Subject(s)
COVID-19/physiopathology , Cerebrovascular Disorders/physiopathology , Cognitive Dysfunction/physiopathology , Deglutition Disorders/physiopathology , Dysphonia/physiopathology , Executive Function , Adult , Angiography, Digital Subtraction , Basal Ganglia/diagnostic imaging , COVID-19/diagnostic imaging , Cerebral Angiography , Cerebrovascular Disorders/diagnostic imaging , Cerebrovascular Disorders/drug therapy , Diffusion Magnetic Resonance Imaging , Emergency Service, Hospital , Glucocorticoids/therapeutic use , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Magnetic Resonance Imaging , Male , Methylprednisolone/therapeutic use , Patient Discharge , Pons/diagnostic imaging , Posterior Cerebral Artery/diagnostic imaging , SARS-CoV-2 , Severity of Illness Index , Thalamus/diagnostic imaging , Tomography, X-Ray Computed , White Matter/diagnostic imaging , COVID-19 Drug TreatmentABSTRACT
Children account for 1% to 5% of diagnosed COVID-19 infection with relatively mild presentation compared to adults. The frequency of neurological involvement in acute COVID-19 infection in children is unclear. COVID-19 is also considered to be a neurotropic virus, but so far, in the pediatric age group, very few cases with involvement of basal ganglia and no case of dentate nucleus involvement have been reported in the literature. The present paper reports two cases of acute encephalopathy with COVID-19, the first case with basal ganglia involvement and the second with dentate nucleus involvement. Both cases required aggressive management and had complete neurological recovery on follow-up. Hence, these cases are reported to make everyone aware of the neurological presentation with atypical neuroimaging finding of acute COVID-19 infection in the pediatric age group; timely management improves the outcome.
Subject(s)
Brain Diseases , COVID-19 , Adult , Basal Ganglia/diagnostic imaging , Brain Diseases/etiology , COVID-19/complications , Cerebellar Nuclei , Child , Humans , NeuroimagingABSTRACT
BACKGROUND: Biotin-thiamine-responsive basal ganglia disease (BTRBGD) is a rare treatable autosomal recessive neurometabolic disorder characterized by progressive encephalopathy that eventually leads to severe disability and death if not treated with biotin and thiamine. BTRBGD is caused by mutations in the SLC19A3 gene on chromosome 2q36.6, encoding human thiamine transporter 2 (hTHTR2). Episodes of BTRBGD are often triggered by febrile illness. CASE REPORT: The patient was 2 years 10 months old male child presented with fever and progressive acute encephalopathy associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus infection. MRI revealed bilateral symmetrical high signal involving both basal ganglia and medial thalami which is swollen with central necrosis, initially diagnosed as acute necrotizing encephalomyelitis with increased severity. Genetic analysis revealed BTRBGD. CONCLUSION: BTRBGD requires high index of suspicion in any patient presenting with acute encephalopathy, characteristic MRI findings (that are difficult to differentiate from necrotizing encephalopathy), regardless of the existence of a proven viral infection.
Subject(s)
Basal Ganglia Diseases/complications , Basal Ganglia Diseases/diagnosis , COVID-19/complications , Acute Febrile Encephalopathy/diagnosis , Acute Febrile Encephalopathy/etiology , Basal Ganglia , Basal Ganglia Diseases/virology , Biotin/genetics , Brain/metabolism , COVID-19/virology , Child, Preschool , Genetic Testing , Humans , Magnetic Resonance Imaging , Male , Membrane Transport Proteins/genetics , Mutation , SARS-CoV-2/pathogenicity , Thiamine/geneticsABSTRACT
BACKGROUND: Coronavirus disease 2019, caused by the severe acute respiratory syndrome coronavirus 2, has a broad clinical spectrum, from asymptomatic to multi-organ dysfunction. Acute cerebrovascular events associated with coronavirus disease 2019 are mainly due to the severe acute respiratory syndrome coronavirus 2-induced prothrombotic state. Bilateral basal ganglia ischemia is rarely reported. CASE PRESENTATION: We report the case of a 64-year-old Asian (Pakistani) gentleman who presented initially with fever, cough, and shortness of breath, likely due to respiratory involvement by severe acute respiratory syndrome coronavirus 2. Later, he developed bilateral lower limb pain, followed by confusion and decreased level of consciousness. Accentuated large hypodense opacities were seen in the left and right basal ganglia, with mass effects on the left frontal horn. CONCLUSION: This case demonstrates the importance of neuroimaging in the effective management of patients with neurological signs associated with coronavirus disease 2019.