MRI of fatal course of acute hemorrhagic leukoencephalitis in a child with SARS-CoV-2 omicron BA 2.0 infection.
Alex Mun-Ching WongJainn-Jim LinShao-Hsuan HsiaKuang-Lin LinPublished in: Neuroradiology (2023)
We present a pediatric case of acute hemorrhagic leukoencephalitis associated with SARS-CoV-2 Omicron BA 2.0 infection. A previously healthy girl presented with ataxia and diplopia three weeks after the COVID-19 confirmation from a nasopharyngeal swab. Acute and symmetrical motor weakness and drowsiness ensued within the following 3 days. She then became spastic tetraplegic. MRI revealed multifocal lesions in the cerebral white matter, basal ganglia, and brainstem, with hemorrhagic changes confirmed with T1-hyperintensity and hypointensity on susceptibility-weighted images. Peripheral areas of decreased diffusion, increased blood flow, and rim contrast enhancement were noted in the majority of lesions. She was treated with a combination of intravenous immunoglobulin and methylprednisolone pulse therapy. Neurological deterioration ensued with coma, ataxic respiratory pattern and decerebrate posture. Repeated MRI performed on day 31 revealed progression of abnormalities, hemorrhages and brain herniation. Despite the administration of plasma exchange, she died two months after admission.
Keyphrases
- sars cov
- contrast enhanced
- liver failure
- blood flow
- white matter
- magnetic resonance imaging
- respiratory failure
- respiratory syndrome coronavirus
- drug induced
- coronavirus disease
- aortic dissection
- computed tomography
- emergency department
- blood pressure
- cerebral ischemia
- extracorporeal membrane oxygenation
- mental health
- early onset
- subarachnoid hemorrhage
- resting state
- intensive care unit
- low dose
- functional connectivity
- bone marrow
- machine learning
- deep learning
- acute respiratory distress syndrome
- young adults