Neuroleptic malignant syndrome in a COVID-19 patient

Abstract

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Central Nervous System Manifestations Associated with COVID-19

“…Among the COVID-19 patients with ICH, 19 (69.6%) patients had lobar hemorrhage, which was significantly high compared to the number of patients with non-lobar hemorrhage (7 [30.4%]) Retrospective Iran Behzadnia et al [ 112 ] Hemorrhagic lesions and white matter microhemorrhages in 30% and 24% of 37 COVID-19 patients presenting with neurological manifestations with relevant abnormal brain MRI, respectively Retrospective France Kremer et al [ 30 ] Bilateral basal ganglia hemorrhage Case report Iran Haddai et al (2020) [ 113 ] Immune thrombocytopenic purpura—SAH Case report France Zulfiqar et al (2020) [ 114 ] Vasculitis Case report France Hanafi et al (2020) [ 115 ] Cerebral venous sinus thrombosis Case report UK Hughes et al (2020) [ 116 ] Cerebral venous thrombosis Case report USA Klein et al [ 117 ] Venus thromboembolism was seen in 36% and ischemic stroke in 2.5% of 388 patients Retrospective Italy Lodigiani et al [ 118 ] Silent hypoxemia Attributable to the brain infection and subsequent dysfunction of breathe controlling centers in cortical regions rather than subcortical structures and the brain stem Commentary NA Coen et al (2020) [ 120 ] White matter and globus pallidum inflammatory lesions CT scan of the brain demonstrated hypodense lesions involving supratentorial white matter and pallidum bilaterally. MRI showed bilateral but asymmetrical lesions with periventricular and deep white matter involvement Case report France Brun et al (2020) [ 147 ] Neuroleptic malignant syndrome Haloperidol decanoate use 3 weeks prior to admission Case report USA Kajani et al (2020) [ 127 ] Steroid responsive encephalitis High dos...…”

“…Neuroleptic malignant syndrome has been reported in a middle-aged male with a medical history of Schizophrenia and administration of haloperidol decanoate 3 weeks prior to the diagnosis of COVID-19. He was admitted to ICU to be on a ventilator and treated for altered mental status with associated rhabdomyolysis and acute kidney failure [ 127 ].…”

Catatonia in a hospitalized patient with COVID-19 and proposed immune-mediated mechanism

“…Other proinflammatory mediators such as interferon-alpha have been associated with a hypodopaminergic state in the basal ganglia ( Felger and Miller, 2012 ), which is postulated to be a potential precipitating factor to the development of catatonia and neuroleptic malignant syndrome (NMS) ( Caroff et al, 2004 , Haroche et al, 2020 ). NMS in a patient with COVID-19 has been recently described ( Kajani et al, 2020 ), further implicating a hyper-inflammatory state in the pathogenesis of these neuropsychiatric complications of severe COVID-19 illness. Further research is needed to elucidate the basic mechanisms of catatonia in COVID-19, and explore the barriers of accessing alternative treatment for catatonia in critically ill patients who cannot tolerate escalation of IV benzodiazepines.…”

Purinergic signaling in infectious diseases of the central nervous system

“…The ability of this virus to induce neurological symptoms such as headache, acute cerebrovascular diseases, and disturbed consciousness in patients with severe respiratory distress has already been reported ( Mao et al, 2020 ). Furthermore, SARS-CoV-2 may cause patients to become more susceptible to neuroleptic malignant syndrome (NMS), meningoencephalitis, hypogeusia, hyposmia, and even to develop autoimmune disorders that affect neuronal cells, including Guillain-Barré syndrome, regardless of the respiratory condition ( Coen et al, 2020 , Duong et al, 2020 , Kajani et al, 2020 , Vavougios, 2020 ).…”