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. 2020 Jul;162(7):1495-1499.
doi: 10.1007/s00701-020-04402-w. Epub 2020 May 20.

COVID-19-associated meningoencephalitis complicated with intracranial hemorrhage: a case report

Mohammad Al-Olama  1 , Anas Rashid  2 , Debora Garozzo  3
Affiliations

COVID-19-associated meningoencephalitis complicated with intracranial hemorrhage: a case report

Mohammad Al-Olama et al. Acta Neurochir (Wien). 2020 Jul.

Abstract

The coronavirus pandemic that started in December 2019 is mainly related to clinical pictures consistent with respiratory symptoms; nevertheless, reports about neurological complications have recently appeared in the medical literature. We describe a case of a 36-year-old coronavirus-positive patient that was admitted on emergency basis; his clinical presentation included neurological symptoms such as drowsiness and mild confusion. Imaging revealed findings consistent with meningoencephalitis complicated by intracerebral hematoma and subdural hematoma. The latter was surgically evacuated after it became chronic and evidence of coronavirus was found in the fluid. Our experience confirms that neurological complications might be a likely event in COVID-19. Although uncommon, the possible occurrence of meningoencephalitis should be kept in mind by physicians involved in the management of COVID-19 patients. Early recognition of brain involvement may provide better prognosis, preventing evolution into intracerebral hemorrhagic events.

Keywords: COVID-19; Encephalitis; ICH; Meningoencephalitis; SDH.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Non-enhanced CT brain axial cut showing a large parenchymal hematoma in the right frontal lobe with surrounding edema. Extracerebral hemorrhage is also observed subdural as well as subarachnoid. Note the cortical swelling evident as loss of demarcation of gray-white matter interface and effacement of sulci in temporo-occipital region on the right side and frontal lobe on the left
Fig. 2
Fig. 2
a Coronal MIP and b axial MIP. CTA findings show reduced and somewhat beaded appearance of the distal ICA, A1, and M1 and M2 branches on the right side reflecting vasospasm/vasculitis
Fig. 3
Fig. 3
a and b Delayed postcontrast imaging shows leptomeningeal as well as cortical gyral enhancement supratentorially bilaterally, more pronounced on the right side. The findings strongly suggestive of meningoencephalitis
Fig.4
Fig.4
Follow-up imaging shows reduced attenuation of the SDH and good resorption of SAH. The intracerebral hematoma shows signs of partial resorption but mild increase of perifocal edema. No significant interval change of mass effect in the form of effaced sulci and midline shift of about 10 mm
See this image and copyright information in PMC

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