Alan Chalil1, Carmen S Baker1, Robert B Johnston1, Caroline Just1, Derek B Debicki1, Michael S Mayich1, Karen J Bosma1, David A Steven1. 1. Department of Clinical Neurological Sciences (AC, RBJ, CJ, DBD, DAS), Schulich School of Medicine and Dentistry, Western University; Department of Physical Medicine and Rehabilitation (CSB), Schulich School of Medicine and Dentistry, Western University; Department of Medical Imaging (MSM), Schulich School of Medicine and Dentistry, Western University; Department of Medicine (KJB), Schulich School of Medicine and Dentistry, Western University; and Department of Epidemiology and Biostatistics (DAS), Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
Abstract
PURPOSE OF REVIEW: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most critical public health challenge in recent history. In this report, we present a case of suspected acute hemorrhagic encephalitis with bilateral intracranial hemorrhages associated with coronavirus disease 2019 (COVID-19) infection. RECENT FINDINGS: A 48-year-old female COVID-19-positive patient developed acute changes in her neurologic status. A head CT with CT angiography demonstrated extensive bilateral parietal and occipital intraparenchymal hemorrhage with intraventricular extension and acute hydrocephalus. The patient was treated with an external ventricular drain, and a CSF sample was tested for SARS-CoV-2 but was found to be negative. SUMMARY: The underlying mechanism for developing acute hemorrhagic encephalitis in viral illnesses may be autoimmune in nature and warrants further investigation. The initial neurologic presentation of COVID-19-related hemorrhagic encephalitis is altered level of consciousness, which may prompt further neurologic examination and imaging to exclude this feature.
PURPOSE OF REVIEW: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most critical public health challenge in recent history. In this report, we present a case of suspected acute hemorrhagic encephalitis with bilateral intracranial hemorrhages associated with coronavirus disease 2019 (COVID-19) infection. RECENT FINDINGS: A 48-year-old female COVID-19-positive patient developed acute changes in her neurologic status. A head CT with CT angiography demonstrated extensive bilateral parietal and occipital intraparenchymal hemorrhage with intraventricular extension and acute hydrocephalus. The patient was treated with an external ventricular drain, and a CSF sample was tested for SARS-CoV-2 but was found to be negative. SUMMARY: The underlying mechanism for developing acute hemorrhagic encephalitis in viral illnesses may be autoimmune in nature and warrants further investigation. The initial neurologic presentation of COVID-19-related hemorrhagic encephalitis is altered level of consciousness, which may prompt further neurologic examination and imaging to exclude this feature.
Authors: Puja Mehta; Daniel F McAuley; Michael Brown; Emilie Sanchez; Rachel S Tattersall; Jessica J Manson Journal: Lancet Date: 2020-03-16 Impact factor: 79.321
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