RT Journal Article
SR Electronic
T1 COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia
JF Neurology - Neuroimmunology Neuroinflammation
JO Neurol Neuroimmunol Neuroinflamm
FD Lippincott Williams & Wilkins
SP e789
DO 10.1212/NXI.0000000000000789
VO 7
IS 5
A1 Luke Dixon
A1 James Varley
A1 Anastassia Gontsarova
A1 Dermot Mallon
A1 Francesca Tona
A1 David Muir
A1 Asad Luqmani
A1 Ieuan Harri Jenkins
A1 Richard Nicholas
A1 Brynmor Jones
A1 Alex Everitt
YR 2020
UL http://nn.neurology.org/content/7/5/e789.abstract
AB Objective To describe a novel case of coronavirus disease 2019 (COVID-19)-associated acute necrotizing encephalopathy (ANE) in a patient with aplastic anemia where there was early brain stem-predominant involvement.Methods Evaluation of cause, clinical symptoms, and treatment response.Results A 59-year-old woman with a background of transfusion-dependent aplastic anemia presented with seizures and reduced level of consciousness 10 days after the onset of subjective fever, cough, and headache. Nasopharyngeal swab testing for severe acute respiratory syndrome coronavirus (SARS-CoV-2) was positive, and CT during admission demonstrated diffuse swelling of the brain stem. She required intubation and mechanical ventilation for airway protection, given her reduced level of consciousness. The patient's condition deteriorated, and MRI on day 6 demonstrated worsening brain stem swelling with symmetrical hemorrhagic lesions in the brain stem, amygdalae, putamina, and thalamic nuclei. Appearances were consistent with hemorrhagic ANE with early brain stem involvement. The patient showed no response to steroid therapy and died on the eighth day of admission.Conclusions COVID-19 may be associated with an acute severe encephalopathy and, in this case, was considered most likely to represent an immune-mediated phenomenon. As the pandemic continues, we anticipate that the spectrum of neurologic presentation will broaden. It will be important to delineate the full clinical range of emergent COVID-19-related neurologic disease.ANE=acute necrotizing encephalopathy; COVID-19=coronavirus disease 2019; GCS=Glasgow Coma Score; GTCS=generalized tonic-clonic seizure; SARS-CoV-2=severe acute respiratory syndrome coronavirus 2