><surname>Wahbi</surname><given-names>A.</given-names></name><address><email>WahbiA@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff8"></xref></contrib><contrib contrib-type="author"><name><surname>Saedy</surname><given-names>A.</given-names></name><address><email>SaedyAb@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff9"></xref></contrib><contrib contrib-type="author"><name><surname>AlDabbagh</surname><given-names>T.</given-names></name><address><email>DabbaghT@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff10"></xref></contrib><contrib contrib-type="author"><name><surname>Okaili</surname><given-names>R.</given-names></name><address><email>OkailiR@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff11"></xref></contrib><contrib contrib-type="author"><name><surname>Sadat</surname><given-names>M.</given-names></name><address><email>sadatmu@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff10"></xref></contrib><contrib contrib-type="author"><name><surname>Balkhy</surname><given-names>H.</given-names></name><address><email>balkhyh@ngha.med.sa</email></address><xref ref-type="aff" rid="Aff12"></xref></contrib><aff id="Aff1"><label></label>Intensive Care Department, MC-1425, Respiratory Services, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426 Kingdom of Saudi Arabia</aff><aff id="Aff2"><label></label>Neuro Physiology Services, Neurology Division, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff3"><label></label>Neuro Radiology Section, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff4"><label></label>Intensive Care Unit, Experimental Medicine Department, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff5"><label></label>Microbiology, Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff6"><label></label>Basic Medical Sciences, Microbiology, Pathology and Laboratory Department, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff7"><label></label>Cardiac Sciences Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff8"><label></label>Vascular Surgery, Department of Surgery, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff9"><label></label>Infectious Disease Section, Department of Medicine, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff10"><label></label>Intensive Care Unit, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff11"><label></label>Neuro Radiology, Nuero Interventionalist, Medical Imaging Department, King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff><aff id="Aff12"><label></label>Infection Prevention and Control Program, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), King Abdulaziz Medical City, Riyadh, 11426 Saudi Arabia</aff></contrib-group><pub-date pub-type="epub"><day>20</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="pmc-release"><day>20</day><month>1</month><year>2015</year></pub-date><pub-date pub-type="ppub"><year>2015</year></pub-date><volume>43</volume><issue>4</issue><fpage>495</fpage><lpage>501</lpage><history><date date-type="received"><day>10</day><month>9</month><year>2014</year></date><date date-type="accepted"><day>4</day><month>1</month><year>2015</year></date></history><permissions><copyright-statement>© The Author(s) 2015</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>Since the identification of the first case of infection with the Middle East respiratory syndrome corona virus (MERS-CoV) in Saudi Arabia in June 2012, the number of laboratory-confirmed cases has exceeded 941 cases globally, of which 347 died. The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. These are so far the first reported cases of neurologic injury associated with MERS-CoV infection.</p></sec><sec><title>Methods</title><p>Data was retrospectively collected from three patients admitted with MERS-CoV infection to Intensive Care unit (ICU) at King Abdulaziz Medical City, Riyadh. They were managed separately in three different wards prior to their admission to ICU.</p></sec><sec><title>Finding</title><p>The three patients presented with severe neurologic syndrome which included altered level of consciousness ranging from confusion to coma, ataxia, and focal motor deficit. Brain MRI revealed striking changes characterized by widespread, bilateral hyperintense lesions on T2-weighted imaging within the white matter and subcortical areas of the frontal, temporal, and parietal lobes, the basal ganglia, and corpus callosum. None of the lesions showed gadolinium enhancement.</p></sec><sec><title>Interpretation</title><p>CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed.</p></sec><sec><title>Electronic supplementary material</title><p>The online version of this article (doi:10.1007/s15010-015-0720-y) contains supplementary material, which is available to authorized users.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Middle East respiratory syndrome corona virus</kwd><kwd>Encephalitis</kwd><kwd>Acute disseminated encephalomyelitis</kwd><kwd>Stroke</kwd><kwd>Pneumonia</kwd><kwd>Acute respiratory distress syndrome</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© Springer-Verlag Berlin Heidelberg 2015</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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