Post‐infectious cerebellar ataxia following COVID‐19 in a patient with epilepsy

Abstract

Background Various neurological manifestations have been described in relation to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection and coronavirus disease 2019 (COVID‐19). However, the development of cerebellar ataxia after recovery from COVID‐19 is rare. We present a case of cerebellar ataxia 3 weeks after recovery from COVID‐19. Case Presentation A 70‐year‐old male patient from an urban area of India presented with ataxia. He was hypertensive and had been receiving treatment for post‐traumatic epilepsy for the previous 3 years. He had previously had laboratory‐confirmed COVID‐19 infection with mild symptoms that resolved within 2 weeks. However, 3 weeks after symptom improvement, he developed severe pan‐cerebellar ataxia. Investigations were suggestive of post‐infectious cerebellar ataxia. Other causes of ataxia were excluded. He responded well to pulse methylprednisolone therapy and was discharged with mild tremor and ataxia. Conclusion Post‐infectious cerebellar ataxia is an unusual presentation after COVID‐19. The clinician should be aware of such complications following COVID‐19 infection as early diagnosis and proper management leads to better outcomes in many patients.

All differential diagnoses of cerebellar ataxia should be ruled out before SARS‐CoV‐2 is blamed as the cause

“… 1 The patient made an incomplete recovery until discharge after 10 days of hospitalization. 1 The study is appealing but raises concerns that warrant further discussion.…”

“…We read with interest the article by Chattopadhyay et al about a 70‐year‐old male who developed sudden onset ataxia 3 weeks after complete recovery from a mild SARS‐CoV‐2 infection. 1 Clinical neurologic examination revealed dysarthria, dysmetria, dysdiadochokinesia, truncal ataxia, intention tremor, ataxic gait, and impaired tandem walking. 1 Cerebral magnetic resonance imaging (MRI) showed small vessel disease with multiple, old lacunar infarcts.…”

“… 1 Clinical neurologic examination revealed dysarthria, dysmetria, dysdiadochokinesia, truncal ataxia, intention tremor, ataxic gait, and impaired tandem walking. 1 Cerebral magnetic resonance imaging (MRI) showed small vessel disease with multiple, old lacunar infarcts. 1 Cerebellar ataxia was interpreted as delayed central nervous system (CNS) complication of COVID‐19 and intravenous methyl prednisolone was given.…”

“… 1 Cerebral magnetic resonance imaging (MRI) showed small vessel disease with multiple, old lacunar infarcts. 1 Cerebellar ataxia was interpreted as delayed central nervous system (CNS) complication of COVID‐19 and intravenous methyl prednisolone was given. 1 The patient made an incomplete recovery until discharge after 10 days of hospitalization.…”

“… 1 Cerebellar ataxia was interpreted as delayed central nervous system (CNS) complication of COVID‐19 and intravenous methyl prednisolone was given. 1 The patient made an incomplete recovery until discharge after 10 days of hospitalization. 1 The study is appealing but raises concerns that warrant further discussion.…”