Background and aims: Neurological complications of coronavirus disease-2019 (COVID-19) are being increasingly reported. Here, we present two cases of COVID-19 para-infectious complications involving the central nervous system, namely acute necrotizing encephalopathy (ANE) and longitudinally extensive transverse myelitis (LETM).
Methods: Patients underwent comprehensive diagnostic work-up to rule out other causes of ANE and LETM: blood and cerebrospinal fluid (CSF) inflammatory markers, PCR for SARS-CoV-2/EBV/HSV1,2,6/CMV, anti-MOG and anti-aquaporin-4 antibodies, brain and spinal cord MRI. Results: 1st case features a 44-years-old man admitted to ICU with altered mental status, bulbar palsy, and bilateral limb ataxia. The naso-/oropharyngeal swabs were positive for SARS-CoV-2 infection. CSF analysis was unremarkable, without detectable SARS-CoV-2 RNA. Brain MRI was characterized by widespread cerebellar and thalamic lesions with a hyperintense signal on FLAIR and DWI, and hemorrhages on SWI. Clinical, CSF and imaging findings were indicative of an ANE. The patient received pulse steroid therapy with a good outcome at discharge. Second case illustrates a 35-years-old breastfeeding woman with confirmed SARS-CoV-2 infection, presenting with upper and lower limb weakness, decreased sensation below the Th8 level, and urinary retention. CSF was dominated by mononuclear pleocytosis, with no traces of SARS-CoV-2 RNA. MRI scan revealed a hyperintense signal on T2 and STIR along the whole thoracic spine. These findings were suggestive of LETM, likely to COVID-19. She received pulse steroid therapy with a gradual improvement of neurological deficits.
Conclusion: Neuroinflammatory syndromes might accompany the course of COVID-19. Cytokine storm triggered by the SARS-CoV-2 infection is thought to account for the emergence of ANE and LETM. Disclosure: Nothing to disclose.