Two COVID-19-related video-accompanied cases of severe ataxia-myoclonus syndrome

Abstract

Aim of study. The pandemic state of COVID-19 has resulted in new neurological post-infection syndromes. Recently, several papers have reported ataxia-myoclonus syndrome following SARS-CoV-2 infection. The aim of this study was to present our two cases and compare them to previously reported cases.Materials and methods. We present two video-accompanied new cases with ataxia-myoclonus syndrome following SARS--CoV-2 infection and discuss the studies published so far.Results. Ataxia-myoclonus syndrome, isolated myoclonus, opsoclonus-myoclonus syndrome as post-COVID-19 syndrome following infection have been described in 16 patients (including our two cases). Patients have been treated with intravenous immunoglobulins and/or steroids except for 4 patients, which resulted in a significant improvement within 1-8 weeks.Conclusions and clinical implications. The increasing number of patients with a similar symptomatology shows a significant relationship between COVID-19 infection and ataxia-myoclonus syndrome. The subacute onset of neurological symptoms after a resolved COVID-19 infection and prominent response to immunotherapy may suggest that the neurological manifestations are immune-mediated. Although recovery is highly possible, it may take several weeks/months, and clinicians should be aware of this diagnosis and the beneficial effects of immunological treatment administered as soon as possible.

Acute post‐infection cerebellar ataxia following SARS‐CoV‐2 infection: A case report

“…Although the number of these cases is rising, there is currently no definition for this condition and the exact mechanism by which SARS‐CoV‐2 may cause cerebellar dysfunction remains unclear until now. But evidence suggests, according to the onset of neurological manifestations after recovery from COVID‐19 contamination and the perfect response of these symptoms to immunotherapy, this phenomenon can be immune‐mediated 6 . Thus, coronavirus probably activates excessive immune system with cytokine storm, or cause immune response cross‐reactive to cerebellar autoantigen to hurt cerebellum 8 .…”

“…However, these children are at risk of developing seizures, meningeal signs, and encephalopathy, with variable severity. 1 There are also some reports of children with encephalitis 2,3 and acute disseminated encephalomyelitis (ADEM) 4,5 post-COVID-19 infection.Even though ataxia following SARS-CoV-2 infection is reported in adults, [6][7][8] there are just two case reports of APCA after COVID-19 before age 18. 9,10 Ataxia is usually a cerebellar disorder with an acute or chronic presentation.…”

Neuro-COVID-19: an insidious virus in action

“…Moreover, two uncommon neurological manifestations associated with COVID-19 have been documented in Poland. Przytuła et al reported ataxia-myoclonus syndrome, isolated myoclonus, and opsoclonus-myoclonus syndrome in two CO-VID-19 patients and postulated the autoimmune symptoms' background [37]. Cutaneous hyperaesthesia, lasting from one day to several months, was described by Krajewski et al in nine COVID-19 patients [38].…”

Manifestationen im Zentralnervensystem nach COVID-19

“…Im Zusammenhang mit COVID-19 gibt es mehrere Fallberichte über das Auftreten eines OMAS in der Postakutphase – die meisten Patient:innen entwickelten die Symptome etwa 2 Wochen (10 Tage bis 6 Wochen) nach der Akutinfektion [ 63 ]. Lediglich bei zwei Fällen trat ein OMAS in der Akutphase von COVID-19 auf [ 16 ].…”