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. 2020 Sep:44:102324.
doi: 10.1016/j.msard.2020.102324. Epub 2020 Jun 24.

A case of possible atypical demyelinating event of the central nervous system following COVID-19

Anahita Zoghi  1 , Mahtab Ramezani  2 , Mehrdad Roozbeh  3 , Ilad Alavi Darazam  4 , Mohammad Ali Sahraian  5
Affiliations

A case of possible atypical demyelinating event of the central nervous system following COVID-19

Anahita Zoghi et al. Mult Scler Relat Disord. 2020 Sep.

Abstract

After the novel coronavirus disease outbreak first began in Wuhan, China, in December 2019, the viral epidemic has quickly spread across the world, and it is now a major public health concern. Here we present a 21-year-old male with encephalomyelitis following intermittent vomiting and malaise for 4 days. He reported upper respiratory signs and symptoms 2 weeks before this presentation. Two cerebrospinal fluid (CSF) analyses were notable for mononuclear pleocytosis, elevated protein (more than 100 mg/dl), and hypoglycorrhachia. Brain Magnetic Resonance Imaging (MRI) showed bilateral posterior internal capsule lesions extending to the ventral portion of the pons and a marbled splenium hyperintensity pattern. Cervical and thoracic MRI showed longitudinally extensive transverse myelitis (LETM), none of which were enhanced with gadolinium. Both the AQP4 and MOG antibodies were negative. Spiral chest computed tomography (CT) scan confirmed to COVID-19 as did the high IgG level against coronavirus, but the oropharyngeal swabs were negative. Neurological manifestations of COVID-19 have not been adequately studied. Some COVID-19 patients, especially those suffering from a severe disease, are highly likely to have central nervous system (CNS) manifestations. Our case is a post-COVID-19 demyelinating event in the CNS.

Keywords: ADEM; COVID-19; Demyelinating event; NMOSD.

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Conflict of interest statement

None.

Figures

Fig. 1
Fig. 1
(A) Spiral chest CT scan without contrast shows left lung ground-glass opacity. (B) Axial FLAIR sequence of brain MRI demonstrates bilateral internal capsule hyperintensity. (C) Axial T2-weighted image of the cervical spine shows longitudinally extensive transverse myelitis and hyperintensity at dorsal of upper pons. (D) Axial FLAIR sequence shows bilateral cerebral peduncle hyperintense lesions. (E) Coronal T2 weighted image demonstrates bilateral corticospinal tract involvement. (F) Sagittal T2 weighted image reveals corpus callosum hyperintensity signal abnormalities.
See this image and copyright information in PMC

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