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Case Reports
. 2020 Sep;91(9):1004-1006.
doi: 10.1136/jnnp-2020-323678. Epub 2020 Jul 10.

COVID-19-associated acute necrotising encephalopathy successfully treated with steroids and polyvalent immunoglobulin with unusual IgG targeting the cerebral fibre network

Louis Delamarre  1 , Cédric Gollion  2 , Gaspard Grouteau  3 , David Rousset  4 , Guillaume Jimena  4 , Jérôme Roustan  5 , François Gaussiat  5 , Etienne Aldigé  4 , Charlène Gaffard  4 , Julien Duplantier  6 , Charlotte Martin  4 , Olivier Fourcade  4 , Chloé Bost  7   8 , Françoise Fortenfant  7 , Pierre Delobel  3 , Guillaume Martin-Blondel  3 , Jérémie Pariente  2 , Fabrice Bonneville  6 , Thomas Geeraerts  4 ; NeuroICU Research Group
Collaborators, Affiliations
Case Reports

COVID-19-associated acute necrotising encephalopathy successfully treated with steroids and polyvalent immunoglobulin with unusual IgG targeting the cerebral fibre network

Louis Delamarre et al. J Neurol Neurosurg Psychiatry. 2020 Sep.
No abstract available

Keywords: autoimmune encephalitis; intensive care; neuropathology, virology; steroids.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
(I–III) MRI of a 51-year-old man with acute encephalopathy. (I) MRI 1 is not shown. MRI 2 (day 22) 1 day after neuroICU admission. (A–D) Axial FLAIR images demonstrate diffuse hyperintense lesions in the cerebellum (star), brainstem (arrows on B), supratentorial grey and white matters (arrows on D), and bilateral and symmetrical lesions in the thalami (arrows on C). (E) Gradient echo T2-weighted image does not reveal any haemorrhage within thalamic lesions, and (F) post-gadolinium T1-weighted image does not show enhancement. (G) Diffusion-weighted image and (H) apparent diffusion coefficient map show mild hyperintensity in the thalami with heterogeneous and variable diffusion (arrows). (II) MRI 3 (day 25) 3 days after treatment initiation: (A) axial FLAIR demonstrates no extension of hyperintensity in both thalami (arrows) and (B) susceptibility-weighted image does not detect any haemorrhage. (C) Diffusion-weighted image and (D) apparent diffusion coefficient map now depict areas of restricted diffusion and cytotoxic oedema (arrows), a feature highly suggesting acute necrotising encephalopathy. (III) MRI 4 (day 35) 13 days after treatment initiation: (A–C) axial FLAIR images demonstrate significant reduction of hyperintensities with only residual lesions in bilateral thalami (arrows). (D) Gradient echo T2-weighted image shows no haemorrhage within the lesions. (IV, V) Indirect immunofluorescence (IF) patterns of patient’s IgG on rat hippocampal slices (×10 magnification, scale bar 100 µm). IF shows an unusual binding of IgG on specific areas in the fibre tracts, sparing the hippocampus and the cortex, (IV) around the ventricle, near the dentate gyrus and (V) close to the hippocampus Ammon’s horn. Hi, hile of the dentate gyrus; GC, granule cells of the dentate gyrus; ML, molecular layer; Py, pyramidal cells in the hippocampus Ammon’s horn.
See this image and copyright information in PMC

References

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