A case of successive development of possible acute necrotizing encephalopathy after COVID-19 pneumonia.
Pasin HemachudhaThanakit PongpitakmethaWanakorn RattanawongPoosanu ThanapornsungsuthYutthana JoyjindaSaowalak BunprakobChanida RuchisrisarodThiravat HemachudhaPublished in: SAGE open medical case reports (2022)
COVID-19 infection often results in an excessive inflammatory response with a spectrum of neurological manifestations. Here, we describe an 81-year-old female with severe COVID-19 pneumonia and subsequent alteration of consciousness after high-dose intravenous dexamethasone and remdesivir. A non-contrast head computed tomography (CT) demonstrated bilateral hypodensities involving bilateral cerebellar hemispheres, thalami, cerebral peduncles and medial parieto-occipital areas. There was no improvement and repeat CT showed progression with findings suggestive of acute necrotizing encephalopathy. Interleukin-6 levels were initially normal; however, subsequent levels were found to be markedly elevated. Acute necrotizing encephalopathy associated with COVID-19 may occur in the setting of severe pneumonia and may represent an immune-mediated process involving inflammatory cytokines such as interleukin-6.
Keyphrases
- respiratory failure
- high dose
- coronavirus disease
- computed tomography
- early onset
- liver failure
- sars cov
- drug induced
- inflammatory response
- contrast enhanced
- dual energy
- positron emission tomography
- image quality
- low dose
- aortic dissection
- extracorporeal membrane oxygenation
- mechanical ventilation
- magnetic resonance imaging
- respiratory syndrome coronavirus
- intensive care unit
- community acquired pneumonia
- physical activity
- optical coherence tomography