Çakmakci Güngör, Çetiner Mustafa, Akdağ Gönül, Akkoyun Arikan Fatma, Canbaz Kabay Sibel
Department of Neurology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey.
Curr Med Imaging. 2023 May 15. doi: 10.2174/1573405620666230515090534.
It is well-known that COVID-19 causes pneumonia and acute respiratory distress syndrome, as well as pathological neuroradiological imaging findings and various neurological symptoms associated with them. These include a range of neurological diseases, such as acute cerebrovascular diseases, encephalopathy, meningitis, encephalitis, epilepsy, cerebral vein thrombosis, and polyneuropathies. Herein, we report a case of reversible intracranial cytotoxic edema due to COVID-19, who fully recovered clinically and radiologically.
A 24-year-old male patient presented with a speech disorder and numbness in his hands and tongue, which developed after flu-like symptoms. An appearance compatible with COVID-19 pneumonia was detected in thorax computed tomography. Delta variant (L452R) was positive in the COVID reverse-transcriptase polymerase chain reaction test (RT-PCR). Cranial radiological imaging revealed intracranial cytotoxic edema, which was thought to be related to COVID-19. Apparent diffusion coefficient (ADC) measurement values in the magnetic resonance imaging (MRI) taken on admission were 228 mm2/sec in the splenium and 151 mm2/sec in the genu. During the follow-up visits of the patient, epileptic seizures developed due to intracranial cytotoxic edema. ADC measurement values in the MRI taken on the 5th day of the patient's symptoms were 232 mm2/sec in the splenium and 153 mm2/sec in the genu. ADC measurement values in the MRI taken on the 15th day were 832 mm2/sec in the splenium and 887 mm2/sec in the genu. He was discharged from the hospital on the 15th day of his complaint with a clinical and radiological complete recovery.
Abnormal neuroimaging findings caused by COVID-19 are quite common. Although not specific to COVID-19, cerebral cytotoxic edema is one of these neuroimaging findings. ADC measurement values are significant for planning follow-up and treatment options. Changes in ADC values in repeated measurements can guide clinicians about the development of suspected cytotoxic lesions. Therefore, clinicians should approach cases of COVID-19 with CNS involvement without extensive systemic involvement with caution.
众所周知，新型冠状病毒肺炎（COVID-19）可导致肺炎和急性呼吸窘迫综合征，以及病理性神经放射学影像学表现和与之相关的各种神经系统症状。这些症状包括一系列神经系统疾病，如急性脑血管疾病、脑病、脑膜炎、脑炎、癫痫、脑静脉血栓形成和多发性神经病。在此，我们报告一例因COVID-19导致的可逆性颅内细胞毒性水肿病例，该患者在临床和影像学上均完全康复。
一名24岁男性患者在出现类似流感症状后出现言语障碍以及手部和舌部麻木。胸部计算机断层扫描显示出与COVID-19肺炎相符的表现。COVID逆转录酶聚合酶链反应检测（RT-PCR）中Delta变异株（L452R）呈阳性。头颅放射学影像学显示颅内细胞毒性水肿，认为与COVID-19有关。入院时进行的磁共振成像（MRI）表观扩散系数（ADC）测量值在压部为228平方毫米/秒，在膝部为151平方毫米/秒。在患者随访期间，由于颅内细胞毒性水肿出现癫痫发作。患者症状出现第5天进行的MRI中ADC测量值在压部为232平方毫米/秒，在膝部为153平方毫米/秒。第15天进行的MRI中ADC测量值在压部为832平方毫米/秒，在膝部为887平方毫米/秒。患者在主诉后第15天临床和影像学完全康复出院。
COVID-19引起的神经影像学异常相当常见。虽然并非COVID-19所特有，但脑实质细胞毒性水肿是这些神经影像学表现之一。ADC测量值对于规划随访和治疗方案具有重要意义。重复测量中ADC值的变化可为临床医生判断疑似细胞毒性病变的发展提供指导。因此，临床医生在处理无广泛全身受累但有中枢神经系统受累的COVID-19病例时应谨慎。
