Signs of rare brain condition including stroke, seizures, confusion seen in some Covid-19 patients

New Delhi, Apr 02: The coronavirus disease 2019 (COVID-19) pandemic which has spread across the world with over 330,000 reported cases in 190 countries, there have been now reports of rare and strange signs of symptoms too.

While most patients typically present with fever, shortness of breath, and cough, some patients exhibit neurologic manifestations, although to a much lesser extent.

A woman who tested positive for COVID-19 had developed a rare brain disease known as acute necrotizing encephalopathy, a condition that can be triggered by viral infections like influenza and herpes.

This is the first reported case of coronavirus associated with acute necrotizing hemorrhagic encephalopathy.

The patient, an airline worker who is in her 50s, presented with a 3-day history of cough, fever and altered mental status.

Initial laboratory work-up was negative for influenza, with the diagnosis of COVID-19 made by detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral nucleic acid in a nasopharyngeal swab specimen using the U.S. Centers for Disease Control and Prevention (CDC) 2019-Novel Coronavirus (2019-nCoV) Real-Time Reverse Transcriptase-Polymerase Chain Reaction assay.

Brain scans showed abnormal swelling and inflammation in several regions, with smaller areas where some cells had died.

Physicians then diagnosed a dangerous condition called acute necrotizing encephalopathy, a rare complication of influenza and other viral infections.

So, what is Acute necrotizing encephalopathy?

Acute necrotizing encephalopathy (ANE) is a rare disease characterized by brain damage (encephalopathy) that usually follows an acute febrile disease, mostly viral infections.

Most of the reported cases are from previously healthy Japanese and Taiwanese children, but it is now known that the disease may affect anybody in the world.

The symptoms of the viral infection (fever, respiratory infection, and gastroenteritis, among others) are followed by seizures, disturbance of consciousness that may rapidly progress to a coma, liver problems, and neurological deficits.

The disease is caused by both environmental factors and genetic factors.

Usually, ANE develops secondary to viral infections, among which the influenza A, influenza B, and the human herpes virus 6, are the most common. ANE can be familial or sporadic, but both forms are very similar to each other. Most familial cases are caused by mutations in the RANBP2 gene, and are known as "infection-induced acute encephalopathy 3 (IIAE3)".

Although the clinical course and the prognosis of ANE are diverse, the characteristic that is specific to the disease is the "multifocal symmetric brain lesions affecting the thalami, brain stem, cerebral white matter, and cerebellum" which can be seen on computed tomography (CT) or magnetic resonance imaging (MRI) exams.
The best treatment of ANE is still under investigation but may include corticosteroids and anticytokine therapies.