NEUTROPHIL MENINGO-ENCEPHALITIS AND VENTRICULITIS IN TWO PATIENTS WITH ACUTE SARS-COV-2 INFECTION

ABSTRACT

Background and Objective: The novel coronavirus SARS-CoV-2 has become a global health emergency. Methods: We report two patients with similar atypical neurological presentation of novel coronavirus SARS-CoV-2 infection admitted in May 2021. Results: A 60-year-old man and a 44-year-old woman were admitted for acute left hemiparesis, respectively unusual headache with photo-, phonophobia. The diagnosis of COVID-19 was made by a positive nasopharyngeal swab RT-PCR. The initial MRI showed for both patients an aspect of unilateral ventriculitis associated with periventricular vasogenic edema and serpiginous periventricular hypo signal in SWI. Both presented in the cerebrospinal fluid, neutrophil pleocytosis WBC 354/mm3, neutrophils 91% and lymphocytes 6% for the first patient and WBC 3000/mm3, neutrophils 91%, lymphocytes 0% for the second patients, associated with hypoglycorrhachia 2,5 mmol/L compared to 7,5 mmol/L glycemia and 2,7 mmol/l compared to 5,9 mmol/L glycemia, respectively. Empirical antibiotic treatment was started, but due to lack of argument for an infection on two consecutively lumbar punctures, the treatment was stopped. Favorable evolution was observed on corticosteroid treatment. The follow-up MRI showed a net reduction of the initial findings for both patients. Conclusion: The presented cases seem to be comparable with the first case of ventriculitis in a patient with SARS-CoV-2 reported by Moriguchi et al in 2020. The particularity of our cases is given by the serpiginous hypo signal in SWI, that was not described in the case report mentioned before. The favorable clinical and radiologic evolution on corticosteroid treatment suggests a probable inflammatory mechanism secondary of COVID.