Demyelinating solitary lesion of the central nervous system associated with COVID-19: a case report and literature review
DOI:
https://doi.org/10.18203/2349-3933.ijam20204998Keywords:
Demyelinating diseases, Myelitis, Encephalomyelitis, COVID-19Abstract
In December 2019, coronavirus disease (COVID-19) emerged in China and rapidly spread to the world to become the largest pandemic since the 1918 influenza. The disease has been identified as a severe acute respiratory syndrome caused by a novel coronavirus-2 (SARS-CoV-2). Although the typical presentation is respiratory symptoms, reports of neurological involvements are increasing, as more than one-third of patients with COVID-19 develop neurological manifestations. The most frequently reported neurological manifestations in COVID-19 patients were headache, dizziness, taste, and smell impairments, and altered level of consciousness. More specific neurological complications were also reported in literature including acute cerebrovascular complications, seizures, meningoencephalitis, and Guillain-Barré syndrome. Very few studies have shown CNS demyelinating lesions as complications of COVID-19. Current report described a case of a COVID-19 patient with an acute solitary demyelinating lesion in the central nervous system. I also reviewed and summarized the available related cases.
References
Chen X, Laurent S, Onur OA, Fink JR, Warnke C, Kleineberg NN, et al. A systematic review of neurological symptoms and complications of COVID-19. J Neurol. 2020;2:1-11.
Pinzon RT, Wijaya VO, Buana RB, Al Jody A, Nunsio PN. Neurologic characteristics in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. Front Neurol. 2020;11:565.
Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Eastor A. Neurological associations of COVID-19. Lancet Neurol. 2020;19(9):763-83.
Nepal G, Rehrig JH, Shrestha GS, Shing YK, Yadav JK, Ojha R, et al. Neurological manifestations of COVID-19: a systematic review. Crit Care. 2020;24(1):421.
Mecha M, Carrillo-Salinas FJ, Mestre L, Feliú A, Guaza C. Viral models of multiple sclerosis: neurodegeneration and demyelination in mice infected with Theiler's virus. Prog Neurobiol. 2013; 101:46-64.
Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol. 2020;267(11):3135-53.
WHO COVID-19 case defination. Available at: WHO-2019-nCoV-Surveillance_Case_Definition-2020.1-eng. Accessed on 20 September 2020.
Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). J Neurol. 2020;267(10):2799-802.
Zanin L, Saraceno G, Panciani PP, Renisi G, Signorini L, Migliorati K, et al. SARS-CoV-2 can induce brain and spine demyelinating lesions. Acta Neurochir (Wien). 2020;162(7):1491-4.
AlKetbi R, AlNuaimi D, AlMulla M, AlTalai N, Samir M, Kumar N, et al. Acute myelitis as a neurological complication of COVID-19: A case report and MRI findings. Radiol Case Rep. 2020;15 (9):1591-5.
Munz M, Wessendorf S, Koretsis G, Tewald F, Baegi R, Krämer S, Geissler M, Reinhard M. Acute transverse myelitis after COVID-19 pneumonia. J Neurol. 2020;267(8):2196-7.
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;44:102324.
Ng Kee Kwong KC, Mehta PR, Shukla G, Mehta AR. COVID-19, SARS and MERS: A neurological perspective. J Clin Neurosci. 2020;77:13-6.
Brun G, Hak JF, Coze S, Kaphan E, Carvelli J, Girard N, et al. COVID-19-White matter and globus pallidum lesions: Demyelination or small-vessel vasculitis?. Neurol Neuroimmunol Neuroinflamm. 2020;7(4):e777.
Chow CCN, Magnussen J, Ip J, Su Y. Acute transverse myelitis in COVID-19 infection. BMJ Case Rep. 2020;13(8):e236720.