Symeonidou Elissavet, Dimitriadou Androniki, Morsi-Yeroyannis Antonios, Sidiropoulou Maria S, Gkoutziotis Ioannis, Petras Panagiotis, Mpallas Konstantinos
5th Department of Surgery, Aristotle University of Thessaloniki School of Medicine, Ippokratio General Hospital, Thessaloniki, Greece.
Department of Neurology, Ippokratio General Hospital, Thessaloniki, Greece.
Arch Clin Cases. 2023 Jun 7;10(2):78-85. doi: 10.22551/2023.39.1002.10246. eCollection 2023.
Besides respiratory and gastrointestinal symptoms, SARS-CoV-2 also has potential neurotropic effects. Acute hemorrhagic necrotizing encephalopathy is a rare complication of Covid-19. This article presents a case of an 81-year-old female, fully vaccinated, who underwent laparoscopic transhiatal esophagectomy due to gastroesophageal junction cancer. In the early postoperative period, the patient developed persistent fever accompanied by acute quadriplegia, impaired consciousness, and no signs of respiratory distress. Imaging with Computed Tomography and Magnetic Resonance revealed multiple bilateral lesions both in gray and white matter, as well as pulmonary embolism. Covid-19 infection was added to the differential diagnosis three weeks later, after other possible causes were excluded. The molecular test obtained at that time for coronavirus was negative. However, the high clinical suspicion index led to Covid-19 antibody testing (IgG and IgA), which confirmed the diagnosis. The patient was treated with corticosteroids with noticeable clinical improvement. She was discharged to a rehabilitation center. Six months later, the patient was in good general condition, although a neurological deficit was still present. This case indicates the significance of a high clinical suspicion index, based on a combination of clinical manifestations and neuroimaging, and the confirmation of the diagnosis with molecular and antibody testing. Constant awareness of a possible Covid-19 infection among hospitalized patients is mandatory.
除了呼吸道和胃肠道症状外，新型冠状病毒2（SARS-CoV-2）还具有潜在的嗜神经作用。急性出血性坏死性脑病是冠状病毒病（Covid-19）的一种罕见并发症。本文介绍了一例81岁的女性患者，该患者已全程接种疫苗，因胃食管交界癌接受了腹腔镜经裂孔食管切除术。术后早期，患者出现持续发热，并伴有急性四肢瘫、意识障碍，且无呼吸窘迫迹象。计算机断层扫描和磁共振成像显示双侧灰质和白质均有多处病变，同时伴有肺栓塞。在排除其他可能原因三周后，Covid-19感染被列入鉴别诊断。当时进行的冠状病毒分子检测结果为阴性。然而，高度的临床怀疑指数促使进行了Covid-19抗体检测（IgG和IgA），结果确诊。患者接受了皮质类固醇治疗，临床症状有明显改善。她出院后前往康复中心。六个月后，患者总体状况良好，尽管仍存在神经功能缺损。该病例表明，基于临床表现和神经影像学相结合的高度临床怀疑指数以及通过分子和抗体检测确诊的重要性。必须始终意识到住院患者可能感染Covid-19。
