COVID-19-Associated Acute Multi-infarct Encephalopathy in an Asymptomatic CADASIL Patient
- PDF / 874,865 Bytes
- 4 Pages / 595.276 x 790.866 pts Page_size
- 97 Downloads / 157 Views
NEURO-IMAGES
COVID‑19‑Associated Acute Multi‑infarct Encephalopathy in an Asymptomatic CADASIL Patient Tianshu Zhang* , Ellen Hirsh, Shadi Zandieh and Michael B. Rodricks © 2020 Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society
COVID-19 is a new disease caused by the SARS-CoV-2 virus. First described in Wuhan, China, the scope and speed with which the disease has spread has placed healthcare systems around the world under pressure. Afflicted patients typically present with fever, cough, myalgia, and eventually dyspnea. Despite the characteristic presentation of COVID-19, we have frequently noted atypical symptoms including gastrointestinal disturbances and neurological symptoms including headache, altered mental status, loss of olfaction, and seizures. We present the case of a patient who presented with significant neurological symptoms. A right-handed female in her early 40s presented to the emergency department after she developed dysphagia, dysarthria, and encephalopathy 2 days prior to admission. She had a history of well-controlled hypertension and dyslipidemia. The patient had no past medical history of stroke, migraines, visual disturbances, or any neurological disease processes. She had no previous brain imaging studies. There was also no family history of stroke, dementia, migraines with aura, or other neurological disorders. Eleven days prior to admission, the patient began suffering from a headache and myalgia. She was seen by her primary care physician and treated as an outpatient with a course of azithromycin. She had a negative influenza swab and a negative rapid strep test at the office. She was, however, not checked for COVID-19 due to the lack of available testing. The patient’s sister, with whom she resided, had recently returned from a trip abroad. The day after returning, the sister developed a headache *Correspondence: [email protected] Robert Wood Johnson University Hospital Somerset, 110 Rehill Ave., Somerville, NJ 08876‑2598, USA
and myalgias which were mild, lasted 4 days, and were self-limited. Her sister did not seek any medical care. The patient fell ill 4 days after her sister’s return with similar symptoms of a headache and myalgias. After developing lethargy, dysphagia, and speech difficulties, she was brought to the emergency department. The physical examination revealed a patient in moderate acute distress. She was febrile with a temperature of 102.2°F. Her blood pressure was 140/80 with a heart rate of 106 and a respiratory rate of 27. The room air oxygen saturation was 92%. Neurologically, she was awake and alert and followed commands although sluggishly. She had difficulty with her speech with components of both dysarthria and expressive aphasia, difficulty handling her secretions, and dysphagia. There was no meningismus which could be elicited. Her pupils were equal round and reactive, but she showed a right gaze preference and a mild left facial droop. She had mildly decreased but equal bilateral strength. The deep tendon re
Data Loading...
