与新型冠状病毒肺炎相关的急性出血性脑炎
Acute Hemorrhagic Encephalitis Related to COVID-19.
作者信息
Chalil Alan, Baker Carmen S, Johnston Robert B, Just Caroline, Debicki Derek B, Mayich Michael S, Bosma Karen J, Steven David A
机构信息
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.
出版信息
Neurol Clin Pract. 2021 Apr;11(2):e147-e151. doi: 10.1212/CPJ.0000000000000900.
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.
综述目的
新型严重急性呼吸综合征冠状病毒2（SARS-CoV-2）是近代以来最严峻的公共卫生挑战。在本报告中，我们呈现了一例疑似急性出血性脑炎病例，该病例伴有双侧颅内出血，与2019冠状病毒病（COVID-19）感染相关。
最新发现
一名48岁的COVID-19阳性女性患者出现了神经系统状态的急性变化。头部CT血管造影显示双侧顶叶和枕叶广泛的脑实质内出血，并伴有脑室扩展和急性脑积水。该患者接受了外部脑室引流治疗，并对脑脊液样本进行了SARS-CoV-2检测，但结果为阴性。
总结
病毒性疾病中发生急性出血性脑炎的潜在机制可能本质上是自身免疫性的，值得进一步研究。COVID-19相关出血性脑炎的初始神经学表现是意识水平改变，这可能促使进一步的神经学检查和影像学检查以排除这一特征。
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