ABSTRACT
We present a case of a 14-year-old, previously healthy female, admitted with acute coronavirus disease 2019 infection and new-onset seizures secondary to virus-associated necrotizing disseminated acute leukoencephalopathy. Her symptoms resolved completely with intravenous immunoglobulin and steroids. Pathophysiology and prognosis of neurologic manifestations of coronavirus disease 2019 remain unclear.
Subject(s)
COVID-19/complications , Intracranial Hemorrhages/etiology , Leukoencephalopathies/etiology , Leukoencephalopathies/virology , SARS-CoV-2 , Adolescent , Anticonvulsants/administration & dosage , Anticonvulsants/therapeutic use , Female , Humans , Immunoglobulins, Intravenous/therapeutic use , Intracranial Hemorrhages/pathology , Leukoencephalopathies/pathology , Levetiracetam/administration & dosage , Levetiracetam/therapeutic use , Lorazepam/administration & dosage , Lorazepam/therapeutic use , Seizures/drug therapy , COVID-19 Drug TreatmentABSTRACT
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) commonly results in a respiratory illness in symptomatic patients; however, those critically ill can develop a leukoencephalopathy. We describe two patients who had novel subacute MRI findings in the context of coronavirus disease 2019 (COVID-19) leukoencephalopathy, which we hypothesize could implicate a potent small-vessel vasculitis, ischemic demyelination and the presence of prolonged ischemia. Recent evidence of the direct neuroinvasiness of SARS-CoV-2 leading to ischemia and vascular damage supports this hypothesis.
Subject(s)
COVID-19/complications , Demyelinating Diseases/pathology , Leukoencephalopathies/pathology , Leukoencephalopathies/virology , Vasculitis, Central Nervous System/pathology , Demyelinating Diseases/virology , Female , Humans , Magnetic Resonance Imaging , Male , Middle Aged , SARS-CoV-2 , Vasculitis, Central Nervous System/virologyABSTRACT
As the novel coronavirus, SARS-CoV-2, has enveloped the world in a pandemic, it has become clear that the symptoms extend far beyond the respiratory system and have particularly caused a wide range of neurologic CNS complications, including diffuse leukoencephalopathy. Here, we describe a case of a 59-year-old male with severe COVID-19 infection who developed severe encephalopathy, which persisted well after his acute infection had subsided and had begun to improve from his respiratory dysfunction. He was found to have diffuse leukoencephalopathy with concomitant diffusion restriction on MR imaging. This case represents a delayed onset of leukoencephalopathy secondary to hypoxia in a small but growing cohort of COVID-related leukoencephalopathy due to similarities in imaging features and lack of superior alternate diagnosis. Patient's clinical improvement suggests reversibility with likely pathology being demyelination rather than infarction.
Subject(s)
COVID-19/complications , Hypoxia, Brain/virology , Leukoencephalopathies/virology , Humans , Male , Middle Aged , SARS-CoV-2Subject(s)
Coronavirus Infections/pathology , Leukoencephalopathies/pathology , Leukoencephalopathies/virology , Pneumonia, Viral/pathology , Adult , Aged , Betacoronavirus , COVID-19 , Critical Illness , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2 , Young AdultABSTRACT
We report the cases of 2 patients hospitalized in our intensive care unit with confirmed coronavirus disease 2019 infection in whom brain MR imaging showed an unusual DWI pattern with nodular and ring-shaped lesions involving the periventricular and deep white matter. We discuss the possible reasons for these findings and their relationship to the infection.