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与新型冠状病毒肺炎相关的胼胝体压部梗死:病例报告

Splenium of the Corpus Callosum Infarct Associated With COVID-19: Case Report.

作者信息

Karp David A, Beaudoin Gabriel, Egan Robert A

机构信息

Alameda Highland Hospital, Department of Neurology, Oakland, CA.

Sutter California Pacific Medical Center, Department of Psychiatry, San Francisco, CA.

出版信息

Neurologist. 2023 Jul 1;28(4):244-246. doi: 10.1097/NRL.0000000000000466.

Abstract

INTRODUCTION

Coronavirus disease 2019 (COVID-19) has been recently associated with infarction of the central splenium of the corpus callosum. These are described as cytotoxic lesions, and imaging rarely reveals enhancement. They have not been described in the body or head of the corpus callosum. Few diseases affect the corpus callosum, but the most common include multiple sclerosis, aquaporin-4 disease, and Susac syndrome. There is also emerging literature on Mild Encephalopathy with Reversible Splenial lesions associated with central and not basal lesions. The reason for the location of these lesions in acute COVID-19 infection is unknown.

CASE REPORT

A 22-year-old female presented to the ED for altered mental status after being found down. A brief history review indicated that the patient had been altered for 2-3 days before being found naked and covered in her own feces and urine by her family after they had not heard from her. As she lived alone, a clear history of the events preceding her admission remains unclear. On initial assessment, the patient was found to be somnolent and nonverbal, though she could follow simple commands. On admission, testing for SARS CoV-2 RNA PCR was positive. Patient was admitted to the hospital for further work up to determine the cause of the altered mental status.

CONCLUSION

We present a new case of a young woman who developed a central splenium lesion during acute COVID-19 infection and explain the predilection for the callosum in these patients, as well as literature to show that COVID-19 was most likely the cause.

摘要

引言

2019年冠状病毒病(COVID-19)最近被发现与胼胝体中央部梗死有关。这些病变被描述为细胞毒性病变,影像学检查很少显示强化。胼胝体体部和头部尚未见相关报道。很少有疾病会影响胼胝体,但最常见的包括多发性硬化症、水通道蛋白4相关疾病和Susac综合征。也有关于与中央而非基底病变相关的轻度脑病伴可逆性胼胝体病变的新文献。这些病变在急性COVID-19感染中发生的部位原因尚不清楚。

病例报告

一名22岁女性因被发现意识改变而被送往急诊科。简短的病史回顾显示,患者在被家人发现裸体且身上覆盖着自己的粪便和尿液之前,意识已经改变了2 - 3天,家人此前一直没有她的消息。由于她独居,入院前事件的清晰病史仍不清楚。初步评估时,发现患者嗜睡且无法言语,但能听从简单指令。入院时,SARS-CoV-2 RNA PCR检测呈阳性。患者被收入院进一步检查以确定意识改变的原因。

结论

我们报告了一例年轻女性在急性COVID-19感染期间出现胼胝体中央部病变的新病例,并解释了这些患者胼胝体受累的倾向,以及相关文献表明COVID-19很可能是病因。

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