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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2020; 78(10): 666
DOI: 10.1590/0004-282X20200126
Editorial

Possible acute multifocal demyelinating lesions in a COVID-19 patient

Possíveis lesões desmielinizantes multifocais agudas em um paciente com COVID-19
Agábio Diógenes PESSOA  NETO
1   Hospital Universitário Onofre Lopes, Department of Neurology, Natal RN, Brazil
,
Manoella do Monte ALVES 
2   Hospital Giselda Trigueiro, Department of Infectious Diseases, Natal RN, Brazil.
,
Paulo Santiago de Morais BRITO 
1   Hospital Universitário Onofre Lopes, Department of Neurology, Natal RN, Brazil
,
Manuel MOREIRA  NETO
3   Hospital Universitário Onofre Lopes, Department of Radiology, Natal RN, Brazil
,
Rodrigo Alencar e SILVA 
1   Hospital Universitário Onofre Lopes, Department of Neurology, Natal RN, Brazil
,
Mario Emílio TEIXEIRA DOURADO 
1   Hospital Universitário Onofre Lopes, Department of Neurology, Natal RN, Brazil
,
Clécio de Oliveira GODEIRO  JUNIOR
1   Hospital Universitário Onofre Lopes, Department of Neurology, Natal RN, Brazil
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A 49-year-old man was admitted with cough, dyspnea, and fever. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) from nasopharyngeal swab was positive. Due to severe acute respiratory syndrome, he was intubated. On day 19, sedatives were held. On neurological examination, he was lethargic, with asymmetric quadriplegia (left>right) and global hyporeflexia. Brain magnetic resonance imaging revealed multifocal brain lesions ([Figures 1A, 1B and 1C]). He was treated with high-dose steroids and showed clinical and radiological improvement ([Figure 1D]).

This case highlights that possible acute disseminated encephalitis should be considered a potentially treatable cause of encephalopathy or multiple neurological deficits in COVID-19 patients[1],[2].

Zoom Image
Figure 1 (A) Axial images in the FLAIR T2W showing multiple lesions with T2 hypersignal in the cerebral and cerebellar white matter (arrows), with no mass effect. (B) Axial diffusion (DWI) - Absence of restriction on diffusion in the topography of the lesions and (C) axial T1 post-contrast (Gd) show no enhancement (arrowhead). (D) Control examination after corticosteroid therapy showing marked involution of brain lesions and disappearance of cerebellar lesions in the axial FLAIR T2W images.

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Conflict of interest:

There is no conflict of interest to declare.

Authors’ contributions:

These authors contributed equally to the manuscript.


  • References

  • 1 Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020 May;1-4. https://doi.org/10.1007/s00415-020-09951-9
  • 2 Zoghi A, Ramezani M, Roozbeh M, Darazam IA, Sahraian MA. A case of possible atypical demyelinating event of the central nervous system following COVID-19. Mult Scler Relat Disord. 2020 Sep;44:102324. https://doi.org/10.1016/j.msard.2020.102324

Address for correspondence

Agábio Diógenes Pessoa Neto

Publication History

Received: 25 August 2020

Accepted: 27 August 2020

Article published online:
13 June 2023

© 2020. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020 May;1-4. https://doi.org/10.1007/s00415-020-09951-9
  • 2 Zoghi A, Ramezani M, Roozbeh M, Darazam IA, Sahraian MA. A case of possible atypical demyelinating event of the central nervous system following COVID-19. Mult Scler Relat Disord. 2020 Sep;44:102324. https://doi.org/10.1016/j.msard.2020.102324

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Zoom Image
Figure 1 (A) Axial images in the FLAIR T2W showing multiple lesions with T2 hypersignal in the cerebral and cerebellar white matter (arrows), with no mass effect. (B) Axial diffusion (DWI) - Absence of restriction on diffusion in the topography of the lesions and (C) axial T1 post-contrast (Gd) show no enhancement (arrowhead). (D) Control examination after corticosteroid therapy showing marked involution of brain lesions and disappearance of cerebellar lesions in the axial FLAIR T2W images.