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1.
BMJ Case Rep ; 15(3)2022 Mar 08.
Article in English | MEDLINE | ID: covidwho-1736042

ABSTRACT

Although neurological manifestations such as headache and myalgias have been observed with COVID-19, presentation with more serious neurological illness is uncommon and rare. We report a case of a middle-aged woman who presented to the emergency department of a tertiary care hospital. Her clinical presentation was primarily neurological rather than the more common presentation with respiratory manifestations. She presented with generalised tonic-clonic seizures, along with history of undocumented low-grade fever and generalised body aches. The positive SARS-CoV-2 RT-PCR nasal swab, the cerebrospinal fluid analysis (lymphocytic pleocytosis) and electroencephalogram were consistent with viral encephalitis; brain imaging was unremarkable. This case highlights the variable presenting features of COVID-19 infection as patients can primarily present with neurological manifestations in the absence of significant respiratory symptoms. We believe it is important to recognise neurological disease associated with SARS-CoV-2 in patients with asymptomatic respiratory infection.


Subject(s)
Brain Diseases , COVID-19 , Status Epilepticus , Brain Diseases/complications , COVID-19/complications , Female , Humans , Middle Aged , SARS-CoV-2 , Seizures/etiology , Status Epilepticus/complications
3.
BMJ Case Rep ; 15(2)2022 Feb 09.
Article in English | MEDLINE | ID: covidwho-1685520

ABSTRACT

Neurological manifestations are common in SARS-CoV-2 infection, including life-threatening acute muscle weakness, due to neuromuscular disorders such as acute transverse myelitis (TM) and Guillain-Barré syndrome (GBS). These syndromes can rarely coexist and present as an overlap syndrome. Here, we report a patient who developed acute symmetrical proximal lower limb weakness 5 days after diagnosis of COVID-19. GBS was diagnosed due to the presence of motor signs, albumin-cytological dissociation in cerebrospinal fluid examination and axonal damage according to nerve condition tests. However, abnormal areas on MRI of the thoracic spine and lack of improvement with intravenous immunoglobulin supported a diagnosis of TM. Therefore, a possible overlap between GBS and TM was established. To our knowledge, this is the third case report of GBS/TM overlap syndrome after COVID-19. The patient's full and rapid recovery with intravenous corticosteroids and plasmapheresis supports our diagnosis.


Subject(s)
Autoimmune Diseases , COVID-19 , Guillain-Barre Syndrome , Myelitis, Transverse , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/drug therapy , Humans , Myelitis, Transverse/diagnosis , Myelitis, Transverse/drug therapy , Myelitis, Transverse/etiology , SARS-CoV-2
4.
BMJ Case Rep ; 15(2)2022 Feb 02.
Article in English | MEDLINE | ID: covidwho-1673378

ABSTRACT

Adverse events occurring after SARS-CoV-2 vaccination have been reported and are the subject of ongoing research. We present the case of a young woman with fully reversible radiculomyelitis, which happened after the first dose of the ChAdOx1 nCOVID-19 vaccine. A previously healthy woman in her 20s presented with a subacute onset of legs' weakness and sensory disturbances, urinary dysfunction and cramping pain after receiving the first dose of the ChAdOx1 nCoV-19 vaccine. A diagnostic workup led to the diagnosis of inflammatory radiculomyelitis. Her clinical status improved, with complete recovery after a few months. The case described a reversible radiculomyelitis associated with the ChAdOx1 nCOVID-19 vaccine. The clinical picture and evolution supported the diagnosis. No other identifiable causes of myelopathy were found. Our patient showed clinically moderate symptoms and signs, showing good recovery. The post-vaccine inflammatory radiculomyelitis is a rare side effect of the anti-COVID-19 vaccination, and it should not discourage the SARS-CoV-2 vaccination programme.


Subject(s)
COVID-19 , Viral Vaccines , COVID-19 Vaccines , Female , Humans , SARS-CoV-2 , Vaccination/adverse effects
7.
BMJ Case Rep ; 14(10)2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1476414

ABSTRACT

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.


Subject(s)
Herpes Zoster , Acyclovir/therapeutic use , Herpes Zoster/complications , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Herpesvirus 3, Human , Humans , Immunocompromised Host , Paresis/etiology
9.
BMJ Case Rep ; 14(9)2021 Sep 13.
Article in English | MEDLINE | ID: covidwho-1406639

ABSTRACT

A 13-year-old girl with perinatally acquired HIV infection was admitted to us with acute onset, right-sided hemiparesis of 30 days duration and right-sided myoclonic jerks of 2 days duration affecting the face, upper and lower limbs. On examination, she exhibited increased tone and a pyramidal pattern of weakness in her right upper and lower limbs, along with spontaneous multifocal myoclonic jerks in the affected area. IgG levels in the serum and cerebrospinal fluid for measles were significantly elevated. Brain MRI depicted T2-weighted-hyperintensities in the subcortical white matter. The electroencephalogram demonstrated evidence of lateralised long interval periodic discharges. This patient had no past behavioural problems or poor academic performance. This case underlines the fact that, though subacute sclerosing panencephalitis (SSPE) is a chronic disease, a rare fulminant form of SSPE might develop acutely and atypically, with an increased proclivity for HIV-infected patients.


Subject(s)
HIV Infections , Subacute Sclerosing Panencephalitis , Adolescent , Electroencephalography , Female , HIV Infections/complications , Humans , Neuroimaging , Paresis/etiology , Subacute Sclerosing Panencephalitis/complications , Subacute Sclerosing Panencephalitis/diagnosis
10.
BMJ Case Rep ; 14(8)2021 Aug 23.
Article in English | MEDLINE | ID: covidwho-1370892

ABSTRACT

Arachnoid cysts are CSF-containing entities that rarely are symptomatic or warrant neurosurgical intervention. In addition, infection of these lesions is an even rarer event, with only four reports in the literature capturing this. In this report, we present the case of a 79-year-old man presenting with paraparesis, secondary to a right parasagittal meningioma, with an incidental asymptomatic right sylvian arachnoid cyst (Galassi type II). The initially planned surgery was postponed for 3 months, due to COVID-19 restrictions, and he was kept on high dose of steroids. Following tumour resection, the patient developed bilateral subdural empyemas with involvement of the arachnoid cyst, requiring bilateral craniotomies for evacuation of the empyemas and drainage of the arachnoid cyst. Suppuration of central nervous system arachnoid cysts is a very rare complication following cranial surgery with the main working hypotheses including direct inoculation from surrounding inflamed meninges or haematogenous spread secondary to systemic bacteraemia, potentiated by steroid-induced immunosuppression. Even though being a rarity, infection of arachnoid cysts should be considered in immunosuppressed patients in the presence of risk factors such as previous craniotomy.


Subject(s)
Arachnoid Cysts , Craniotomy , Meningeal Neoplasms , Meningioma , Aged , Arachnoid Cysts/diagnostic imaging , Arachnoid Cysts/surgery , Craniotomy/adverse effects , Humans , Male , Meningeal Neoplasms/surgery , Meningioma/surgery
12.
BMJ Case Rep ; 14(7)2021 Jul 21.
Article in English | MEDLINE | ID: covidwho-1320438

ABSTRACT

We describe the case of an immunocompetent 75-year-old man with Capnocytophaga canimorsus bacteraemia and meningitis. C. canimorsus is commonly found in the oral flora of dogs with human infection typically occurring following a bite. Unusually, while our patient was a dog owner, there was no history of bite nor scratch mark. Admission blood cultures flagged positive for Gram-negative bacilli, but prolonged molecular analysis was required before C. canimorsus was isolated in blood and cerebrospinal fluid. There is a high mortality rate in invasive infection, and in our patient's case, antibiotic therapy was commenced prior to laboratory confirmation with our patient making a complete recovery. This case highlights the importance of including C. canimorsus in the differential diagnosis of unwell patients who keep dogs, even without a bite. This case occurred amid heightened awareness of COVID-19, which may represent predisposition for zoonoses during social isolation and increased human-pet contact.


Subject(s)
Bacteremia , Bites and Stings , COVID-19 , Gram-Negative Bacterial Infections , Meningitis , Animals , Bacteremia/diagnosis , Bacteremia/drug therapy , Bites and Stings/complications , Capnocytophaga , Dogs , Gram-Negative Bacterial Infections/diagnosis , Gram-Negative Bacterial Infections/drug therapy , Humans , SARS-CoV-2
13.
BMJ Case Rep ; 13(9)2020 Sep 21.
Article in English | MEDLINE | ID: covidwho-1304172

ABSTRACT

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Subject(s)
Coronavirus Infections/complications , Guillain-Barre Syndrome/physiopathology , Low Back Pain/physiopathology , Muscle Weakness/physiopathology , Paresthesia/physiopathology , Pneumonia, Viral/complications , Analgesics/therapeutic use , Betacoronavirus , Brain/diagnostic imaging , COVID-19 , Coronavirus Infections/diagnosis , Diagnosis, Differential , Female , Gabapentin/therapeutic use , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiculopathy/diagnosis , SARS-CoV-2 , Spinal Cord/diagnostic imaging
14.
BMJ Case Rep ; 14(6)2021 Jun 04.
Article in English | MEDLINE | ID: covidwho-1258998

ABSTRACT

COVID-19 has shown different neurological manifestations even sometimes there are the initial or the main presentation.The following case report is about a middle-aged woman who, over 3 days, developed fever, clinical neurological alterations (stupor, muteness, fixed gaze and catatonia), cerebrospinal fluid (16 lymphocytes) and an electroencephalogram (EEG) (4-6 Hz generalised activity) with characteristics of encephalitis. A serum IgG, IgM, nasopharyngeal swab PCR for SARS-CoV-2. The patient responded positively to support measures, symptomatic and corticosteroid treatment. At discharge, the patient was independent and improved considerably.We report the presence of catatonia as a possible and atypical manifestation of encephalitis in association with COVID-19.


Subject(s)
COVID-19 , Catatonia , Encephalitis , Catatonia/diagnosis , Catatonia/etiology , Electroencephalography , Female , Humans , Middle Aged , SARS-CoV-2
15.
BMJ Case Rep ; 14(3)2021 Mar 24.
Article in English | MEDLINE | ID: covidwho-1150215

ABSTRACT

COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.


Subject(s)
Brain Diseases/etiology , COVID-19/complications , Seizures/etiology , Adenosine Monophosphate/analogs & derivatives , Adenosine Monophosphate/therapeutic use , Adult , Alanine/analogs & derivatives , Alanine/therapeutic use , Anticonvulsants/therapeutic use , Antiviral Agents/therapeutic use , Brain Diseases/diagnosis , Brain Diseases/therapy , COVID-19/diagnosis , COVID-19/therapy , Confusion/complications , Humans , Immunization, Passive/methods , Magnetic Resonance Imaging/methods , Male , Polymerase Chain Reaction , Radiography/methods , SARS-CoV-2 , Seizures/therapy , Treatment Outcome
16.
BMJ Case Rep ; 14(3)2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1112321

ABSTRACT

COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.


Subject(s)
Bell Palsy , COVID-19 , Facial Paralysis , Guillain-Barre Syndrome/diagnosis , Prednisolone/administration & dosage , Pregnancy Complications, Infectious , Stroke/diagnosis , Valacyclovir/administration & dosage , Adult , Anti-Inflammatory Agents/administration & dosage , Antiviral Agents/administration & dosage , Bell Palsy/etiology , Bell Palsy/physiopathology , Bell Palsy/therapy , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Diagnosis, Differential , Facial Paralysis/diagnosis , Facial Paralysis/physiopathology , Facial Paralysis/therapy , Facial Paralysis/virology , Female , Humans , Neurologic Examination/methods , Physical Therapy Modalities , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Treatment Outcome
17.
BMJ Case Rep ; 13(10)2020 Oct 10.
Article in English | MEDLINE | ID: covidwho-844303

ABSTRACT

The SARS-CoV-2 outbreak has disrupted the delivery of routine healthcare services on a global scale. With many regions suspending the provision of non-essential healthcare services, there is a risk that patients with common treatable illnesses do not receive prompt treatment, leading to more serious and complex presentations at a later date. Lemierre's syndrome is a potentially life-threatening and under-recognised sequela of an oropharyngeal or dental infection. It is characterised by septic embolisation of the gram-negative bacillus Fusobacterium necrophorum to a variety of different organs, most commonly to the lungs. Thrombophlebitis of the internal jugular vein is frequently identified. We describe an atypical case of Lemierre's syndrome involving the brain, liver and lungs following a dental infection in a young male who delayed seeking dental or medical attention due to a lack of routine services and concerns about the SARS-CoV-2 outbreak.


Subject(s)
Brain Abscess , Coronavirus Infections , Critical Care/methods , Delayed Diagnosis , Fusobacterium necrophorum , Liver Abscess, Pyogenic , Multiple Pulmonary Nodules , Pandemics , Pneumonia, Viral , Quarantine , Tooth Diseases , Anti-Bacterial Agents/administration & dosage , Anticoagulants/administration & dosage , Betacoronavirus , Brain Abscess/diagnostic imaging , Brain Abscess/etiology , COVID-19 , Clinical Deterioration , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Diagnosis, Differential , Fusobacterium necrophorum/isolation & purification , Fusobacterium necrophorum/pathogenicity , Humans , Lemierre Syndrome/diagnosis , Lemierre Syndrome/etiology , Lemierre Syndrome/physiopathology , Liver Abscess, Pyogenic/diagnostic imaging , Liver Abscess, Pyogenic/etiology , Liver Abscess, Pyogenic/surgery , Magnetic Resonance Imaging/methods , Male , Multiple Pulmonary Nodules/diagnostic imaging , Multiple Pulmonary Nodules/etiology , Pandemics/prevention & control , Patient Acceptance of Health Care , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Quarantine/methods , Quarantine/psychology , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Tooth Diseases/complications , Tooth Diseases/diagnosis , Tooth Diseases/microbiology , Treatment Outcome , Young Adult
19.
BMJ Case Rep ; 13(10)2020 Oct 04.
Article in English | MEDLINE | ID: covidwho-814255

ABSTRACT

We present a case of non-convulsive status epilepticus in a 57-year-old woman with a schizoaffective disorder, without an antecedent seizure history, with two possible aetiologies including SARS-CoV-2 infection and clozapine uptitration. We discuss the presentation, investigations, differential diagnosis and management. In particular, we focus on the electroencephalogram (EEG) findings seen in this case and the electroclinical response to antiepileptic medication. We review the literature and discuss the relevance of this case to the SARS-CoV-2 global pandemic. We emphasise the importance of considering possible neurological manifestations of SARS-CoV-2 infection and highlight seizure disorder as one of the possible presentations. In addition, we discuss the possible effects of clozapine on the electroclinical presentation by way of possible seizure induction as well as discuss the possible EEG changes and we highlight that this needs to be kept in mind especially during rapid titration.


Subject(s)
Antipsychotic Agents/adverse effects , Betacoronavirus , Clozapine/adverse effects , Coronavirus Infections/complications , Pneumonia, Viral/complications , Psychotic Disorders/drug therapy , Status Epilepticus/etiology , COVID-19 , Clozapine/therapeutic use , Diagnosis, Differential , Electroencephalography/methods , Female , Humans , Middle Aged , Pandemics , SARS-CoV-2 , Status Epilepticus/physiopathology
20.
BMJ Case Rep ; 13(9)2020 Sep 16.
Article in English | MEDLINE | ID: covidwho-772246

ABSTRACT

The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19's classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.


Subject(s)
Coronavirus Infections/complications , Encephalitis, Viral/cerebrospinal fluid , Pneumonia, Viral/complications , Adult , COVID-19 , Coronavirus Infections/drug therapy , Encephalitis, Viral/diagnosis , Encephalitis, Viral/drug therapy , Encephalitis, Viral/virology , Humans , Male , Pandemics , Pneumonia, Viral/drug therapy , Remission Induction
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