Extensive cerebellar involvement and cognitive impairment in COVID-19-associated acute necrotizing encephalopathy

Abstract

Neurological complications of the newly appeared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are increasingly recognized. Here, we report a case of a young male presenting with a clinical and neuroimaging scenario of an acute necrotizing encephalopathy related to the coronavirus disease 2019 (COVID-19). This case is notable by its distinct pattern of magnetic resonance imaging findings of an extensive involvement of the cerebellum, and emergence of cognitive and behavioral impairment.

Keywords: COVID-19; SARS-CoV-2; acute necrotizing encephalopathy; cerebellum.

Figure 1.

Brain and chest CT. Axial brain non-contrast CT images with an unremarkable appearance (A). Plain axial chest CT images showing multiple, bilateral, and peripherally distributed opacities (arrows) with a ground glass pattern (B). CT, computed tomography.

Figure 2.

Brain MRI. Widespread bilateral cerebellar and thalamic lesions (arrows) showing a hyperintense signal on axial fluid-attenuated inversion recovery images (A, G), restricted diffusion (cytotoxic edema) on diffusion-weighted images (B, H), and apparent diffusion coefficient maps (C, I), hemorrhages on susceptibility-weighted images (D, J), hypo-hyperintense signal on T1-weighted pre-contrast images (E, K), and contrast enhancement on T1-weighted post-contrast images (F, L). MRI, magnetic resonance imaging.