Eur J Neurol. 2020 Aug 15. doi: 10.1111/ene.14478. Online ahead of print.
BACKGROUND: A variety of neurological manifestations have been reported in association with Covid-19. Covid-19-related encephalopathy has seldom been reported and studied.
METHODS: We report four cases of Covid-19-related encephalopathy. The diagnosis was made in patients with confirmed Covid-19 who presented with new-onset cognitive disturbances, central focal neurological signs or seizures. All patients underwent cognitive screening, brain MRI, lumbar puncture, and brain FDG-PET/CT.
RESULTS: The four patients were 60 years of age or older, and presented with various degrees of cognitive impairment, with predominant frontal lobe impairment. Two patients presented with cerebellar syndrome, one had myoclonus, one had psychiatric manifestations, and one patient had status epilepticus. The delay between first Covid-19 symptoms and onset of neurological symptoms was between 0 and 12 days. None of the patients had MRI features of encephalitis nor significant CSF abnormalities. SARS-CoV-2 RT-PCR in the CSF was negative for all patients. All patients presented with a consistent brain FDG-PET/CT pattern of abnormalities, namely frontal hypometabolism and cerebellar hypermetabolism. All patients improved after immunotherapy.
CONCLUSIONS: Despite varied clinical presentations, all patients presented with a consistent FDG-PET pattern which may reflect an immune mechanism.