New-onset refractory status epilepticus (NORSE) in post SARS-CoV-2 autoimmune encephalitis: a case report
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COVID-19
New-onset refractory status epilepticus (NORSE) in post SARS-CoV-2 autoimmune encephalitis: a case report Fedele Dono 1 & Claudia Carrarini 1 & Mirella Russo 1 & Maria Vittoria De Angelis 2 & Francesca Anzellotti 3 & Marco Onofrj 1 & Laura Bonanni 1 Received: 12 August 2020 / Accepted: 17 October 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract The 2019 new coronavirus (SARS-CoV-2) is a novel respiratory virus which has increasingly spread all over the world. Although the predominant clinical presentation is represented by respiratory symptoms, neurological manifestation of SARS-CoV-2 is being increasingly recognized. In the present report, we present a case of post SARS-CoV-2 autoimmune encephalitis associated with a new-onset refractory status epilepticus (NORSE). Keywords COVID-19 . Epilepsy . Autoimmune encephalitis . Status epilepticus . Case report
Introduction
Case presentation
COVID-19 pandemic caused by the novel coronavirus (SARS-CoV-2) represents one of the largest emergencies that humanity had to be dealing with in the last century. Several reports indicate that SARS-CoV-2 infection can be associated with acute neurological manifestations [1]. Although the knowledge of central nervous system (CNS) acute comorbidities is increasing, little is known about the possible neurological sequelae of the infection. In the present report, we describe a case of post-SARS-CoV-2 autoimmune encephalitis presenting as new-onset refractory status epilepticus (NORSE).
On May 12th, an 81-year-old man was admitted to the Emergency Department, due to persistent fever, mild dyspnea, and dry coughing started 7 days before the admission. His past medical history showed mild hypertension. Arterial blood gas analysis showed respiratory alkalosis (pH: 7.542) with normal blood oxygen saturation (SO2: 94.6%), mild hypoxemia (70.5 mmHg), and hypocapnia (23.4 mmHg). Blood sample analysis documented slight lymphocytopenia, increased D-dimer (1.23 mg/ml), and normal level of procalcitonin and Creactive protein. Chest X-ray was unremarkable (Fig. 1a). Computed tomography (CT) scan of the lungs showed a ground-glass pattern in both the inferior lobe segments (Fig.
Supplementary Information The online version contains supplementary material available at https://doi.org/10.1007/s10072-02004846-z. * Laura Bonanni [email protected]
Francesca Anzellotti [email protected]
Fedele Dono [email protected]
Marco Onofrj [email protected]
Claudia Carrarini [email protected]
1
Mirella Russo [email protected]
Department of Neuroscience, Imaging and Clinical Science, “G. D’Annunzio” University of Chieti-Pescara, Chieti, Italy
2
Neurology Unit, “SS Annunziata University Hospital, Chieti, Italy
3
Department of Neurology, Epilepsy Center, Neurology Unit, “SS Annunziata” University Hospital, Chieti, Italy
Maria Vittoria De Angelis [email protected]
Neurol Sci Fig. 1 Radiological findings. Chest X-ray (a) excluding signs of lobar pneumonia. Computed tomography (CT) of the l
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