COVID-19-associated encephalopathy with fulminant cerebral vasoconstriction: CT and MRI findings

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) can cause various mild to severe neurologic symptoms, leading to significant morbidity and mortality. We hereby present a fatal case of a 50-year-old male health care provider, admitted due to altered mental status due to encephalopathy, cerebral edema, and fulminant cerebral vasoconstriction caused by SARS-Cov-2. Our case highlights the importance of considering SARS-Cov-2 infection in the differential diagnosis for patients with unexplained central nervous system dysfunction and cerebral edema to prevent delayed diagnosis and render rapid treatment.

Spontaneous Intracerebral Hemorrhage and Delayed Cerebral Vasospasm in a Patient with COVID-19 Infection

“…Third, a reversible vaso-constriction syndrome (RCVS) of cerebral arteries has been described (11,12). Another patient succumbed to a devastating diffuse arterial and dural venous sinus construction with generalized cerebral edema four days after admission (13). It was hypothesized that SARS-CoV-2 might induce vasoconstriction due to downregulation of the ACE2 receptor, which then provoked an over activation of the renin-angiotensin-aldosterone axis.…”

Clinical symptoms, diagnosis, treatment, and outcome of COVID‐19‐associated encephalitis: A systematic review of case reports and case series

“… 1 As of early August 2020, more than 17.5 million cases of COVID‐19 were identified in 188 countries, including 680,000 deaths. 2 The disease that often has respiratory symptoms but sometimes also has extrapulmonary manifestations such as neurological symptoms. 1 On average, neurological symptoms appear three weeks after respiratory symptoms.…”

“… 3 Less common clinical manifestations of COVID‐19 include headache, brain status alteration, chest pain, abdominal pain, diarrhea, and nausea. 2 Nervous manifestations can range from a mild nervous agitation to severe encephalitis. 4 The roll of central nervous system in SARS‐CoV‐2 epidemic has been determined.…”

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,…”