Assistant professor of Neurology, Skull Base research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Assistant professor of Neurology, Skull Base research center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Mult Scler Relat Disord. 2020 Sep;44:102324. doi: 10.1016/j.msard.2020.102324. Epub 2020 Jun 24.
After the novel coronavirus disease outbreak first began in Wuhan, China, in December 2019, the viral epidemic has quickly spread across the world, and it is now a major public health concern. Here we present a 21-year-old male with encephalomyelitis following intermittent vomiting and malaise for 4 days. He reported upper respiratory signs and symptoms 2 weeks before this presentation. Two cerebrospinal fluid (CSF) analyses were notable for mononuclear pleocytosis, elevated protein (more than 100 mg/dl), and hypoglycorrhachia. Brain Magnetic Resonance Imaging (MRI) showed bilateral posterior internal capsule lesions extending to the ventral portion of the pons and a marbled splenium hyperintensity pattern. Cervical and thoracic MRI showed longitudinally extensive transverse myelitis (LETM), none of which were enhanced with gadolinium. Both the AQP4 and MOG antibodies were negative. Spiral chest computed tomography (CT) scan confirmed to COVID-19 as did the high IgG level against coronavirus, but the oropharyngeal swabs were negative. Neurological manifestations of COVID-19 have not been adequately studied. Some COVID-19 patients, especially those suffering from a severe disease, are highly likely to have central nervous system (CNS) manifestations. Our case is a post-COVID-19 demyelinating event in the CNS.
自 2019 年 12 月中国武汉首次爆发新型冠状病毒病以来，该病毒疫情迅速在全球蔓延，现已成为主要的公共卫生关注点。本研究报告了一例 21 岁男性，因间歇性呕吐和不适 4 天后出现脑脊髓炎。他在出现此症状前 2 周有上呼吸道感染的迹象和症状。两次脑脊液（CSF）分析均表现为单核细胞增多症、蛋白升高（超过 100mg/dl）和低颅压。脑磁共振成像（MRI）显示双侧后内囊病变延伸至脑桥腹侧，大理石样胼胝体高信号模式。颈胸部 MRI 显示长节段横贯性脊髓炎（LETM），均无钆增强。AQP4 和 MOG 抗体均为阴性。螺旋胸部 CT 扫描证实了 COVID-19 的存在，以及冠状病毒 IgG 水平升高，但咽拭子为阴性。COVID-19 的神经系统表现尚未得到充分研究。一些 COVID-19 患者，尤其是患有严重疾病的患者，极有可能出现中枢神经系统（CNS）表现。我们的病例是中枢神经系统的 COVID-19 后脱髓鞘事件。
