Tenpaku Yosuke, Mabuchi Naoki, Kawase Takahiro, Oguro Hideki, Tatsumi Hiroshi, Satoh Masayuki
Department of Rehabilitation Nagoya Ekisaikai Hospital Aichi Japan.
Graduate School of Health Science Aichi Gakuin University Aichi Japan.
PCN Rep. 2024 Jul 15;3(3):e224. doi: 10.1002/pcn5.224. eCollection 2024 Sep.
We report a case of suspected autoimmune encephalopathy with involuntary movements and concomitant cognitive dysfunction after COVID-19.
The patient is a male in his 20s who presented with fever and generalized involuntary movements and was diagnosed with COVID-19. The involuntary movements improved slightly, and the fever resolved within a week of the diagnosis. However, about a month later, the patient presented with severe recurrence of the involuntary movements. Antiepileptic drugs were ineffective, and the patient was re-hospitalized with suspected autoimmune encephalopathy. The electroencephalogram (EEG) was difficult to assess accurately due to involuntary movements. Neuropsychological testing on re-admission revealed mild memory impairment, executive dysfunction, and decreased processing speed. We treated the patient with methylprednisolone (mPSL) 1000 mg/day for a total of 8 days and intravenous immunoglobulin therapy (IVIG) 27.5 g/day for 5 days. Involuntary movements were mild after 59 days. A repeat neuropsychological assessment conducted 3 weeks later showed improvement of both memory and executive functions. The patient was discharged on Day 75, and he returned to work the following month.
In our patient reported herein, early and appropriate treatment was successful. Impaired activities of daily living and cognitive dysfunction rapidly improved. The case serves to underscore the importance of early detection and intervention for the sequelae of COVID-19.
我们报告一例新型冠状病毒肺炎（COVID-19）后疑似自身免疫性脑病伴不自主运动及认知功能障碍的病例。
患者为一名20多岁男性，出现发热及全身性不自主运动，被诊断为COVID-19。不自主运动稍有改善，发热在诊断后一周内消退。然而，约一个月后，患者不自主运动严重复发。抗癫痫药物无效，患者因疑似自身免疫性脑病再次住院。由于不自主运动，脑电图（EEG）难以准确评估。再次入院时的神经心理学测试显示轻度记忆障碍、执行功能障碍及处理速度下降。我们给予患者甲泼尼龙（mPSL）1000毫克/天，共8天，静脉注射免疫球蛋白治疗（IVIG）27.5克/天，共5天。59天后不自主运动减轻。3周后再次进行神经心理学评估显示记忆和执行功能均有改善。患者于第75天出院，次月恢复工作。
在我们报告的该病例中，早期且恰当的治疗取得了成功。日常生活活动能力受损及认知功能障碍迅速改善。该病例强调了对COVID-19后遗症进行早期检测和干预的重要性。
