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Case Reports
. 2022 Jul 10;12(7):902.
doi: 10.3390/brainsci12070902.

Tolosa-Hunt Syndrome and Hemorrhagic Encephalitis Presenting in a Patient after COVID-19 Vaccination Followed by COVID-19 Infection

Anca Elena Gogu  1   2 , Andrei Gheorghe Motoc  3 , Any Docu Axelerad  4 , Alina Zorina Stroe  4 , Andreea Alexandra Gogu  5 , Dragos Catalin Jianu  1   2
Affiliations
Case Reports

Tolosa-Hunt Syndrome and Hemorrhagic Encephalitis Presenting in a Patient after COVID-19 Vaccination Followed by COVID-19 Infection

Anca Elena Gogu et al. Brain Sci. .

Abstract

The presence of neurological symptoms within the clinical range of COVID-19 disease infection has increased. This paper presents the situation of a 45-year-old man having the medical antecedent diabetes mellitus, who presented to the emergency department with fever, headache, and respiratory symptoms, nine days following vaccination with the Ad26.COV2-S COVID-19 vaccine. The patient tested positive for SARS-CoV-2 based on nasal polymerase chain reaction (RT-PCR). Two weeks after the presentation, he developed Tolosa-Hunt Syndrome, an autoimmune phenomenon, with painful left ophthalmoplegia. Significant improvement was seen in terms of his discomfort; however, ptosis and ocular mobility improved only moderately after treatment with intravenous methylprednisolone, and the patient was discharged on a new insulin regimen. The patient returned after four weeks and the neurological exam results showed significant signs of right hemiparesis, mixed aphasia, incomplete left ophthalmoplegia, severe headache, and agitation; after a few days, the patient experienced a depressed level of consciousness and coma. The patient's clinical condition worsened and, unfortunately, he died. MRI brain images revealed multiple ischemic strokes, meningitis, infectious vasculitis, and hemorrhagic encephalitis, which are all serious complications of COVID-19.

Keywords: COVID-19 infection; Tolosa–Hunt syndrome; hemorrhagic encephalitis; infectious/autoimmune vasculitis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
MRI T2 axial Flair (a) and coronal T1 FSE (b) images demonstrated perineural tissue extending into the left cavernous sinus. Postcontrast T1 axial FSE (c) and coronal T1 FSE (d) images showed an inflammatory process involving the left cavernous sinus and orbital apex with perineural enhancement surrounding the left optic nerve sheath. MRI: magnetic resonance imaging; Flair: fluid attenuated inversion recovery; FSE: fast spin-echo.
Figure 2
Figure 2
MRI brain images with contrast showed aspects of T2 axial Flair hypersignal in the left temporal lobe (a,b), respectively, in the hippocampal and parahippocampal region (c). The lesion is hyperintense on the DWI axial image (d). MRI: magnetic resonance imaging; Flair: fluid attenuated inversion recovery; DWI: diffusion weighted imaging.
Figure 3
Figure 3
MRI T2 axial Flair (a) and axial DWI (b) images demonstrated extension of the lesion in the fronto-parieto-temporal left lobes. Coronal T1 FSE (c) and axial T1 FSE (d) with contrast showing a hyperdense aspect of the left middle cerebral artery wall, suggestive of infectious/autoimmune vasculitis.
Figure 3
Figure 3
MRI T2 axial Flair (a) and axial DWI (b) images demonstrated extension of the lesion in the fronto-parieto-temporal left lobes. Coronal T1 FSE (c) and axial T1 FSE (d) with contrast showing a hyperdense aspect of the left middle cerebral artery wall, suggestive of infectious/autoimmune vasculitis.
Figure 4
Figure 4
(a,b), Brain-CT showed acute hemorrhage of intraparenchymal fronto-parieto-temporal lobes with important edema and ventricular extension.
See this image and copyright information in PMC

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