Evolution and resolution of brain involvement associated with SARS- CoV2 infection: A close Clinical - Paraclinical follow up study of a case

Abstract

The new severe acute respiratory syndrome- coronavirus 2 is reported to affect the nervous system. Among the reports of the various neurological manifestations, there are a few documented specific processes to explain the neurological signs. We report a para-infectious encephalitis patient with clinical, laboratory, and imaging findings during evolution and convalescence phase of coronavirus infection. This comprehensive overview can illuminate the natural history of similar cases. As the two previously reported cases of encephalitis associated with this virus were not widely discussed regarding the treatment, we share our successful approach and add some recommendations about this new and scarce entity.

Keywords: COVID-19; SARS-Cov-2; encephalitis; immunotherapy; natural history; post-infectious.

Figure 1

Axial chest CT scans of the patient at days 10 (upper row), 22 (middle row) and 28 (bottom row) after onset of symptoms.

Figure 2

Three sets of axial (A-M except E) and coronal (E) brain MRIs obtained at days 11 (planes A1-M1), 22 (planes A2-M2) and 33 (planes A3-M3) after symptoms onset, show the evolution of brain lesions over time. There are T2-FLAIR high signal lesions in bilateral pons (A1, B1, E1, F1 & G1), medial temporal lobes (C1 & H1) and thalami (D1 & I1) and with low signal in T1 sequences (J1-M1). Corresponding images in second and third series show considerable resolution of signal intense lesions. There was neither gadolinium enhancement nor diffusion restriction in post-contrast T1 and diffusion weighted imagings (not shown here).