![]() Delayed neuroinflammation could also be a possible cause to explain longstanding brain dysfunctions. Whereas probable hypoxia was present in the first case, it was absent in the second patient. ![]() Hypometabolic PET regions are more widespread in patient 1 affecting the cingulate, the precuneus and some other cortical regions, whereas only the cingulate cortex was affected in patient 2.The nature of the brain lesions linked to cognitive signs and abnormal PET results are unknown in these two cases. Patient 1 was admitted for several days and received oxygen supplementation, whereas patient 2 has been hill at home for 2 weeks. Cortical hypometabolisms were clearly more pronounced in the first patient who experienced a more severe COVID evolution. Hypometabolisms of the cingulate cortex have been observed in several neurological and psychiatric diseases including mild cognitive impairment due to Alzheimer’s disease, severe depression and internet gaming disorder. These deficient brain connections could explain the cognitive signs observed in these patients and characterized by episodic memory deficits and abnormal executive and attentional functions. The posterior cingulate cortex has outcomes towards the hippocampus. The anterior cingulate cortex receives inputs from the orbitofrontal cortex in the outcome rewards. Previous experimental and clinical studies have shown that the anterior and posterior cingulate cortex are implicated in emotions, memory, depression, and decision of action. The cingulate cortex is involved in many cognitive functions. It is interesting to note that MRI were considered in the normal range in both cases. 1).īoth patients complained of brain fog and cognitive symptoms confirmed by neuropsychological tests and which could be related at least to the dysfunction of the cingulate cortex as revealed cerebral FDG PET scans. EEG showed theta waves in the left temporal region and the FDG PET scan revealed abnormal hypometabolic regions (Fig. Extensive neuropsychological tests revealed mildly affected episodic and visuo-spatial memory and a deficit of executive functions. Hospital anxiety and depression scale (HADS) was normal for depression and slightly increased for anxiety. In October 2020, the disorders persisted, and the neurological examination and the brain MRI was normal. Serotonin reuptake inhibitor therapy was introduced. Then, he returns home and gradually develops cognitive disorders combining memory problems, slowness of ideation, general fatigue, anxiety, and depression without anosmia. Blood C reactive protein (CRP) levels were increased during the acute phase. After a week of progress with cough, fever, he was admitted to hospital due to dyspnea and hypoxia and put on oxygen therapy for 7 days. Patient 1: a 45-year-old man in good health with no pathological history suffers from COVID in March 2020. These patients had no risk factors such as obesity, diabetes or hypertension. In the etiology of neurocognitive disorders occurring at a distance from the acute episode of COVID, involvement of the cingulate cortex has been little described, and we report here the cases of two patients who developed neurocognitive disorders after their acute COVID infectious episode with positive PCR. The pathophysiology of the disease is complex, incorporating direct viral neuronal damage, neuroinflammation, rupture of the blood brain barrier, microvasculitis and hypoxia. The neurological complications of COVID include damage to the central nervous system (CNS) and the peripheral nervous system encompassing stokes, encephalitis, myelitis, myositis, Guillain Barré syndromes, and cognitive impairments. Long COVID can be seen not only in patients who have been hospitalized in an intensive care unit but also in patients who have had less serious forms that did not require hospital admissions. In some cases additional explorations are normal. Clinical signs can include fatigue, dyspnea, myalgia, diffuse pain, headaches, anxiety/depression and cognitive impairments (brain fog). The post-acute COVID syndrome or long COVID syndrome has been described at debated. Long-term complications are now described as the long COVID and affect many organs such as the heart, brain, kidney, pancreas and digestive system. The COVID pandemic has reached tens of millions of people around the world and has resulted in the deaths of several millions people.
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