“POST COVID-19 ENCEPHALITIS PRESENTING WITH CEREBELLAR SYNDROME”

• DOI: 10.22533/at.ed.5922224031

• Palavras-chave: ENCEPHALITIS CEREBELLAR SYNDROME COVID-19

• Keywords: ENCEPHALITIS CEREBELLAR SYNDROME COVID-19

• Abstract:

  ase presentation
  In December 2020, a 46-year-old woman began experiencing pain in her lower limbs, which persisted for weeks. She had RT-PCR for Covid-19 positive on 01/27/2021. In early February 2021, she started to present ataxia, slow speech and drowsiness, seeking for an Emergency at another hospital. The electroneuromyography of 02/09/2021 showed no signs of radiculopathy or polyneuropathy. Brain, cervical and thoracic MRIs on 02/09/2021 were normal. CSF analysis on 02/10/2021 showed 161 cells, with a predominance of lymphomononuclear cells (89%). The diagnosis of viral rhombencephalitis was assumed. She reported partial improvement of symptoms in the following weeks. In April 2021, the neurological condition worsened and the patient was referred to our service. On admission, she presented with vertical nystagmus, head tremor, dysmetria, cerebelar speech, dysdiadochokinesia, astasia, abasia, muscle hypotonia, pendular reflexes. She also had Lhermitte’s sign. The rapid test for Covid-19 on 05/25/2021 was negative for IgM and IgG. The RT-PCR for Covid-19 of 05/31/2021 was negative. CSF analysis on 04/23/2021 was with no abnormalities: 5 cells, protein 35, glucose 63, negative VDRL and fungal screening, also negative bacterioscopy. Brain MRI on 05/03/2021: hypersignal observed at the level of the cerebellar peduncles; leukoencephalopathy with a nonspecific pattern (diffuse and symmetrical alteration of the supratentorial white matter of the pre-rolandic region on the right and of the cortico-spinal bundles) was also observed. Serologies, including anti-HIV, was non-reactive. The investigation of neoplasms was negative.
  Discussion: When symptoms worsened again in April, we suspected it could be a case of post-Covid-19 autoimmune encephalitis. Then, she was submitted to pulse therapy and 07 alternate days of plasmapheresis, evolving with improvement in cerebellar signs obtained by the SARA test (Scale for the assessment and rating of ataxia).
  Final Comments: Patient with cerebellar syndrome after Covid-19 infection, with clinical, radiological and laboratory data compatible with rhombencephalitis, showing improvement after pulse therapy and plasma exchange, with autoimmune etiology for the condition. The results of the investigation of autoantibodies in CSF are still awaited.

• Número de páginas: 2