High-dose steroid-responsive COVID-19-related encephalopathy with a sudden onset of dysarthria mimicking stroke: a case report

Abstract

There has been limited research on encephalitis/encephalopathy, which is a less common coronavirus disease 2019 (COVID-19) neurological complication. The differentiation between stroke and encephalopathy with stroke mimickers is challenging in patients with COVID-19. Here, we describe a case of COVID-19-related encephalopathy mimicking stroke that was successfully treated with high-dose steroid pulse therapy. The patient suddenly experienced language disturbance with a left facial droop and symmetric numbness in his upper limbs. Magnetic resonance imaging (MRI) scans revealed hyperintensities in both the white matter and splenium. No pneumonia was observed. MRI abnormalities and neurological symptoms resolved after steroid pulse therapy and administration of remdesivir. High-dose steroid pulse treatment (for 3 days) might alleviate COVID-19-related encephalopathy.

Keywords: COVID-19; Encephalitis; coronavirus; steroid; stroke.

Figure 1.

Diffusion-weighted magnetic resonance imaging (MRI) (panel a and e) demonstrated increased signal intensity, and the apparent diffusion coefficient (ADC) map (panel b and f) revealed decreased water diffusivity in both the white matter and splenium. The lesions showed the hyperintensities on fluid attenuated inversion recovery and slightly decreased intensities on T1-weighted MRI.

Figure 2.

Chest radiography did not showed pneumonia at the admission (left panel). A minor mottled shadow in the lower lung lobe was evident on follow-up chest computed tomography (CT) (right panel).