ABSTRACT
Background: Systemic autoimmune disorders are associated with an increased risk of hypercoagulability. The hypercoagulable state in people with systemic autoimmune disorders has lately gained attention. Presentation of case: We presented a 44-year-old male with a chief complaint of progressive difficulty concentrating, memory impairment, and weakness in all limbs. Seven months before admission to our Memory Clinic, the patient began to have infrequent short-term memory loss and sometimes got lost when he went for a drive. Three months later, he complained of feeling dizzy when in a crowd, being unable to watch television for a long time, and easily forgetting. Computed tomography (CT) scan showed brain infarction. After receiving the first dose of COVID-19 vaccine (Sinovac), the patient had difficulty communicating verbally and could only point at objects, as well as tetraparesis. These conditions severely intervened in his daily activities. The patient was then referred to an immunologist and diagnosed with autoimmune disease. In our Memory Clinic, his performances of attention, memory, language, visuospatial, and executive function were very poor. We diagnosed him with autoimmune dementia. The administration of methylprednisolone, mycophenolate mofetil, vitamin D3, donepezil, and memantine could improve his condition. Discussion: Autoimmune disease can cause microvascular thrombosis and microembolism at the central nervous system level, which would cause vascular damage and cognitive impairment leading to brain infarction and dementia. Conclusion: There seems to be a link between autoimmune disease, hypercoagulable state, and dementia, although the magnitude of this link and the underlying processes are not fully understood.
ABSTRACT
Since the emergence of the severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) infection in Wuhan China at the end of 2019 the Coronavirus disease 2019 (COVID-19) has become pandemic for months. Due to the fast increased number of the positive patients with COVID-19 SARS-CoV-2 is considered a highly pathogenic virus with various clinical presentations. Apart from the typical respiratory symptoms neurological complaints in COVID-19 involving central and peripheral nervous systems have been reported. This paper aimed to review the neurological findings reported in patients with COVID-19. We qualitatively reviewed studies reporting COVID-19 patient(s) with neurological manifestations according to the recommendations of PRISMA statement. There were twelve studies included in this brief review. We found that patients with neurological findings were reported ranging from symptomatic complaints of headache and dizziness to specific neurological diseases/syndromes such as meningitis/encephalitis acute cerebrovascular diseases Guillain-Barré syndrome and Miller Fisher syndrome. This review suggests the possible neurological involvement in COVID-19. We hope to raise the awareness of the health workers in taking care of the patients with COVID-19 and neurological diseases.