ABSTRACT
RATIONALE: This is a case report describing delayed complications of COVID-19 pneumonia, which evolved into the vascular-ischemic complications leading to quadrantanopia and MRI findings consistent with recent ischemic event in the occipital pole of the brain. PATIENT CONCERNS: We report a case of a 46-year-old woman with quadrantanopia due to stroke confirmed with brain MRI, secondary to COVID-19 infection with chronically elevated D-dimers and treated with anticoagulation/antithrombotic modalities. Quadrantanopia was the only symptom recognized by the patient of a stroke localized in the occipital pole of the brain. DIAGNOSIS: The patient was diagnosed with quadrantanopia due to stroke confirmed with brain MRI, secondary to COVID-19 infection. INTERVENTION: Patient underwent ophthalmological examination and MRI. OUTCOMES: A thrombotic or ischemic risks in the chronic recovery from COVID-19 should be considered in patients with elevated D-dimers. LESSONS: An MRI should be considered as a long term follow up for post-COVID-19 patients reporting ophthalmic or neurologic complains.
Subject(s)
COVID-19 , Hemianopsia , Stroke , COVID-19/complications , Female , Hemianopsia/diagnosis , Hemianopsia/virology , Humans , Middle Aged , Occipital Lobe/diagnostic imaging , Stroke/diagnostic imaging , Stroke/virologySubject(s)
AIDS-Related Opportunistic Infections/diagnosis , Cytomegalovirus Retinitis/diagnosis , Encephalitis Virus, California , Encephalitis, California/diagnosis , HIV Seropositivity/diagnosis , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Diagnosis, Differential , Hemianopsia/virology , Humans , Male , Middle Aged , Treatment OutcomeABSTRACT
INTRODUCTION: Encephalitis is a rare complication of primary varicella-zoster virus (VZV) infection in immunocompetent children. METHODS: The clinical and laboratory findings of two girls with VZV-related encephalitis are reported. RESULTS: Both children presented with focal epileptic seizures, corresponding to cortical/subcortical as well as white matter lesions. The first showed a typical vesicular skin rash. She was easily diagnosed and made a rapid recovery during acyclovir and steroid treatment. In the second girl, a preceding measles-mumps-rubella virus vaccination and the absence of skin vesicles were misleading with respect to the diagnosis, which was finally proven by IgG seroconversion and intrathecal synthesis of IgG antibodies to VZV. She developed left parieto-occipital tissue necrosis and recovered only transiently during initial acyclovir/steroid treatment. Eight weeks after onset, progressive white matter demyelination and the occurrence of erythema nodosum in the lower limbs necessitated a second 4-month course of oral steroids. The VZV PCR from cerebrospinal fluid was negative in both children. CONCLUSIONS: Primary VZV infection may cause severe encephalitis that may occur without skin vesicles and lead to a chronic course with systemic vasculitis. The coincidence of vaccination and neurologic diseases offers no proof per se of a causal relationship.
