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COVID-19-related acute necrotizing encephalopathy with brain stem involvement in a patient with aplastic anemia

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

Year of Publication: 2020
Contained in: Neurology(R) neuroimmunology & neuroinflammation Vol. 7, No. 5 (2020)
All journal articles: Search for all articles in this journal
Language: English
Contributors: Dixon, Luke | Author
Varley, James
Gontsarova, Anastassia
Mallon, Dermot
Tona, Francesca
Muir, David
Luqmani, Asad
Jenkins, Ieuan Harri
Nicholas, Richard
Jones, Brynmor
Everitt, Alex
Full text access:
Electronic availability is being checked...
Links: Full Text (dx.doi.org)
Keywords: 7S5I7G3JQL
Case Reports
Journal Article
Research Support, Non-U.S. Gov't
Additional Keywords: Amygdala
Anemia, Aplastic
Brain Edema
Brain Stem
Coronavirus Infections
Dexamethasone
Diffusion Magnetic Resonance Imaging
Fatal Outcome
Female
Glucocorticoids
Humans
Intracranial Hemorrhages
Leukoencephalitis, Acute Hemorrhagic
Magnetic Resonance Imaging
Middle Aged
Pandemics
Platelet Transfusion
Pneumonia, Viral
Putaminal Hemorrhage
Respiration, Artificial
Seizures
Thalamic Nuclei
Tomography, X-Ray Computed
ISSN: 2332-7812
Note: Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Notes: Date Completed 04.06.2020
Date Revised 30.06.2020
published: Electronic-Print
Citation Status MEDLINE
Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
PMID:
    32457227
Physical Description: Online-Ressource
ID (e.g. DOI, URN): 10.1212/NXI.0000000000000789
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520 |a METHODS: Evaluation of cause, clinical symptoms, and treatment response 
520 |a 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 
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