Department of Neurology, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Brain Science, Ajou University School of Medicine, Suwon, Republic of Korea.
BMC Neurol. 2022 Jul 11;22(1):253. doi: 10.1186/s12883-022-02782-3.
Neurological manifestations of COVID-19 are thought to be associated with the disease severity of COVID-19 and poor clinical outcomes. Dysregulated immune responses are considered to be mediating such complications. Our case illustrates multiple critical neurological complications simultaneously developed in a patient with non-severe COVID-19 and successful recovery with a multifaceted therapeutic approach. The cerebrospinal fluid (CSF) interleukin-6 (IL-6) level was temporally correlated with the clinical severity of the status epilepticus in our patient, suggesting a causal relationship.
A previously healthy 20-year-old female patient presented with a first-onset seizure. Concomitant non-severe COVID-19 pneumonia was diagnosed. CSF study showed lymphocytic pleocytosis with elevated IL-6 levels in CSF. During hospitalization under the diagnosis of autoimmune encephalitis, status epilepticus developed, and the seizure frequency was temporally correlated with the CSF IL-6 level. Furthermore, a new embolic stroke developed without a significant cardioembolic source. Contrary to the exacerbated COVID-19-associated neurological complications, COVID-19 pneumonia was cleared entirely. After treatment with antiseizure medications, antithrombotics, antiviral agents, and immunotherapy, the patient was discharged with near-complete recovery.
Active serological, and radiological evaluation can be helpful even in non-severe COVID-19, and multidimensional treatment strategies, including immunotherapy, can successfully reverse the neurological complication.
COVID-19 的神经系统表现被认为与 COVID-19 的疾病严重程度和不良临床结局有关。免疫反应失调被认为是介导这些并发症的原因。我们的病例说明了一例非重症 COVID-19 患者同时出现多种严重的神经系统并发症，并通过多方面的治疗方法成功康复。患者的脑脊液（CSF）白细胞介素-6（IL-6）水平与癫痫持续状态的临床严重程度呈时间相关性，提示存在因果关系。
一位既往健康的 20 岁女性患者出现首次发作性癫痫。同时诊断出非重症 COVID-19 肺炎。CSF 研究显示 CSF 中有淋巴细胞增多和 IL-6 水平升高。在诊断为自身免疫性脑炎住院期间，出现癫痫持续状态，癫痫发作频率与 CSF IL-6 水平呈时间相关性。此外，还发生了新的栓塞性中风，而无明显心源性栓塞源。与 COVID-19 相关的神经系统并发症加重相反，COVID-19 肺炎完全清除。经过抗癫痫药物、抗血栓药物、抗病毒药物和免疫治疗后，患者出院时接近完全康复。
即使在非重症 COVID-19 中，积极的血清学和影像学评估也可能有帮助，包括免疫治疗在内的多维治疗策略可以成功逆转神经系统并发症。
