Covid 19 related encephalopathy: a case series with brain FDG PET/CT findings
Abstract 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.
European journal of neurology