| Abstrakt: |
Case presentation: A one-month-old male presented with fever, flu-like symptoms, decreased level of consciousness and seizures. He tested positive for SARS-CoV-2. Cerebrospinal fluid (CSF) analysis revealed pleocitosis and elevated protein, and the viral panel for herpes simplex virus (HSV) types 1 and 2, human herpesvirus (HHV) type 6, cytomegalovirus (CMV), Influenza A, B, Parechovirus e Enterovirus and COVID tested negative. Brain magnetic resonance imaging (MRI) showed tumefactive lesions in the basal ganglia, mostly thalamus, with increased signal in diffusion-weighted imaging (DWI) and evidence of necrosis and anaerobiosis in spectroscopy. The patient was treated with intravenous immunoglobulin at the time, with no significant response. On the follow-up, he presented with epileptic spasms and hypsarrhythmia demonstrated by electroencephalography. Despite the early introduction of Vigabatrin and high dose prednisolone, the response to treatment was poor. Discussion: Central nervous system involvement in COVID-19 infection is frequent, and range from mild symptoms to life-threatening conditions, namely meningitis, encephalitis and stroke, which are often associated with multisystem inflammatory syndrome. Since the CSF analysis for SARS-CoV-2 is not always available, most studies consider the presumed diagnosis when patients present with clinical findings and serological positivity for COVID-19. MRI abnormalities include acute disseminated encephalomyelitis (ADEM)-like pattern, myelitis, cranial nerve enhancement and hemorrhagic encephalitis. Basal ganglia hemorrhage and ischemia was found mostly in adults and was related to both altered mental status and movement disorders. Final comments: Despite severe neurological manifestations being rare in children, there are cases of life-threatening neurologic conditions associated with COVID-19. Even though there are no specific MRI findings related to the SARS-CoV-2 infection, basal ganglia ischemia has been reported. The potential effects of COVID-19 on brain development are still to be appreciated and studied. [ABSTRACT FROM AUTHOR] |
