Mild Encephalopathy With Partial Reversible Splenium Lesion Associated With SARS-CoV-2 Infection.

Viral-associated encephalitis/encephalopathy includes a wide spectrum of syndromes reported often in children. A rare form presents with mild encephalitis/encephalopathy and reversible splenial lesion(s). This report describes a case of this rare presentation associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a 68-year-old woman. The patient presented to the hospital with altered mental status. Examination revealed mild encephalopathy with disorientation to date and time. Initial laboratory workup was significant for mild hypernatremia and acute kidney injury, and a polymerase chain reaction (PCR) test for SARS-CoV-2 was positive. MRI of the brain revealed an area of hyperintensity and water restriction in the corpus callosum. The patient was treated with tocilizumab, dexamethasone, and remdesivir. MRI of the brain five weeks later revealed partial resolution of the hyperintensity, and complete resolution of the restricted diffusion previously seen in the corpus callosum, which confirmed the diagnosis of mild encephalitis/encephalopathy with a reversible splenial lesion. We highlight the importance of recognizing this phenomenon in association with SARS-CoV-2 infection.

Unusual Lesion in the Splenium of the Corpus Callosum and COVID-19 Infection: A Case Report.

The novel coronavirus (SARS-CoV-2) causing the recent pandemic outbreak may result in brain injuries. The disease has a high prevalence for thromboembolic complications and a massive release of cytokines. We report a case of CLOCCS, one of the rare neurological complications of SARS-CoV-2 infection. Teaching Point: The imaging features of the cytotoxic lesion of the corpus callosum (CLOCCS) on magnetic resonance imaging should be known by every radiologist, to make the positive diagnosis and prevent misdiagnosis, especially in the setting of a COVID-19 infection.

Cerebellar ataxia: a rare toxicity of commonly used drug

Background and Aim: Metronidazole is commonly prescribed drug for amoebiasis and is usually well tolerated, and safe but can cause serious neurological adverse events including peripheral neuropathy which is relatively common but CNS toxicity is rare. We report a case of cerebellar ataxia who had taken metronidazole inadvertently for amoebic liver abscess. Case summary: Young male with history of toddy inking admitted for management of amoebic liver abscess. He was managed with percutaneous ain and intravenous metronidazole. He was discharged on oral metronidazole tablet for a total duration of 10 days. Due to COVID-19 pandemic, he did not turn up and continued taking metronidazole. Two months’ later patient presented with progressive slurring of speech and unsteady gait. On examination, cerebellar sign was present with normal motor and sensory system. Blood investigations including complete blood count, liver function test, kidney function test and thyroid profile were normal. Vitamin B12 and fasting blood sugar levels were normal. Non-contrast computed tomographic (NCCT) scan of brain was normal. Magnetic resonance imaging (MRI) scan of the brain showed areas of hyperintense signal change in dentate nucleus of cerebellum, two small foci in dorsal pons and splenium of corpus callosum with no restriction in T2 FLAIR, DWI and ADC sequences suggestive of interstitial edema. On stopping metronidazole, his sign and symptoms started waning and was symptom free after 10 days. Conclusions: Neurological toxicity may be related to prolonged administration, high doses, or high cumulative doses of metronidazole and prompt identification of neuropathy and cerebellar ataxia is essential to avoid permanent damage. Clinicians should avoid the use of metronidazole for more than 2 weeks in case of amoebic liver abscess.

Mild encephalitis/encephalopathy with reversible splenial lesion after COVID-19 vaccination

Objective: To investigate the clinical features of the two cases presenting neurological syndrome after receiving COVID-19 vaccination, who were diagnosed with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS). Background: Neurological symptoms can occur after COVID-19 mRNA vaccination. However, its etiology hasn't been fully revealed. Design/Methods: A 23-year-old previously healthy man (Patient 1) and a 33-year-old woman with a history of depression (Patient 2) developed neurological symptoms approximately one week after receipt of the first standard dose (0.3 mL, intramuscular injection) of COVID-19 mRNA vaccination (Coronavirus Modified Uridine RNA Vaccine (SARS-CoV-2)) (Day 1) and deteriorated over the next week. Clinical course, laboratory and MRI findings were serially analyzed. Results: Patient 1 presented with headache, low-grade fever and memory disturbance (Day 3). Intravenous acyclovir and meropenem were administered under a possible diagnosis of aseptic meningitis but not effective. Patient 2 presented with visual disturbance, headache, dysarthria, a left forearm tremor, dysesthesia of the mouth and distal limbs, and visual agnosia (Day 10). In both patients, reverse transcription polymerase chain reaction test results for severe acute respiratory syndrome coronavirus 2 were negative. Complete blood cell count, blood-chemistry including electrolytes and antibody titers, and cerebrospinal fluid test findings were unremarkable initially. However, second cerebrospinal fluid test of Patient 1 (Day 8) showed pleocytosis (942 cells/μL, normal ≤ 5 cells/μL) and elevated protein levels (181 mg/dL, normal 10-40 mg/dL). Brain MRI on Day 17 in Patient 1 and Day 15 in Patient 2 after receiving the vaccination showed high signal intensity lesions at the midline of the splenium of the corpus callosum. Based on the typical imaging features, the patients were diagnosed with MERS. Intravenous methylprednisolone therapy (1,000 mg/day for 3 days) improved their symptoms and MRI lesion disappeared. Conclusions: MERS should be considered in patients with neurological manifestation after COVID-19 vaccination, even though symptoms were mild and nonspecific.

NEUROLOGIC AND RADIOGRAPHIC FINDINGS ASSOCIATED WITH PAEDIATRIC INFLAMMATORY MULTISYSTEM SYNDROME TEMPORALLY ASSOCIATED WITH SARS-COV-2 (PIMS-TS)

Objective Our aim was to report neurological manifestations of children with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS). Methods Patients (<18yrs) presenting to Great Ormond Street Hospital between March 1, 2020, and June 21, 2020 fulfilling RCPCH PIMS-TS criteria, were included. Clinical and paraclinical features were retrieved retrospectively from electronic patient records. Results New-onset neurological symptoms/signs were reported in 23/45 (51.1%);headaches (n=16), encephalopathy (n=7), dysarthria/ dysphonia (n=6), hallucinations (n=4), ataxia (n=4), peripheral nerve involvement (n=3), and seizures (n=1). Five (21.7%) patients had CSF analysis;1 patient had 118 leukocytes in CSF. Splenium signal changes were seen in 4/14 patients who had brain MRI. A mild excess of slow activity was found in 10/10 who had an EEG and mild myopathic and neuropathic changes were seen 4/5 who underwent nerve conduction studies and electromyography. Children with neurological involvement had higher peak inflammatory markers and were more likely to be ventilated and require inotropic support in PICU (p<0.05). Conclusions Children with PIMS-TS presented with new neurological symptoms involving both the central and peripheral nervous systems, in the absence of respiratory symptoms. Neurological symptoms were seen more frequently in more severe presentations.

An Equivocal SCC Lesion-Antiepileptic-Induced CLOCC.

We present a case of a woman who reported to the emergency unit due to recurrent episodes of severe headache and collapse. MRI examination revealed no relevant findings apart from small meningioma of the right parietal region. The patient was diagnosed with epilepsy and received outpatient treatment, which was changed due to poor toleration. A follow-up MRI was performed which revealed an isolated, focal lesion of the splenium of the corpus callosum. The patient underwent extensive laboratory testing and antiseizure medications were started again. Another MRI indicated substantial regression of the splenium of the corpus callosum (SCC) lesion. Both the complete clinical image and results of the diagnostic evaluation spoke in favor of cytotoxicity of the corpus callosum associated with anti-epileptic drug treatment. Pathologies involving the corpus callosum include congenital, demyelination, infection, neoplasm, trauma and vascular changes. Isolated, non-specific lesions of the splenium of corpus callosum usually indicate multiple sclerosis; however, other pathologies should be considered. Anti-epileptic drugs may evoke cytotoxic lesions of the corpus callosum (CLOCCs).

Neurological and radiological findings associated with paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) in children

Background: Neurological manifestations have been reported both in adults and children with coronavirus disease 2019 (COVID-19). Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a recently described severe post-infectious immune-mediated disorder. Objective: Our aim was to report neurological manifestations of children with PIMS-TS. Methods: Patients (<18y) presenting to Great Ormond Street Hospital between April 4, 2020, and May 1, 2021 fulfilling PIMS-TS criteria, were included. Clinical and paraclinical features were retrieved retrospectively from electronic patient records. Results: Data was available for 125 patients who presented during the study period. Median age was 10 years (IQR 7, 12), 71 (56.8%) were male and 96 (76.8%) were of non-white ethnicities. New-onset neurological symptoms were reported in 73/125 (58.4%);headaches (n=47), encephalopathy (n=41), hallucinations (n=15), ataxia (n=12), dysarthria/dysphonia (n=12), peripheral nerve involvement (n=3), and seizures (n=1). Thirteen patients had CSF examined;one patient had 118 leukocytes in CSF. Abnormalities were noted in 16/32 patients with neuroimaging, with splenium of the corpus callosum signal changes most commonly seen in 9 patients. An excess of slow activity was found in 78/98 who had an EEG;38 mild, 34 moderate and 7 had severe encephalopathy on EEG. Myopathic and neuropathic changes were seen in 7/12 who underwent nerve conduction studies and electromyography (EMG). Children with neurological involvement had higher peak inflammatory markers and were more likely to be ventilated and require inotropic support in PICU (p<0.05). Conclusions: Children with PIMS-TS presented with new neurological symptoms involving both the central and peripheral nervous systems, in the absence of respiratory symptoms. Neurological symptoms were seen more frequently in more severe presentations.

p Reversible lesion of the corpus callosum associated with COVID-19: A case report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may affect the central nervous system and peripheral nervous system. Major central nervous system manifestations of SARS-CoV-2 infection include seizures, meningoencephalitis, ischemic stroke, anosmia, and hypogeusia. The reversible splenial lesion syndrome was first described in 2004. Although reversible splenial lesion syndrome was initially recognized as a benign phenomenon, a second type of reversible splenial lesion syndrome was identified in later years, which has a poorer prognosis and potentially serious sequela. Reversible splenial lesion syndrome can be caused by numerous etiologies including viruses. In this report, we present a rare case of COVID-19 with reversible splenial lesion, who presented with ataxia and dizziness.

[SARS-CoV-2 and neurological disorders: the revelance of biomarkers?] / SARS-CoV-2 et atteintes neurologiques : quelle est la place des biomarqueurs ?

Soon after the pandemic, numerous publications described cases of neurological disorders associated with the SARS-CoV-2 infection. The range of neurological symptoms is becoming increasingly more extensive as the pandemic progresses. However, it is not yet well established whether the manifestations are due to direct viral damage to the nervous system or indirect consequences of the infection. This review presents an inventory of the biochemical markers studied in the context of neurological disorders related to SARS-CoV-2. By reflecting various physiopathological mechanisms, these biomarkers allow both a better understanding of the pathophysiology of Covid-19 and a contribution to the diagnosis of neurologic troubles; they could participate in the prognostic evaluation of patients.

Mild encephalopathy with reversible splenium lesion (MERS) in a patient with COVID-19.

Neurological complications of coronavirus 2019 (COVID-19) are common, and novel manifestations are increasingly being recognized. Mild encephalopathy with reversible splenium lesion (MERS) is a syndrome that has been associated with viral infections, but not previously with COVID-19. In this report, we describe the case of a 69 year-old man who presented with fever and encephalopathy in the setting of a diffusion-restricting splenium lesion, initially mimicking an ischemic stroke. A comprehensive infectious workup revealed positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, and a pro-inflammatory laboratory profile characteristic of COVID-19 infection. His symptoms resolved and the brain MRI findings completely normalized on repeat imaging, consistent with MERS. This case suggests that MERS may manifest as an autoimmune response to SARS-CoV-2 infection and should be considered in a patient with evidence of recent COVID-19 infection and the characteristic MERS clinico-radiological syndrome.