Postinfectious Neurologic Complications in COVID-19: A Complex Case Report

Area of Science:

• Neurology
• Infectious Diseases
• Neuroimaging

Background:

• Neurologic manifestations can occur following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
• The specific mechanisms and imaging findings of SARS-CoV-2-related neurological complications require further investigation.

Observation:

• A 40-year-old woman presented with confusion, agitation, seizures, dyskinesias, and parkinsonism weeks after SARS-CoV-2 infection.
• Standard neurological workup including MRI and cerebrospinal fluid analysis yielded unremarkable results.
• ¹⁸F-FDG PET/CT revealed limbic and extralimbic hypermetabolism, indicating altered brain glucose metabolism.

Findings:

• ¹⁸F-FDG PET/CT identified specific patterns of brain hypermetabolism associated with SARS-CoV-2 neurological symptoms.
• The patient experienced a complete recovery from her neurological deficits.
• Post-treatment imaging showed normalization of ¹⁸F-FDG uptake in previously hypermetabolic brain regions.

Implications:

• Intravenous immunoglobulin (IVIG) may be an effective treatment for certain SARS-CoV-2-induced neurological disorders.
• ¹⁸F-FDG PET/CT is a valuable tool for diagnosing and monitoring SARS-CoV-2-related encephalopathy.
• This case highlights the potential for SARS-CoV-2 to trigger autoimmune or inflammatory neurological processes responsive to immunomodulatory therapy.