Acute Disseminated Encephalomyelitis Post COVID-19 Pneumonia

Area of Science:

• Neurology
• Infectious Diseases
• Neuroimmunology

Background:

• Acute disseminated encephalomyelitis (ADEM) is an inflammatory demyelinating disorder of the central nervous system.
• ADEM is typically monophasic and often follows an infection or immunization, presenting with neurological symptoms.
• COVID-19 has been associated with various neurological complications, including inflammatory conditions.

Observation:

• An 80-year-old woman with COVID-19 pneumonia developed sudden decreased consciousness, focal seizure, and right-sided weakness.
• Brain MRI revealed multifocal hemorrhagic lesions with surrounding edema, indicative of ADEM.
• Electroencephalogram (EEG) showed moderate generalized encephalopathy.

Findings:

• The patient's presentation and imaging findings were consistent with ADEM secondary to coronavirus disease.
• Treatment with pulse steroids and plasma exchange did not prevent clinical deterioration.
• The patient required inotropic support and ultimately expired.

Implications:

• This case underscores the potential for ADEM development in elderly patients with severe COVID-19.
• It highlights the challenges in managing ADEM, particularly in older individuals with co-existing critical illness.
• Further research is needed to understand the neuroinflammatory mechanisms of COVID-19 and optimize ADEM treatment strategies.