ABSTRACT
We report the case of a 35-year-old male with COVID-19 encephalitis presenting as a stroke mimic with sudden-onset expressive and receptive dysphasia, mild confusion and right arm incoordination. The patient received thrombolysis for a suspected ischaemic stroke, but later became febrile and SARS-CoV-2 was detected in cerebrospinal fluid. Electroencephalography demonstrated excess in slow waves, but neuroimaging was reported as normal. Respiratory symptoms were absent throughout and nasopharyngeal swab was negative for SARS-CoV-2. At the most recent follow-up, the patient had made a full neurological recovery. Clinicians should therefore consider testing for SARS-CoV-2 in CSF in patients who present with acute focal neurology, confusion and fever during the pandemic, even when there is no evidence of respiratory infection.
Subject(s)
COVID-19 Nucleic Acid Testing , COVID-19/diagnosis , Encephalitis, Viral/diagnosis , Ischemic Stroke/diagnosis , RNA, Viral/cerebrospinal fluid , SARS-CoV-2/genetics , Adult , COVID-19/cerebrospinal fluid , COVID-19/virology , Diagnosis, Differential , Electroencephalography , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/virology , Humans , Magnetic Resonance Imaging , Male , Predictive Value of Tests , Tomography, X-Ray ComputedABSTRACT
Patients suffering from Coronavirus disease 2019 (COVID-19) can develop neurological sequelae, such as headache and neuroinflammatory or cerebrovascular disease. These conditions-termed here as Neuro-COVID-are more frequent in patients with severe COVID-19. To understand the etiology of these neurological sequelae, we utilized single-cell sequencing and examined the immune cell profiles from the cerebrospinal fluid (CSF) of Neuro-COVID patients compared with patients with non-inflammatory and autoimmune neurological diseases or with viral encephalitis. The CSF of Neuro-COVID patients exhibited an expansion of dedifferentiated monocytes and of exhausted CD4+ T cells. Neuro-COVID CSF leukocytes featured an enriched interferon signature; however, this was less pronounced than in viral encephalitis. Repertoire analysis revealed broad clonal T cell expansion and curtailed interferon response in severe compared with mild Neuro-COVID patients. Collectively, our findings document the CSF immune compartment in Neuro-COVID patients and suggest compromised antiviral responses in this setting.
Subject(s)
COVID-19/immunology , Monocytes/immunology , Nervous System Diseases/immunology , T-Lymphocytes/immunology , COVID-19/cerebrospinal fluid , COVID-19/complications , COVID-19/pathology , Cell Differentiation , Cerebrospinal Fluid/immunology , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/immunology , Gene Expression Profiling , Humans , Interferons/genetics , Interferons/immunology , Leukocytes/immunology , Lymphocyte Activation , Nervous System Diseases/cerebrospinal fluid , Nervous System Diseases/etiology , Nervous System Diseases/pathology , Receptors, Antigen, T-Cell/genetics , Receptors, Antigen, T-Cell/metabolism , SARS-CoV-2/immunology , Single-Cell AnalysisABSTRACT
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 InductionABSTRACT
There are few detailed investigations of neurologic complications in severe acute respiratory syndrome coronavirus 2 infection. We describe 3 patients with laboratory-confirmed coronavirus disease who had encephalopathy and encephalitis develop. Neuroimaging showed nonenhancing unilateral, bilateral, and midline changes not readily attributable to vascular causes. All 3 patients had increased cerebrospinal fluid (CSF) levels of anti-S1 IgM. One patient who died also had increased levels of anti-envelope protein IgM. CSF analysis also showed markedly increased levels of interleukin (IL)-6, IL-8, and IL-10, but severe acute respiratory syndrome coronavirus 2 was not identified in any CSF sample. These changes provide evidence of CSF periinfectious/postinfectious inflammatory changes during coronavirus disease with neurologic complications.