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SARS-CoV-2-related encephalitis with prominent parkinsonism: clinical and FDG-PET correlates in two patients.
Morassi, Mauro; Palmerini, Francesco; Nici, Stefania; Magni, Eugenio; Savelli, Giordano; Guerra, Ugo Paolo; Chieregato, Matteo; Morbelli, Silvia; Vogrig, Alberto.
  • Morassi M; Department of Diagnostic Imaging, Unit of Neuroradiology, Fondazione Poliambulanza Hospital, Via L. Bissolati 57, 25124, Brescia, Italy. mauro.morassi@poliambulanza.it.
  • Palmerini F; Unit of Neurology, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Nici S; Unit of Medical Physics, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Magni E; Unit of Neurology, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Savelli G; Unit of Nuclear Medicine, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Guerra UP; Unit of Nuclear Medicine, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Chieregato M; Unit of Medical Physics, Fondazione Poliambulanza Hospital, Brescia, Italy.
  • Morbelli S; Department of Health Sciences, Unit of Nuclear Medicine, Ospedale Policlinico San Martino, Genoa, Italy.
  • Vogrig A; Clinical Neurology Unit, Santa Maria della Misericordia University Hospital, Piazzale Santa Maria della Misericordia, Udine, Italy.
J Neurol ; 268(11): 3980-3987, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1196579
ABSTRACT
Considering the similarities with other pandemics due to respiratory virus infections and subsequent development of neurological disorders (e.g. encephalitis lethargica after the 1918 influenza), there is growing concern about a possible new wave of neurological complications following the worldwide spread of SARS-CoV-2. However, data on COVID-19-related encephalitis and movement disorders are still limited. Herein, we describe the clinical and neuroimaging (FDG-PET/CT, MRI and DaT-SPECT) findings of two patients with COVID-19-related encephalopathy who developed prominent parkinsonism. None of the patients had previous history of parkinsonian signs/symptoms, and none had prodromal features of Parkinson's disease (hyposmia or RBD). Both developed a rapidly progressive form of atypical parkinsonism along with distinctive features suggestive of encephalitis. A possible immune-mediated etiology was suggested in Patient 2 by the presence of CSF-restricted oligoclonal bands, but none of the patients responded favorably to immunotherapy. Interestingly, FDG-PET/CT findings were similar in both cases and reminiscent of those observed in post-encephalitic parkinsonism, with cortical hypo-metabolism associated with hyper-metabolism in the brainstem, mesial temporal lobes, and basal ganglia. Patient's FDG-PET/CT findings were validated by performing a Statistical Parametric Mapping analysis and comparing the results with a cohort of healthy controls (n = 48). Cerebrum cortical thickness map was obtained in Patient 1 from MRI examinations to evaluate the structural correlates of the metabolic alterations detected with FDG-PET/CT. Hypermetabolic areas correlated with brain regions showing increased cortical thickness, suggesting their involvement during the inflammatory process. Overall, these observations suggest that SARS-CoV-2 infection may trigger an encephalitis with prominent parkinsonism and distinctive brain metabolic alterations.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Parkinsonian Disorders / Encephalitis / COVID-19 Type of study: Case report / Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Neurol Year: 2021 Document Type: Article Affiliation country: S00415-021-10560-3

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Parkinsonian Disorders / Encephalitis / COVID-19 Type of study: Case report / Cohort study / Etiology study / Experimental Studies / Observational study / Prognostic study Limits: Humans Language: English Journal: J Neurol Year: 2021 Document Type: Article Affiliation country: S00415-021-10560-3