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.
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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.
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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.