COVID 19 RELATED ACUTE NECROTIZING ENCEPHALOPATHY COMPLICATED WITH PITUITARY APOPLEXY
Neuroepidemiology
; 56(SUPPL 1):69, 2022.
Article
in English
| EMBASE | ID: covidwho-1812949
ABSTRACT
Background:
Severe Acute Respiratory Syndrome Corona Virus 2(SARS-Cov2) is well known to cause a multitude of neurologic conditions out of which remains the rather rare condition of Acute Necrotizing Encephalopathy. It's a devastating condition with early immunotherapy bringing a more favorable outcome. Pathophysiology suggests the dysregulation of the blood brain barrier secondary to the cytokine storm. Pituitary apoplexy is an unrelated acute condition in which there is either hemorrhagic or non- hemorrhagic necrosis of the pituitary gland. It again has multiple predisposing factors including changes in intracranial pressure and underlying coagulation disorders. Case Presentation A thirty-five-year-old male patient with poorly controlled diabetes presented to our emergency department with fever, cough and progressive respiratory distress for three days. He was drowsy with clinical features of bronchopneumonia and his COVID PCR was positive (He had taken only the first dose of Sinopharm nearly a month before). Within twenty-four hours, he was sent to the ICU for ventilatory support mainly due to low GCS. His HRCT Chest revealed severe COVID pneumonia. MRI brain revealed high signal intensities involving cerebellum, brainstem, bilateral thalami and mesial temporal lobes compatible with acute necrotizing encephalopathy with a pituitary macroadenoma and bleeding into it. He received high dose steroids followed by plasma exchange leading to resolution of the above changes within a month but passed away at the end of six weeks due to secondary bacterial sepsis.Discussion:
Here the pituitary macroadema was an incidental finding and the bleeding was postulated to be secondary to changes in intra cranial pressure. Both the Necrotizing encephalopathy and the pituitary apoplexy might have resulted in the reduced conscious level in the above patient in the background of severe COVID pneumonia. The immunotherapy was successful in resolution of the radiologic changes though the patient deteriorated clinically following a transient improvement due to bacterial sepsis.
steroid; acute disease; acute necrotizing encephalopathy; adult; assisted ventilation; blood clotting disorder; brain stem; bronchopneumonia; case report; cerebellum; clinical article; clinical feature; complication; conference abstract; coronavirus disease 2019; coughing; COVID-19-associated acute hemorrhagic necrotizing encephalopathy; diabetes mellitus; drug megadose; emergency ward; fever; human; hypophysis; hypophysis apoplexy; immunotherapy; incidental finding; intracranial pressure; macroadenoma; male; necrosis; neuroimaging; nuclear magnetic resonance imaging; plasma exchange; pneumonia; respiratory distress; sepsis; temporal lobe; thalamus; thorax
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Collection:
Databases of international organizations
Database:
EMBASE
Language:
English
Journal:
Neuroepidemiology
Year:
2022
Document Type:
Article
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