Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China.
Department of Nuclear Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing Key Laboratory of Molecular Targeted Diagnosis and Therapy in Nuclear Medicine, Beijing, China.
Cerebellum. 2024 Dec;23(6):2237-2243. doi: 10.1007/s12311-024-01712-y. Epub 2024 Jul 10.
COVID-19-associated cerebellar ataxia has rarely been reported and its clinical characteristics remain understudied. This study aims to report patients with COVID-19-associated cerebellar ataxia from our institution. COVID-19-associated cerebellar ataxia was diagnosed based on the prodromal COVID-19 infection and the exclusion of other causes. This study provides a summary of the patients' clinical presentations, neuroimaging features, and the results of anti-cerebellar antibody examinations. Our study included 11 patients and 4 were male. The median onset age was 38 years. Five patients also demonstrated signs of encephalopathy. Brain magnetic resonance imaging (MRI) was either unremarkable (n = 6) or showed bilateral cerebellar lesions (n = 5), which were typically transient, although brain atrophy could be observed later in the disease course. Anti-Homer-3 and anti-Yo antibodies were each detected in one patient, respectively. All patients received immunotherapy and nine improved. Compared with the late-onset group, individuals who exhibited ataxia earlier following COVID-19 onset (interval<5 days) were significantly younger [median age 18 (15.5-31) vs. 53.5 (44-64.8) years, p = 0.009] and more likely to present with encephalopathy (5/5 vs. 0/6, p = 0.002).They also experienced more severe symptoms [median modified Rankin scale (mRS) score at zenith 5 (5-5) vs. 2 (1.75-2.75), p = 0.017] and had a less favorable prognosis [median mRS score at the last follow-up 4 (2-5) vs. 1 (0-1.25), p = 0.009]. COVID-19-associated cerebellar ataxia can appear with encephalopathy. Brain MRI may show transient bilateral cerebellar lesions and brain atrophy later. Patients who exhibited ataxia earlier following COVID-19 were younger, had more severe symptoms and poorer outcomes.
新冠相关小脑性共济失调鲜有报道，其临床特征仍有待研究。本研究旨在报告本中心的新冠相关小脑性共济失调患者。新冠相关小脑性共济失调的诊断基于前驱性新冠感染和排除其他病因。本研究总结了患者的临床表现、神经影像学特征和抗小脑抗体检查结果。本研究共纳入 11 例患者，其中 4 例为男性。中位发病年龄为 38 岁。5 例患者还存在脑病表现。脑磁共振成像（MRI）无明显异常（n=6）或显示双侧小脑病变（n=5），病变通常为短暂性，尽管疾病后期可能会观察到脑萎缩。1 例患者分别检测到抗 Homer-3 和抗 Yo 抗体。所有患者均接受免疫治疗，9 例患者好转。与迟发型组相比，新冠发病后更早出现共济失调（间隔<5 天）的患者年龄更小[中位年龄 18（15.5-31）岁 vs. 53.5（44-64.8）岁，p=0.009]，更易出现脑病[5/5 例 vs. 0/6 例，p=0.002]，症状更重[峰值改良 Rankin 量表（mRS）评分中位数 5（5-5）分 vs. 2（1.75-2.75）分，p=0.017]，预后更差[末次随访 mRS 评分中位数 4（2-5）分 vs. 1（0-1.25）分，p=0.009]。新冠相关小脑性共济失调可伴有脑病。脑 MRI 可显示短暂性双侧小脑病变和后期脑萎缩。新冠后更早出现共济失调的患者年龄更小，症状更重，预后更差。
