Central nervous system vasculopathy associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): a novel case report from Iran

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) represents respiratory symptoms as the most common clinical manifestations. Similar to some other viral infections, it can cause severe neurological damages. Here, we describe a 40-year-old man case who initially was admitted to a major hospital with presenting 7 days with weak flu-like symptoms (cough) and fever then presented neurology signs for 3 days. Physical examination and brain magnetic resonance imaging (MRI) showed cerebral vasculopathy. Molecular testing was performed on nasopharyngeal swab by real-time reverse transcription polymerase chain reaction (RT-PCR) which was positive for SARS-CoV-2. The patient received supportive cares and was treated with routine antiplatelet therapy. He was improved and discharged 10 days after admission with no symptoms. Our findings report a 40-year-old man with flu-like symptoms that indicate cerebral vasculopathy that was discharged with no symptoms. Therefore, physicians should be monitor patients with worsening or progressive central nervous system results. The pathobiology of this virus is still incompletely known; therefore, extensive studies are needed to reveal the effect of COVID-19 on the nervous system.

Guillain-Barré syndrome associated with COVID-19: a case report study

“…Although many new insights into the pathogenesis and immunity of COVID-19 have been provided, the main molecular mechanisms mediating COVID-19 nerve damage are still unclear (Allahyari et al 2021;Hosseini et al 2021). One hypothesis described that coronavirus may invade the neuroephithelium of the olfactory nerve.…”

Unprovoked serotonin syndrome-like presentation of SARS-CoV-2 infection: A small case series

“…1,2 The spectrum of neurologic disease has been broad, from encephalopathy to thromboembolic disease, 1,2 among a series of other pathologic mechanisms described by others. 3–12 While these reports have not described serotonin syndrome-like manifestations per se, the evidence is mounting in regard to the presence of elevated plasma serotonin levels in COVID-19 patients, 13,14 both in severe and non-severe disease, thought to be a result of an intense degree of platelet activation and serotonin liberation from activated platelets due to severe acute respiratory distress syndrome 2 (SARS-CoV-2) infection. 13,15,16 Clinically, in two case series, more than 60% of severe COVID-19 subjects exhibited hyperreflexia or myoclonus, 17,18 signs relatively specific for serotonin toxicity, occurring at a high enough rate in severe COVID-19 that is unaccountable for by pre-existing use of serotonergic medication.…”

“…1,2 The spectrum of neurologic disease has been broad, from encephalopathy to thromboembolic disease, 1,2 among a series of other pathologic mechanisms described by others. [3][4][5][6][7][8][9][10][11][12] While these reports have not described serotonin syndrome-like manifestations per se, the evidence is mounting in regard to the presence of elevated plasma serotonin levels in COVID-19 patients, 13,14 both in severe and non-severe disease, thought to be a result of an intense degree of platelet activation and serotonin liberation from activated platelets due to severe acute respiratory distress syndrome 2 (SARS-CoV-2) infection. 13,15,16 Clinically,…”

COVID-19 and a mysterious case of transient cerebral arteriopathy

“…To the best of our knowledge, no one has had reported COVID-19–induced transient and reversible CNS arteriopathy presenting as a moyamoya-like angiographic picture. Although COVID-19–associated CNS vasculitis is in the literature,[ 6 ] the transient and reversible nature of arteriopathy has not been established. The association is difficult to prove but based on the clinic-radiological evidence, we can say that COVID-19 infection can present with transient cerebral arteriopathy, like VZV or CMV infection.…”