Abstract
Aim: To describe post-infectious neurological aspects of COVID-19 in a patient with progressive post-infectious peripheral (PNS), autonomic (ANS) and central nervous system (CNS) involvement due to SARS-CoV-2 infection. Background and Purpose: A variety of neurological manifestations have been described in association with Covid-19, however, progressive multisystem neurological aspects have not been described. Methods: A case report detailing the history, examination, and infectious serology associated with SARS-CoV-2, and subsequent neurodiagnostic laboratory testing and treatment. Results: Neurodiagnostic laboratory studies showed large-fiber demyelinating sensorimotor and painful small fiber sensory polyneuropathy, orthostatic hypotension, and hypometabolism of bilateral anterior and mesial temporal lobes with a possible frontal seizure focus. Treatment was initiated with high-dose immune globulin therapy. Conclusions: The combination of PNS, ANS and CNS involvement in this patient was associated with post-infectious acquired immunity to SARS-CoV-2.
Highlights
The 2019 novel coronavirus (2019-nCoV [COVID-19]) epidemic is caused by the novel Severe Acute Respiratory Syndrome-Coronavirus-2
Autonomic evaluation of beat-to-beat blood pressure acquisition for testing of cardiovagal function, adrenergic function of heart rate (HR) and systolic blood pressure (SBP) during rapid respiration, Valsalva maneuver and 5-minute 70-degree head up tilt (HUT) table test were performed according to standard guidelines. [5] 18Fluorodeoxyglucose (FDG) positron emission tomography fused to non-contrast magnetic resonance imaging (PET/MRI) of the brain with 3D rendering was performed using a standard protocol for autoimmune encephalopathy
HUT table testing showed symptomatic orthostatic intolerance associated with a sustained fall in SBP to 80 mmHg and a compensatory HR acceleration to 121 bpm
Summary
To describe post-infectious neurological aspects of COVID-19 in a patient with progressive post-infectious peripheral (PNS), autonomic (ANS) and central nervous system (CNS) involvement due to SARS-CoV-2 infection
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