There is increasing evidence that COVID-19 is associated with neurological manifestations. The current case is reported by Luca Zombori et al. A 17-year-old female sustained a significant cortical injury during COVID-19-associated multi-inflammatory syndrome. The girl had Cornelia de Lange syndrome (a genetic condition that leads to moderate to severe developmental growth disability) and well-controlled epilepsy.
Before her COVID-19 symptoms, she was able to mobilize by shuffling her body from her seated position and communicate her needs non-verbally. When she had a cough, breathing difficulty, and fever, she developed signs of medical distress. She was intubated and transferred to critical care. The respiratory secretions were positive for SARS-CoV-2, Pseudomonas aeruginosa, and Influenza-b. Her condition improved despite the fever and she was extubated on day 20.
However, she suffered from respiratory deterioration and was re-intubated. She had episodes of tachycardia and tachypnoea. EEG observations showed seizure activity was distinct from the patient’s usual epileptic seizures. A time-dependent brain MRI – before illness, during illness, repeat, and follow-up – showed widespread bilateral cortical, cerebellar and thalamic signal change and swelling; persistent multifocal areas of neuroparenchymal signal change; and evolving laminar necrosis in the areas previously affected. Further episodes of suspected seizures persisted intermittently.
Theories of coronavirus-induced neuropathology caused by misdirected host immune response have been postulated.
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