Encephalopathy in COVID-19 patients; viral, parainfectious, or both?
Data
2020Autor
Umapathi, Thirugnanam
Ming Jason, Quek Wei
Min, Yen Jia
Wai, Khin Hnin Su
Yuan, Mah Yun
Yee, Joel Chan Chee
Min, Ling Li
Wai-Yung, Yu
Metadata
Mostrar registro completoResumo
We describe the clinical, laboratory and radiological features of 3 critically ill patients
with COVID-19 who developed severe encephalopathy. The first patient did not regain
consciousness when sedation was removed at the end of 2 weeks of intensive care. He
had received treatment with convalescent plasma. His clinical examination was
remarkable for intact brainstem reflexes, roving eye movements, later transient ocular
flutter; and then what appeared to be slow ocular dipping. He had no coherent volitional
response to the environment. The second patient recovered with measurable cognitive
deficits after a prolonged period of encephalopathy. He had received combination
treatment with interferon beta 1b and lopinavir/ritonavir. The third patient remained in
persistent, severe agitated delirium and died 3 months into his illness. The MRI of the 3
patients showed multifocal abnormalities predominantly in the cerebral white matter,
with varying involvement of the grey matter, brainstem and spinal cord. Case 1’s MRI
changes were consistent with acute disseminated encephalomyelitis. The patients also
displayed blood markers, to varying degree, of autoimmunity and hypercoagulability. We
were not able to convincingly show, from microbiological as well as immunological
evaluation, if the effects of COVID-19 on these patients’ nervous system were a direct
consequence of the virus, proinflammatory-thrombotic state or a combination. Patient 1
responded partially to empirical, albeit delayed, therapy with intravenous
immunoglobulins. Patient 2 recovered with no specific treatment. These cases illustrate
the need to understand the full spectrum of encephalopathy associated with COVID-19 so
as to better guide its management.
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Palabras clave
COVID-19; SARS-CoV-2 virus; Encephalitis; Parainfectious; AutoimmunityLink para o recurso
https://doi.org/10.1016/j.ensci.2020.100275Collections
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