A middle-aged American woman is believed to be the first person to experience a rare type of brain swelling following a diagnosis of COVID-19, the respiratory disease caused by SARS-CoV-2.
The 58-year-old airline worker has developed a case of Acute Necrotizing Encephalitis, or ANE, a rare complication of the flu and other viral infections commonly seen in children, according to the United States National Library of Medicine.
“This is important for all providers to be aware and attentive in patients with an impaired level of consciousness. We need to think about how we will integrate patients with severe neurological conditions into our treatment paradigm, “said Elissa Fory, MD, neurologist Henry Ford who was part of the team of medical experts involved in the diagnosis, into a statement. “This complication is as devastating as a serious lung disease.”
After three days of coughing, fever and an “altered mental state”, the woman’s nasopharyngeal swab tested positive for the new coronavirus responsible for the global pandemic. On March 19, the Henry Ford health care system said the woman was transported by ambulance to the emergency department and showed signs of confusion and disorientation. Doctors ordered CT scans and MRIs, which revealed abnormal damage to the thalami and temporal lobes, areas of the brain associated with cognitive function and memory. People with certain types of ANE will continue to develop lesions or lesions in certain parts of the brain that can eventually lead to swelling, bleeding, and tissue death.
“About a third of people with type 1 acute necrotizing encephalopathy do not survive their disease and the resulting neurological decline. Of those who survive, about half have permanent brain damage due to tissue necrosis, resulting in impaired walking, speech and other basic functions, “writes the National Institutes of Health.
“Over time, many of these skills can be recovered, but the loss of brain tissue is permanent. Other people who survive their illness seem to be recovering completely. “
Accumulating Evidence Suggests Some People Diagnosed With COVID-19 May Develop Cytokine Storm Syndrome, An Over-Reaction Of The Immune System That Can Lead To A Break In The Blood Brain Barrier, According To A March 16 Study Published In The Lancet . Although the neurological complications associated with COVID-19 are not clear, doctors have reported that a rare subset of those diagnosed with COVID-19 also develop complications in the brain.
“This is the first reported case of acute necrotizing hemorrhagic encephalopathy associated with COVID-19. As the number of COVID-19 patients increases worldwide, clinicians and radiologists should monitor this presentation among patients with COVID-19 and altered mental status, “the study authors wrote in the journal. Radiology.
Influenza A has also been linked to ANE in children and adults. In 2018, two siblings who had not received the flu vaccine were diagnosed with the condition following infection with the influenza A (H1N1) virus. Neuroimaging has revealed brain damage compatible with ANE. The older child recovered fully and was discharged two weeks after being sick, but the younger brother developed severe swelling and died after 11 days. A 2017 case report describes a 55-year-old man who was diagnosed with ANE after also being diagnosed with influenza A. In this case, it is speculated that the cytokine storm may have played a role in the swelling of his brain.
The woman received intravenous immunoglobin rather than steroids as these can worsen lung damage related to COVID-19. On April 1, she was hospitalized in serious condition.