Unit of Neurosurgery, Department of Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Department of Infection and Tropical Disease, University of Brescia, Brescia, Italy.
Int J Neurosci. 2023 Jan;133(1):77-80. doi: 10.1080/00207454.2021.1886095. Epub 2021 Feb 23.
The SARS-nCoV-2019 epidemic has spread since December 2019, quickly gaining worldwide attention. Symptoms consist of fever, cough and breathing difficulties. An increasing number of studies are focusing on neurological manifestations. In addition to the typical ageusia and anosmia, up to 30% of cases can present headache, nausea and vomiting. More serious neurological manifestations, such as encephalitis, thrombosis and cerebral haemorrhage have been reported.
We described the case of a 47-year-old man who tested positive for COVID-19 virus in early March 2020. After two negative nasopharyngeal swabs, 41 days after the diagnosis of COVID-19 infection, he developed intense headache with fever, and he was hospitalized. He had subsequent generalized epileptic seizures and intubation was necessary. Contrast Head MRI was negative for brain abscesses or tumours but detected severe vasogenic oedema of the white matter with 10 mm shift of the midline and compression of the right lateral ventricle. Massive cortisone support therapy was ineffective. We diagnosed brain death on day 43 from the infection diagnosis.
COVID-19 virus can reach the brain, penetrating into the neuronal cells through the interaction between the spike protein S1 and the host ACE-2 receptor, expressed in the capillary endothelium. We believe that in this infection, the pro-inflammatory state induced by the cytokine storm can cause a cerebral cell-mediated response, with subsequent vasodilatation and brain oedema.
To our knowledge, this is the first description of a delayed onset cell-mediated encephalitis caused by COVID-19 virus after more than 40 days from the diagnosis.
自 2019 年 12 月以来，SARS-nCoV-2019 疫情蔓延，迅速引起全球关注。症状包括发热、咳嗽和呼吸困难。越来越多的研究集中在神经系统表现上。除了典型的味觉和嗅觉丧失外，多达 30%的病例可出现头痛、恶心和呕吐。更严重的神经系统表现，如脑炎、血栓形成和脑出血已有报道。
我们描述了一名 47 岁男性的病例，他于 2020 年 3 月初检测出 COVID-19 病毒阳性。在两次鼻咽拭子检测为阴性后，在 COVID-19 感染诊断后第 41 天，他出现剧烈头痛伴发热，住院治疗。他随后出现全身癫痫发作，需要插管。对比头部 MRI 未发现脑脓肿或肿瘤，但发现白质有严重的血管源性水肿，中线移位 10 毫米，右侧侧脑室受压。大剂量皮质激素支持治疗无效。在感染诊断后第 43 天，我们诊断为脑死亡。
COVID-19 病毒可到达大脑，通过刺突蛋白 S1 与宿主 ACE-2 受体之间的相互作用穿透神经元细胞，该受体表达于毛细血管内皮细胞。我们认为，在这种感染中，细胞因子风暴引起的促炎状态可导致细胞介导的脑反应，随后出现血管扩张和脑水肿。
据我们所知，这是首例 COVID-19 病毒感染后超过 40 天发生的迟发性细胞介导性脑炎的描述。
