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A Post-Infectious Steroid-Responsive Brainstem Lesion Associated With COVID-19
Philip Chang1, Edwin S Tasch1, Lisa N Rapoport2
1Department of Neurology, Kaiser Permanente Santa Clara Medical Center, Assistant Professor of Neurology, Boston University Medical School, Santa Clara, CA, USA.
The Neurohospitalist
|April 1, 2021
Summary
A COVID-19 patient developed severe neurological symptoms, including coma and paralysis. Prompt steroid treatment resolved the brainstem lesion and neurological deficits, highlighting a new post-infectious complication.
Area of Science:
- Neurology
- Infectious Diseases
- Neuroimmunology
Background:
- COVID-19 is known to cause a range of neurological complications.
- Post-infectious encephalopathies can manifest with diverse clinical and radiological findings.
Observation:
- A 51-year-old male presented with coma, bilateral pupillary dilation, ophthalmoplegia, and quadriplegia four weeks post-COVID-19 diagnosis.
- Brain MRI revealed a symmetric, midline pontine T2-FLAIR hyperintense lesion without enhancement.
Findings:
- The patient received intravenous methylprednisolone for suspected steroid-responsive encephalopathy.
- Neurological improvement was rapid, with Glasgow Coma Scale (GCS) increasing from 3 to 15 within five days.
Implications:
- This case represents the first reported instance of a steroid-responsive brainstem lesion associated with COVID-19.
- COVID-19 can precipitate severe, treatable post-infectious neurological sequelae, necessitating consideration in differential diagnoses.
