COVID-19 Late Breaking Abstracts

LB1203 - Neuromyelitis optica spectrum disorders (NMOSD) attack triggered by COVID-19 infection (A case report) (ID 2044)

Speakers
  • A. Nasreldein
Authors
  • A. Nasreldein
  • H. Ibrahem
  • A. Bahie
Presentation Number
LB1203
Presentation Topic
COVID-19

Abstract

Background

Neurological presentations of SARS-CoV-2 infection (COVID-19) are now increasingly reported, however some specific presentations as well as the neurological para or post infectious sequels are still under recognized. Here, we report a patient with acute bilateral diminution of vision and acute diencephalic syndrome wiith clinical and imaging findings consistent with NMOSD, 2 weeks following a COVID-19 infection.

Objectives

We would report a case of female patient with COVID-19 who had clinical and radiological disease consistent with NMOSD 2 weeks after her COVID-19 infection

Methods

A 56 years old female patient who was completely healthy without any previous history of neurologic disease except past history of left temporal meningioma which removed surgically successfuly 12 years ago. The patient had developed fever (up to 39 C), associated with respiratory symptoms, easy fatigability, anorexia and generalized body aches. Her Blood picture showed lymphopenia with normal other labs, CT chest showed bilateral ground glass appearance highly suggestive of Covid -19 infection. SARS-CoV-2 PCR sample from nasopharyngeal swab was positive. Patient recieved treatment for her COVID-19 infection at her home according to the treatment protocl. Her fever as her other symptoms gradually improved within 2 weeks. At the end of 2 weeks,the patient presented to the emergency department with acute bilateral loss of vision, lethargy and disorientation.Her tvital signs were within normal refrences, Oxygen saturation was 95% and the patient metabolic profile was within normal range. Neurological examination showed disorientation to time, place and person. All extremities moved spontaneously equal with normal tone, intact deep tendon reflexes and positive planter response. Brain MRI showed abnormal signal intensity seen involving diencephalic, medial thalamic, optic chiasm, optic tracts and radiation, being hyper intense inT2W1 and FLAIR, no DW restriction, no perilesional edema or mass effect. According to examination and imaging findings, NMOSD diagnosis was postulated. Methylprednisolone 1 g IV daily was administered for the presumed acute demyelinating event. Later on patient developed bradycardia (50 b/min), became shocked, uncorrected hypothermia (35 c). At the end she developed central diabetes insipidus complicated by hypernatremia (160 mmol/L).A follow up MRI with contrast was done and showed no significant changes from baseline MRI with partial enhancement of the chiasm and diencephalic region. Patient developed 2 attacks of generalised tonic clonic convulsions, aspirated, arrested respiratory, mechanicaly ventilated and died few hours later.

Results

The diagnosis of the patient as NMOSD was established according to patient clinical scenario and radiological findings.

Conclusions

NMOSD could be a possible complication to COVID-19 infection, In addition to its previously known neurologic complications

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