Mild encephalopathy with reversible splenium lesion (MERS) in a patient with COVID-19

Abstract

Neurological complications of coronavirus 2019 (COVID-19) are common, and novel manifestations are increasingly being recognized. Mild encephalopathy with reversible splenium lesion (MERS) is a syndrome that has been associated with viral infections, but not previously with COVID-19. In this report, we describe the case of a 69 year-old man who presented with fever and encephalopathy in the setting of a diffusion-restricting splenium lesion, initially mimicking an ischemic stroke. A comprehensive infectious workup revealed positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies, and a pro-inflammatory laboratory profile characteristic of COVID-19 infection. His symptoms resolved and the brain MRI findings completely normalized on repeat imaging, consistent with MERS. This case suggests that MERS may manifest as an autoimmune response to SARS-CoV-2 infection and should be considered in a patient with evidence of recent COVID-19 infection and the characteristic MERS clinico-radiological syndrome.

Keywords: COVID-19; MERS; Mild encephalopathy with reversible splenium lesion; SARS-CoV-2.

Fig. 1

A reversible splenium lesion on MRI in a patient with antibodies to SARS-CoV-2. Initial MRI brain showed a midline splenium increased signal on (a) DWI and (b) FLAIR, and decreased signal on (b) ADC sequences. After two weeks, there was complete reversal of these changes on (d) DWI, (e) ADC, and (f) FLAIR sequences.