Acute necrotizing encephalopathy with SARS-CoV-2 RNA confirmed in cerebrospinal fluid.
Neurology
; 95(10): 445-449, 2020 09 08.
Article
in English
| MEDLINE | ID: covidwho-999777
ABSTRACT
Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Brain
/
RNA, Viral
/
Coronavirus Infections
/
Leukoencephalitis, Acute Hemorrhagic
Type of study:
Case report
/
Diagnostic study
Limits:
Female
/
Humans
/
Middle aged
Language:
English
Journal:
Neurology
Year:
2020
Document Type:
Article
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