ABSTRACT
OBJECTIVE: To report a case of a patient infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who acutely developed a hypokinetic-rigid syndrome. METHODS: Patient data were obtained from medical records from the Hospital Universitario 12 de Octubre in Madrid, Spain. [123I]-ioflupane dopamine transporter (DaT) SPECT images were acquired 4 hours after a single dose of 185 MBq of 123I-FP-CIT. Quantitative analysis was performed with DaTQUANT software providing the specific binding ratio and z score values of the striatum. RESULTS: We report a previously healthy 58-year-old man who developed hyposmia, generalized myoclonus, fluctuating and transient changes in level of consciousness, opsoclonus, and an asymmetric hypokinetic-rigid syndrome with ocular abnormalities after a severe SARS-CoV-2 infection. DaT-SPECT confirmed a bilateral decrease in presynaptic dopamine uptake asymmetrically involving both putamina. Significant improvement in the parkinsonian symptoms was observed without any specific treatment. CONCLUSION: This case study provides clinical and functional neuroimaging evidence to support that SARS-CoV-2 can gain access to the CNS, affecting midbrain structures and leading to neurologic signs and symptoms.
Subject(s)
Coronavirus Infections/physiopathology , Parkinson Disease, Postencephalitic/physiopathology , Pneumonia, Viral/physiopathology , Putamen/diagnostic imaging , Betacoronavirus , Brain/diagnostic imaging , Brain/metabolism , COVID-19 , Consciousness Disorders , Coronavirus Infections/complications , Coronavirus Infections/diagnostic imaging , Disease Progression , Dopamine Plasma Membrane Transport Proteins/metabolism , Electroencephalography , Humans , Hypokinesia/diagnostic imaging , Hypokinesia/etiology , Hypokinesia/physiopathology , Magnetic Resonance Imaging , Male , Middle Aged , Muscle Rigidity/diagnostic imaging , Muscle Rigidity/etiology , Muscle Rigidity/physiopathology , Nortropanes , Ocular Motility Disorders , Pandemics , Parkinson Disease, Postencephalitic/diagnostic imaging , Parkinson Disease, Postencephalitic/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnostic imaging , Putamen/metabolism , SARS-CoV-2 , Tomography, Emission-Computed, Single-PhotonABSTRACT
OBJECTIVE: To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus. METHODS: Patient data were obtained from medical records from the University Hospital "12 de Octubre," Madrid, Spain. RESULTS: Three patients (2 men and 1 woman, aged 63-88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy. CONCLUSIONS: Our 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.