ABSTRACT
Myoclonus in the context of COVID-19 is an increasingly recognized condition. The occurrence in an ICU context in hypoxic patients, with metabolic disorders, taking several types of medication, makes difficult to establish a precise cause. Also, the implication of SARS-CoV-2 by direct invasion of the CNS or by immune-mediated phenomena is not yet clear. Currently, a dozen of cases of myoclonus as a predominant clinical manifestation, immune-mediated by SARS-Cov-2 are published. In all these cases, myoclonus was preceded by respiratory or other suggestive symptoms (e.g., anosmia) for this infection making straightforward the causal link. We describe a case of an isolated generalized myoclonus without other clinical complaints nor chest CT scan abnormalities nor SARS-CoV-2 RNA detection on nasopharyngeal swabs and on the CSF, as a para-infectious phenomenon of COVID-19 infection with excellent response to steroids perfusion. This challenging diagnosis was made upon confirmation of seroconversion (serology was negative at admission, then positive for IgM at day 6, then for both IgM and IgG at day 10) underlying that repeating serology is a diagnostic key to capture a similar findings.
Subject(s)
COVID-19 , Myoclonus , Humans , Immunoglobulin M , Myoclonus/diagnostic imaging , Myoclonus/etiology , RNA, Viral , SARS-CoV-2 , SeroconversionABSTRACT
AIM: The aim of this paper is to describe the clinical features of COVID-19-related encephalopathy and their metabolic correlates using brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) imaging. BACKGROUND AND PURPOSE: A variety of neurological manifestations have been reported in association with COVID-19. COVID-19-related encephalopathy has seldom been reported and studied. METHODS: We report four cases of COVID-19-related encephalopathy. The diagnosis was made in patients with confirmed COVID-19 who presented with new-onset cognitive disturbances, central focal neurological signs, or seizures. All patients underwent cognitive screening, brain magnetic resonance imaging (MRI), lumbar puncture, and brain 2-desoxy-2-fluoro-D-glucose (FDG)-positron-emission tomography (PET)/computed tomography (CT) (FDG-PET/CT). RESULTS: The four patients were aged 60 years or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one patient had myoclonus, one had psychiatric manifestations, and one had status epilepticus. The delay between first COVID-19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant cerebrospinal fluid (CSF) abnormalities. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG-PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy. CONCLUSIONS: Despite varied clinical presentations, all patients presented with a consistent FDG-PET pattern, which may reflect an immune mechanism.
Subject(s)
Brain Diseases/diagnostic imaging , COVID-19/complications , Aged , Brain Diseases/psychology , Brain Diseases/therapy , COVID-19/therapy , Cerebellar Diseases/diagnostic imaging , Cerebellar Diseases/etiology , Cognition Disorders/etiology , Cognition Disorders/psychology , Female , Fluorodeoxyglucose F18 , Frontal Lobe/diagnostic imaging , Humans , Immunotherapy , Magnetic Resonance Imaging , Male , Mental Disorders/etiology , Mental Disorders/psychology , Middle Aged , Myoclonus/diagnostic imaging , Myoclonus/etiology , Neuropsychological Tests , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Status Epilepticus/etiology , Treatment OutcomeABSTRACT
OBJECTIVE: To report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus. METHODS: Patient data were obtained from medical records from the University Hospital "12 de Octubre," Madrid, Spain. RESULTS: Three patients (2 men and 1 woman, aged 63-88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy. CONCLUSIONS: Our 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.