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“No Man is an Island” John Donne

“No Man is an Island” John Donne LETTERS “No ManisanIsland” John Donne e read with great interest the recent Editorial by Mahajan ally: Neuroradiologists are responding to a constant barrage of of- Wand Hirsch in the American Journal of Neuroradiology ficial directives, planning for potential disruptions, and adjusting (AJNR). At a time when the coronavirus disease 2019 (COVID- to patient case mixes as they occur. We urge good citizen neuro- 19) pandemic is raging, it provides a helpful and succinct sum- radiologists to learn as much as we can, report and share accurate mary and reminds us to play our part as good citizens as an data on patients undergoing CNS imaging, keep up with fast- informed and steadying influence on our colleagues, nurses, tech- moving developments, and help one another. In a worldwide nologists, patients, families, and community. pandemic, we are all in this together and we are all citizens of the As neuroradiologists, readers of the AJNR might also be con- world. Therefore, we would be wise to heed the famous quotation cerned about the possible CNS manifestations or complications in from John Donne, “No man is an island...Any man’sdeath diminishes this novel disease. Outbreaks of zoonotic viral diseases affecting the me, because I am involved in mankind. And therefore, never send to CNShavehappenedpreviously: TheNipah virusoutbreakin1998 know for whom the bell tolls; It tolls for thee.” was spread from bats via pigs to humans and caused respiratory and encephalopathic symptoms. MR imaging patterns included ei- REFERENCES ther extensive involvement of the cortex, temporal lobe, and pons, 1. Mahajan A, Hirsch JA. Novel coronavirus: what neuroradiologists as or multiple small (,1 cm in maximum diameter) abnormalities citizens of the world need to know. AJNR Am J Neuroradiol 2020 involving the subcortical and deep white matter, corpus callosum, Mar 20. [Epub ahead of print] CrossRef Medline and brain stem, especially visible on diffusion-weighted images. In 2. Lim C, Sitoh YY, Hui F, et al. Nipah viral encephalitis or Japanese en- a case report of a patient with sequential organ failure, including cephalitis? MR findings in a new zoonotic disease. AJNR Am J meningoencephalitis from the Ebola virus, MR imaging showed Neuroradiol 2000;21:455–61 Medline 3. Chertow DS, Nath A, Suffredini AF, et al. Severe meningoencephalitis multiple punctate lesions in the corpus callosum, cerebral white in a case of Ebola virus disease: a case report. Ann Intern Med matter, and spinal cord, some with restricted diffusion, consistent 3 2016;165:301–04 CrossRef Medline with microvascular occlusion and ischemia. However, the litera- 4. Umapathi T, Kor AC, Venketasubramanian N, et al. Large artery ture on imaging of CNS involvement in the Coronaviridae family, ischaemic stroke in severe acute respiratory syndrome (SARS). J which also includes the Severe Acute Respiratory Syndrome Neurol 2004;251:1227–31 CrossRef Medline (SARS) and the Middle East Respiratory Syndrome (MERS), is 5. Mao L, Wang M, Chen S, et al. Neurological manifestations of hospi- more limited. In the previous SARS outbreak in 2003, CT findings talized patients with COVID-19 in Wuhan, China: a retrospective in 5 patients who developed large-artery ischemic stroke were case series study. medRxiv 2020 CrossRef https://www.medrxiv.org/ content/10.1101/2020.02.22.20026500v1.AccessedMarch 21,2020 reported, with the recommendation to be vigilant in future out- 6. New research sparks debate over whether Coronavirus can infect the breaks for thrombotic complications in critically ill patients, espe- nervous system. Caixin https://www.caixinglobal.com/2020-03-06/new- cially if intravenous immunoglobulin is being used for treatment. research-sparks-debate-over-whether-coronavirus-can-infect-the- Similarly, neurologic symptoms have been observed in a pre- nervous-system-101524986.html. Accessed March 21, 2020 printreportonseverelyill patients in Wuhanduring the current 7. Shah S. Can novel Coronavirus cause meningitis? Japan has the an- COVID-19 outbreak, including acute cerebrovascular diseases, con- swer. International Business Times March 8, 2020. https://www. sciousness impairment, and skeletal muscle symptoms; unfortu- ibtimes.sg/can-novel-coronavirus-cause-meningitis-japan-has-answer- 40647.Accessed March 21,2020 nately, no CT or MR imaging has been described thus far. Case reports of encephalitis and meningitis have also appeared in the lay C.C.T. Lim 6 7 press in both Beijing, China, and Yamanashi, Japan. We await the Department of Neuroradiology full publication of these results, to respond appropriately. National Neuroscience Institute Duke-NUS Graduate Medical School Unlike previous, localized outbreaks among smaller clusters Singapore of patients, this current COVID-19 epidemic affects us all person- K. Tsuchiya Department of Radiology Indicates open access to non-subscribers at www.ajnr.org Saitama Medical Center, Saitama Medical University Kawagoe City, Saitama, Japan http://dx.doi.org/10.3174/ajnr.A6544 E40 Letters Jun 2020 www.ajnr.org http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Neuroradiology American Journal of Neuroradiology

“No Man is an Island” John Donne

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Publisher
American Journal of Neuroradiology
Copyright
© 2020 by American Journal of Neuroradiology. Indicates open access to non-subscribers at www.ajnr.org
ISSN
0195-6108
eISSN
1936-959X
DOI
10.3174/ajnr.A6544
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Abstract

LETTERS “No ManisanIsland” John Donne e read with great interest the recent Editorial by Mahajan ally: Neuroradiologists are responding to a constant barrage of of- Wand Hirsch in the American Journal of Neuroradiology ficial directives, planning for potential disruptions, and adjusting (AJNR). At a time when the coronavirus disease 2019 (COVID- to patient case mixes as they occur. We urge good citizen neuro- 19) pandemic is raging, it provides a helpful and succinct sum- radiologists to learn as much as we can, report and share accurate mary and reminds us to play our part as good citizens as an data on patients undergoing CNS imaging, keep up with fast- informed and steadying influence on our colleagues, nurses, tech- moving developments, and help one another. In a worldwide nologists, patients, families, and community. pandemic, we are all in this together and we are all citizens of the As neuroradiologists, readers of the AJNR might also be con- world. Therefore, we would be wise to heed the famous quotation cerned about the possible CNS manifestations or complications in from John Donne, “No man is an island...Any man’sdeath diminishes this novel disease. Outbreaks of zoonotic viral diseases affecting the me, because I am involved in mankind. And therefore, never send to CNShavehappenedpreviously: TheNipah virusoutbreakin1998 know for whom the bell tolls; It tolls for thee.” was spread from bats via pigs to humans and caused respiratory and encephalopathic symptoms. MR imaging patterns included ei- REFERENCES ther extensive involvement of the cortex, temporal lobe, and pons, 1. Mahajan A, Hirsch JA. Novel coronavirus: what neuroradiologists as or multiple small (,1 cm in maximum diameter) abnormalities citizens of the world need to know. AJNR Am J Neuroradiol 2020 involving the subcortical and deep white matter, corpus callosum, Mar 20. [Epub ahead of print] CrossRef Medline and brain stem, especially visible on diffusion-weighted images. In 2. Lim C, Sitoh YY, Hui F, et al. Nipah viral encephalitis or Japanese en- a case report of a patient with sequential organ failure, including cephalitis? MR findings in a new zoonotic disease. AJNR Am J meningoencephalitis from the Ebola virus, MR imaging showed Neuroradiol 2000;21:455–61 Medline 3. Chertow DS, Nath A, Suffredini AF, et al. Severe meningoencephalitis multiple punctate lesions in the corpus callosum, cerebral white in a case of Ebola virus disease: a case report. Ann Intern Med matter, and spinal cord, some with restricted diffusion, consistent 3 2016;165:301–04 CrossRef Medline with microvascular occlusion and ischemia. However, the litera- 4. Umapathi T, Kor AC, Venketasubramanian N, et al. Large artery ture on imaging of CNS involvement in the Coronaviridae family, ischaemic stroke in severe acute respiratory syndrome (SARS). J which also includes the Severe Acute Respiratory Syndrome Neurol 2004;251:1227–31 CrossRef Medline (SARS) and the Middle East Respiratory Syndrome (MERS), is 5. Mao L, Wang M, Chen S, et al. Neurological manifestations of hospi- more limited. In the previous SARS outbreak in 2003, CT findings talized patients with COVID-19 in Wuhan, China: a retrospective in 5 patients who developed large-artery ischemic stroke were case series study. medRxiv 2020 CrossRef https://www.medrxiv.org/ content/10.1101/2020.02.22.20026500v1.AccessedMarch 21,2020 reported, with the recommendation to be vigilant in future out- 6. New research sparks debate over whether Coronavirus can infect the breaks for thrombotic complications in critically ill patients, espe- nervous system. Caixin https://www.caixinglobal.com/2020-03-06/new- cially if intravenous immunoglobulin is being used for treatment. research-sparks-debate-over-whether-coronavirus-can-infect-the- Similarly, neurologic symptoms have been observed in a pre- nervous-system-101524986.html. Accessed March 21, 2020 printreportonseverelyill patients in Wuhanduring the current 7. Shah S. Can novel Coronavirus cause meningitis? Japan has the an- COVID-19 outbreak, including acute cerebrovascular diseases, con- swer. International Business Times March 8, 2020. https://www. sciousness impairment, and skeletal muscle symptoms; unfortu- ibtimes.sg/can-novel-coronavirus-cause-meningitis-japan-has-answer- 40647.Accessed March 21,2020 nately, no CT or MR imaging has been described thus far. Case reports of encephalitis and meningitis have also appeared in the lay C.C.T. Lim 6 7 press in both Beijing, China, and Yamanashi, Japan. We await the Department of Neuroradiology full publication of these results, to respond appropriately. National Neuroscience Institute Duke-NUS Graduate Medical School Unlike previous, localized outbreaks among smaller clusters Singapore of patients, this current COVID-19 epidemic affects us all person- K. Tsuchiya Department of Radiology Indicates open access to non-subscribers at www.ajnr.org Saitama Medical Center, Saitama Medical University Kawagoe City, Saitama, Japan http://dx.doi.org/10.3174/ajnr.A6544 E40 Letters Jun 2020 www.ajnr.org

Journal

American Journal of NeuroradiologyAmerican Journal of Neuroradiology

Published: Jun 1, 2020

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