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Proceedings SNO “Percorsi clinici in Neuroscienze”

Case report I SESSIONE
“LA NEUROLOGIA AL TEMPO DEL COVID-19”

Atypical encephalitis in patients
with SARS-CoV-2 infection

A. GIORGETTI, R. BRUSA, A. PRELLE

Department of Neuroscience, ASST Ovest-Mi, Legnano (Milano), Italy

INTRODUCTION HIV, were normal. Antibodies related to autoimmune
encephalitis resulted negative. During hospitaliza-
Severe Acute Respiratory Syndrome-CoronaVirus-2 tion, he developed dyspnoea and tested positive for
disease leads generally to respiratory tract symptoms, SARS-CoV-2. Whole body CT scan detected bilateral
from cough and fever to interstitial pneumonia and ground glass opacities, a typical radiological pattern
acute respiratory distress syndrome. Since the begin- of COVID19 pneumonia. RT-PCR for SARS-CoV-2
ning of the COVID-19 outbreak, several neurological in CSF was negative. Treatment for pneumonia in-
symptoms have been reported, including anosmia, cluded low doses of steroids. Negativizazion occur-
headache and confusion . Some cases of encephalitis red after two weeks, alongside spontaneous neurolo-
(6)
have been outlined in patients regardless of the pres- gical improvement.
(1)

ence of severe respiratory distress. Here we present ■ ■ Case 2 : a 79 years old woman presented with an
two cases of transient neurological syndromes with acute onset of amnesia and confusion. She did not ta-
spontaneous regression in patients with concurrent ke medications, except for risedronate for osteoporo-
SARS-CoV-2 infection. sis. Clinical evaluation showed memory loss and dis-
orientation without focal neurological signs. Brain
CT scan revealed abnormalities in the left hippocam-
CASE REPORTS pus. Subsequent brain MRI confirmed hyperintense
middle and posterior portions of the left hippocampus

(5)
■ ■ Case 1 : a 58-year-old male was admitted to our in T2-weighted and FLAIR images, reminiscent of
hospital due to subacute onset of behavioral abnor- limbic encephalitis. A similar but smaller lesion was
malities and unsteady gait. His medical history was observed in the right hippocampus. EEG showed
unremarkable, except for a fever around 2 weeks ear- temporal slow waves. CSF proteins and cells were wi-
lier. Neurological evaluation showed symptoms sug- thin normal limits, while cytopathologic examination
gestive of opsoclonus myoclonus syndrome, a neuro- revealed a mild nonspecific inflammation. No neopla-
logical disorder characterized by multi-directional stic cells, bacteria or viruses (Cryptococcus neofor-
eye movements and involuntary muscle jerks, usually mans, Cryptococcus gattii, Enterovirus, Herpes sim-
related with paraneoplastic or post-infectious etiolo- plex 1 and 2, Human herpesvirus 6, Human parecho-
gies. Brain MRI, EEG, CSF analysis and serological virus, Cytomegalovirus, Varicella zoster virus, Adeno-
viral screening, including treponema pallidum and virus, Listeria monocytogenes, Neisseria meningiti-

Corrispondenza: Dr. Andrea Giorgetti, UOC di Neurologia, Ospedale Nuovo, via Papa Giovanni Paolo II, 20025 Legnano (MI), e-
mail: andrea.giorgetti@asst-ovestmi.it
Percorsi clinici in Neuroscienze. Clinical Round SIN e SNO Lombardia, 21 gennaio 2022, Desio (Monza e Brianza)
Atti a cura di Paolo Ferroli, Alessandra Protti, Andrea Salmaggi, Ignazio Michele Santilli, Luca Valvassori
Copyright © 2022 by new Magazine edizioni s.r.l., Trento, Italia. www.newmagazine.it ISBN: 978-88-8041-135-2

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