Demyelinating Disease of the Central Nervous System Concurrent With COVID-19

Abstract

Neurological diseases related to coronavirus disease-2019 (COVID-19) are increasingly reported. We report here three cases that presented with subtle neurologic findings manifesting within a range of 15 days to four months after their COVID-19 diagnoses. Magnetic resonance imaging showed acute multifocal periventricular and subcortical demyelinating lesions. Some of the lesions showed contrast enhancement and diffusion restriction. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR was found in the cerebrospinal fluid of just one patient. All patients received intravenous methylprednisolone therapy. In this report, we aim to discuss the aspects of possible COVID-19-related demyelination that support a diagnosis of multiple sclerosis (MS) or acute disseminated encephalomyelitis (ADEM).

Keywords: adem; covid-19; demiyelination; demyelinating disease; multiple sclerosis.

Figure 1. Case 1

Brain MRI revealed hyperintense periventricular and juxtacortical lesions in an axial FLAIR sequence (A) and contrast enhancements in axial T1 sequence (B). After two months, it was observed that the lesions regressed in the FLAIR sequence (C).

Figure 2. Case 2

MRI showed multiple, periventricular, bilateral, symmetrical, ovoid and round, prone to confluent, hyperintense lesions in an axial FLAIR (A) restriction on DWI (B), the trace apparent diffusion coefficient (ADC) in some lesions (C), and contrast enhancement in axial T1 sequence (D).  A contrast-enhancing hyperintense lesion covering one segment was observed on a sagittal T1 image of cervical spine MRI (E).

Figure 3. Case 2 five months later MRI

After five months, note the development of new contrast-enhancing lesions in the centrum semiovale (A) and thoracal spinal cord (B).

Figure 4. Case 3

Hyperintense lesions in the periventricular area in an axial FLAIR (A), and contrast enhancement lesions involving centrum semiovale in axial T1 sequences (B). After two months, note the new contrast-enhancing lesions in the cervical spinal cord in sagittal (C) and axial T2 sequences (D).