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Review
. 2021 Apr;11(2):e147-e151.
doi: 10.1212/CPJ.0000000000000900.

Acute Hemorrhagic Encephalitis Related to COVID-19

Alan Chalil  1 , Carmen S Baker  1 , Robert B Johnston  1 , Caroline Just  1 , Derek B Debicki  1 , Michael S Mayich  1 , Karen J Bosma  1 , David A Steven  1
Affiliations
Review

Acute Hemorrhagic Encephalitis Related to COVID-19

Alan Chalil et al. Neurol Clin Pract. 2021 Apr.

Abstract

Purpose of review: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most critical public health challenge in recent history. In this report, we present a case of suspected acute hemorrhagic encephalitis with bilateral intracranial hemorrhages associated with coronavirus disease 2019 (COVID-19) infection.

Recent findings: A 48-year-old female COVID-19-positive patient developed acute changes in her neurologic status. A head CT with CT angiography demonstrated extensive bilateral parietal and occipital intraparenchymal hemorrhage with intraventricular extension and acute hydrocephalus. The patient was treated with an external ventricular drain, and a CSF sample was tested for SARS-CoV-2 but was found to be negative.

Summary: The underlying mechanism for developing acute hemorrhagic encephalitis in viral illnesses may be autoimmune in nature and warrants further investigation. The initial neurologic presentation of COVID-19-related hemorrhagic encephalitis is altered level of consciousness, which may prompt further neurologic examination and imaging to exclude this feature.

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Figures

Figure 1
Figure 1. Unenhanced Axial CT of the Thorax
An axial image through the level of the carina demonstrating bilaterally extensive ground-glass opacity with early consolidation and interlobular septal thickening.
Figure 2
Figure 2. Unenhanced CT of the Head
Axial and coronal reformatted unenhanced CT images demonstrating extensive intraparenchymal hemorrhage in bilateral parietal and occipital lobes with intraventricular extension and acute hydrocephalus.
Figure 3
Figure 3. Axial MRI of the Head
DWI-ADC images (A and B) demonstrating diffusion restriction limited to areas of hemorrhage demonstrated on MPGR images (C). T2 images (D) demonstrate extensive associated edema. Postcontrast T1 images (F) demonstrate extensive enhancement in addition to intrinsic T1 related to blood products on precontrast images (E), including involvement of the cortex. ADC = apparent diffusion coefficient; DWI = diffusion-weighted imaging; MPGR = multiplanar gradient recalled acquisition.
See this image and copyright information in PMC

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