Yiannopoulou Konstantina, Vakrakou Aigli G, Anastasiou Aikaterini, Nikolopoulou Georgia, Sourdi Athina, Tzartos John S, Kilidireas Constantinos, Dimitrakopoulos Antonios
Second Neurological Department, Henry Dunant Hospital Center, 115 26 Athens, Greece.
1st Department of Neurology, Eginition Hospital, Medical School, National and Kapodistrian University of Athens, Vas. Sofias 72-74, 11528 Athens, Greece.
Diagnostics (Basel). 2023 Jun 14;13(12):2055. doi: 10.3390/diagnostics13122055.
Since the outbreak of coronavirus (COVID-19) in 2019, various rare movement disorders and cognitive changes have been recognized as potential neurological complications. The early treatment of some of these allows rapid recovery; therefore, we must diagnose these manifestations in a timely way. We describe the case of a 76-year-old man infected with severe acute respiratory syndrome coronavirus-2 who presented with confusion and hallucinations and was admitted to our hospital 14 days after the onset of symptoms. One day later, he developed generalized myoclonus, dysarthria and ataxia, and tonic clonic seizures and was admitted to the intensive care unit. A diagnosis of COVID-19-associated autoimmune encephalitis with characteristics of limbic encephalitis and immune-mediated acute cerebellar ataxia and myoclonus syndrome was supported by alterations in the limbic system shown in magnetic resonance imaging, lateralized discharges shown in electroencephalography, a slightly elevated protein level in the cerebrospinal fluid (CSF), and indirect immunofluorescence in the CSF with autoantibody binding to anatomical structures of the cerebellum and hippocampus. The patient improved with 2 weeks of corticosteroid treatment and four sessions of plasmapheresis. Our current case study describes a rare case of COVID-19-related limbic encephalitis with immune-mediated acute cerebellar ataxia and myoclonus syndrome (ACAM syndrome) and strengthens the need for tissue-based assays (TBAs) to screen the serum and/or CSF of patients highly suspected to have autoimmune encephalitis. We believe that the timely diagnosis and targeted aggressive immunotherapy were mainly responsible for the patient's total recovery.
自2019年冠状病毒病（COVID-19）疫情爆发以来，各种罕见的运动障碍和认知变化已被确认为潜在的神经并发症。其中一些疾病的早期治疗可实现快速康复；因此，我们必须及时诊断这些表现。我们描述了一例感染严重急性呼吸综合征冠状病毒2的76岁男性病例，该患者出现意识模糊和幻觉，在症状出现14天后入院。一天后，他出现全身性肌阵挛、构音障碍和共济失调，以及强直性阵挛发作，并被收入重症监护病房。磁共振成像显示边缘系统改变、脑电图显示单侧放电、脑脊液（CSF）蛋白水平略有升高以及脑脊液间接免疫荧光显示自身抗体与小脑和海马体的解剖结构结合，这些均支持诊断为具有边缘性脑炎特征以及免疫介导的急性小脑性共济失调和肌阵挛综合征的COVID-19相关自身免疫性脑炎。患者接受了2周的皮质类固醇治疗和4次血浆置换后病情好转。我们目前的病例研究描述了一例罕见的与COVID-19相关的边缘性脑炎伴免疫介导的急性小脑性共济失调和肌阵挛综合征（ACAM综合征），并强调了需要基于组织的检测方法（TBA）来筛查高度怀疑患有自身免疫性脑炎患者的血清和/或脑脊液。我们认为，及时诊断和有针对性的积极免疫治疗是患者完全康复的主要原因。
