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Steroid-Responsive Encephalitis in Coronavirus Disease 2019.
Andrea Pilotto1,2, Silvia Odolini3, Stefano Masciocchi1
1Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Annals of Neurology
|May 18, 2020
Summary
A COVID-19 patient developed encephalitis presenting as akinetic mutism, despite mild respiratory symptoms. Steroid treatment improved the condition, suggesting an inflammatory brain response to SARS-CoV-2 infection.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- Coronavirus disease 2019 (COVID-19) can affect the central nervous system.
- Neurological symptoms are reported in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Observation:
- A 60-year-old patient with mild SARS-CoV-2 infection presented with akinetic mutism due to encephalitis.
- Cerebrospinal fluid showed pleocytosis, hyperproteinorrachia, and elevated inflammatory markers (IL-8, TNF-α).
- Cranial MRI was normal, but EEG revealed generalized theta slowing.
Findings:
- SARS-CoV-2 was not detected in cerebrospinal fluid.
- Infectious and autoimmune causes of encephalitis were ruled out.
- High-dose steroid treatment led to clinical improvement and reduced inflammatory markers.
Implications:
- This case suggests that COVID-19 can cause encephalitis through an inflammatory mechanism.
- Neurological complications of SARS-CoV-2 infection warrant further investigation.
- Early recognition and management of COVID-19-related encephalitis may improve patient outcomes.
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