A fatal case of COVID-19-associated acute necrotizing encephalopathy.
Eur J Neurol
; 28(11): 3870-3872, 2021 11.
Article
in English
| MEDLINE | ID: covidwho-1470416
ABSTRACT
INTRODUCTION:
An increasing number of published reports on SARS-CoV-2 neurological manifestations have revealed a wide spectrum of symptoms, diagnostic features, and outcomes. We report a fatal case of a COVID-19-associated acute necrotizing encephalopathy (ANE). CASE REPORT We report a 70-year-old man brought to the hospital after a generalized tonic-clonic seizure. He was confused and disoriented. Nasopharyngeal swab testing for SARS-CoV-2 was positive. A head computed tomography (CT) scan and cerebrospinal fluid (CSF) analysis showed no signs of acute pathology. After recurrent seizures, he was sedated and intubated. Throughout the days that followed he remained in a therapeutic coma. After discontinuation of sedatives, he remained unconscious. A repeated head CT scan showed signs of pontine edema, and brain magnetic resonance imaging (MRI) revealed inhomogeneous hyperintensities with microhemorrhages and small autonecrotic cavities in both thalami, brain stem, and cerebellar peduncles. With a high suspicion of a COVID-19-associated ANE, the patient was started on high-dose glucocorticoids; however, he died the next day. The CSF tested negative for SARS-CoV-2.DISCUSSION:
A variety of COVID-19 neurological manifestations have been reported to date, including various forms of encephalitis and encephalopathy. In our patient, encephalopathy with seizures was the presenting symptom of SARS-CoV-2 infection. The radiological findings on days 8 and 9 were consistent with an ANE. The precise pathogenesis of ANE remains unclear; however, an immune-mediated mechanism is suspected. Early diagnostics with prompt administration of immunomodulators may be lifesaving. Suspicion of a COVID-19-related encephalopathy/encephalitis should be raised in all patients with altered mental status, seizures, and/or coma.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Brain Diseases
/
COVID-19
Type of study:
Case report
/
Diagnostic study
Limits:
Aged
/
Humans
/
Male
Language:
English
Journal:
Eur J Neurol
Journal subject:
Neurology
Year:
2021
Document Type:
Article
Affiliation country:
Ene.14966
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