Hemachudha Pasin, Pongpitakmetha Thanakit, Rattanawong Wanakorn, Thanapornsungsuth Poosanu, Joyjinda Yutthana, Bunprakob Saowalak, Ruchisrisarod Chanida, Hemachudha Thiravat
Thai Red Cross Emerging Infectious Diseases Health Science Centre, World Health Organization Collaborating Centre for Research and Training on Viral Zoonoses, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
Division of Neurology, Department of Medicine, King Chulalongkorn Memorial Hospital, Faculty of Medicine, Chulalongkorn University, Chulalongkorn University, Bangkok, Thailand.
SAGE Open Med Case Rep. 2022 Mar 15;10:2050313X221083653. doi: 10.1177/2050313X221083653. eCollection 2022.
COVID-19 infection often results in an excessive inflammatory response with a spectrum of neurological manifestations. Here, we describe an 81-year-old female with severe COVID-19 pneumonia and subsequent alteration of consciousness after high-dose intravenous dexamethasone and remdesivir. A non-contrast head computed tomography (CT) demonstrated bilateral hypodensities involving bilateral cerebellar hemispheres, thalami, cerebral peduncles and medial parieto-occipital areas. There was no improvement and repeat CT showed progression with findings suggestive of acute necrotizing encephalopathy. Interleukin-6 levels were initially normal; however, subsequent levels were found to be markedly elevated. Acute necrotizing encephalopathy associated with COVID-19 may occur in the setting of severe pneumonia and may represent an immune-mediated process involving inflammatory cytokines such as interleukin-6.
新型冠状病毒肺炎（COVID-19）感染常导致过度炎症反应，并伴有一系列神经学表现。在此，我们描述一名81岁女性，患有重症COVID-19肺炎，在接受大剂量静脉注射地塞米松和瑞德西韦治疗后出现意识改变。头颅非增强计算机断层扫描（CT）显示双侧低密度影，累及双侧小脑半球、丘脑、大脑脚及顶枕叶内侧区域。病情无改善，复查CT显示病变进展，提示急性坏死性脑病。白细胞介素-6水平最初正常；然而，随后发现其水平显著升高。与COVID-19相关的急性坏死性脑病可能发生在重症肺炎的情况下，可能代表一种涉及白细胞介素-6等炎性细胞因子的免疫介导过程。
