ABSTRACT
INTRODUCTION: Various neurologic manifestations have already been described in children during or after severe acute respiratory syndrome coronavirus 2 (SARS-Cov2) infections,. The central nervous system disorders reported in children are mainly encephalopathies during Multisystem inflammatory syndrome (MIS-C). We present here an acute meningo-encephalitis with cerebral vasculitis associated to a COVID-19 infection in a thirteen-year-old girl with a 1-year clinical, EEG and MRI follow-up. CASE-REPORT: A thirteen-year-old girl presented acute symptoms of consciousness impairment, frontal headache, hyperthermia and aphasia, with moderate lymphopenia (900/mm3),elevated C-reactive protein (CRP) (17mg/l), cerebrospinal fluid (CSF) pleiocytosis (15 cells/mm3), slow background with frontal focalization on electroencephalogram (EEG), an left frontal ischemic lesion, leptomeningeal enhancement and bilateral limbic FLAIR hyperintensity on cerebral magnetic resonance imaging (MRI). Reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV2 was positive in nasopharyngeal swab and COVID serology was positive for IgM and Ig, whereas extensive auto-immune antibody investigation was negative except for a positive low titre of anti-MOG in CSF and blood. The diagnosis of probable encephalitis associated to cerebral vasculitis after COVID infection was suggested and steroids pulse were started. She recovered within a few days. Six months laters, she had moderate clinical sequels including persistent intermittent headaches, an isolated spatial deficit and focal spikes on the EEG without argument for epilepsia. CONCLUSION: a teenager without previous medical history presented an acute encephalitis with leptomeningitis and vasculitis after a recent COVID-19 infection. Steroids pulse therapy allowed clinical improvement. Cerebral MRI and EEG helped diagnosis, follow-up of the encephalitis and evolution after treatment.
ABSTRACT
OBJECTIVE: To describe EEG patterns of critical Coronavirus Disease 2019 (COVID-19) patients with suspicion of encephalopathy and test their association with clinical outcome. METHODS: EEG after discontinuation of sedation in all patients, and somesthesic evoked potentials and brainstem auditive evoked potentials when EEG did not show reactivity, were performed. Clinical outcome was assessed at day 7 and 14 after neurophysiological explorations. RESULTS: 33 patients were included for analysis. We found slowed background activity in 85% of cases, unreactive activity in 42% of cases, low-voltage activity in 21% of cases and rhythmic or periodic delta waves in 61% of cases. EEG epileptic events were never recorded. Clinical outcome at day 14 was associated with unreactive background activity and tended to be associated with rhythmic or periodic delta waves and with low-voltage activity. Results of multimodal evoked potentials were in favor of a preservation of central nervous system somatosensory and auditory functions. CONCLUSIONS: Among critical COVID-19 patients with abnormal arousal at discontinuation of sedation, EEG patterns consistent with encephalopathy are found and are predictive for short term clinical outcome. SIGNIFICANCE: The abnormal EEG with presence of periodic discharges and lack of reactivity could be related to encephalopathy linked to COVID-19.