Michigan researchers have reported the first probable case of a brain disorder called acute necrotizing hemorrhagic encephalopathy associated with COVID-19, the disease caused by the novel coronavirus.
The team of clinicians from Henry Ford Health System in Detroit, Michigan, published their findings online Tuesday in Radiology.
“As the number of patients with COVID-19 increases worldwide, clinicians and radiologists should be watching for this presentation among patients presenting with COVID-19 and altered mental status,” the researchers wrote.
Dr. Elissa Fory, a neurologist with Henry Ford, said in a statement, “This is significant for all providers to be aware of and looking out for in [COVID-19] patients who present with an altered level of consciousness. This complication is as devastating as severe lung disease.”
“We need to be thinking of how we’re going to incorporate patients with severe neurological disease into our treatment paradigm,” Dr. Fory added.
Senior author and radiologist with Henry Ford Dr. Brent Griffith said the case shows “the important role that imaging can play in COVID-19 cases.”
The researchers diagnosed the case through neuroimaging.
The 58-year-old woman, who was diagnosed with acute necrotizing hemorrhagic encephalopathy, had a 3-day history of fever, cough, and muscle pain, the symptoms consistent with the coronavirus.
She was taken to the ER and she showed signs of confusion, lethargy, and disorientation. The woman tested negative for influenza but tested positive for COVID-19 through a rapid coronavirus test.
The doctors confirmed she had severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2. And then she was diagnosed with acute hemorrhagic necrotizing encephalopathy.
Dr. Fory said, “The team had suspected encephalitis at the outset, but then back-to-back CT and MRI scans made the diagnosis.”
The clinicians wrote CT revealed “symmetric hypoattenuation within the bilateral medial thalami with a normal CT angiogram and CT venogram.” Brain MRI showed “hemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes, and subinsular regions.”
The doctors started her on intravenous immunoglobulin but not with high-dose steroids, as there could be a concern of respiratory compromise.
Acute necrotizing encephalopathy is one of the rare complications of viral infections. However, it has not been known to have occurred due to COVID-19 infection until now.
Dr. Cyrus Raji told Medscape Medical News, “Since this is just one report of one patient, the findings are the most preliminary we can conceive, and more research is needed to determine the extent to which COVID-19 may affect the central nervous system.” He is an assistant professor of radiology and neurology at Washington University in St. Louis, Missouri.
