Susac syndrome following COVID-19 infection
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LETTER TO THE EDITOR
Susac syndrome following COVID‑19 infection Laura Venditti1,2 · Antoine Rousseau3 · Claire Ancelet4 · Thomas Papo5 · Christian Denier1,2 Received: 15 October 2020 / Accepted: 10 November 2020 © Belgian Neurological Society 2020
Keywords Susac syndrome · SICRET · COVID-19 · SARS-CoV-2 · Stroke · Vascular endothelial cell Abbreviations ACE-2 Angiotensin-converting enzyme 2 ADC Apparent diffusion coefficient COVID-19 Coronavirus disease of 2019 DWI Diffusion-weighted imaging FLAIR Fluid-attenuated inversion recovery MoCa Montreal cognitive assessment PCR Polymerase chain reaction SARS-CoV-2 Severe acute respiratory syndrome-coronavirus type 2 Dear Editor, Susac syndrome is a very rare cause of stroke characterized by microvessel occlusion with a typical clinical triad of encephalopathy, branch retinal artery occlusions and sensorineural hearing impairment. Recently, stroke has been described as a possible complication in coronavirus disease of 2019 (COVID-19) patients, with various mechanisms involving inflammation and microvascular events. We report the first case of Susac syndrome occurring after COVID-19 infection. * Laura Venditti [email protected] 1
Department of Neurology, Centre Hospitalo-Universitaire de Bicêtre, Assistance Publique-Hôpitaux de Paris (AP-HP), 78 Rue du Général Leclerc, 94275 Le Kremlin‑Bicêtre, France
2
Faculté de Médecine, Université Paris-Saclay, 63 Rue Gabriel Péri, 94270 Le Kremlin‑Bicêtre, France
3
Department of Ophtalmology, Centre Hospitalo-Universitaire de Bicêtre, AP-HP, 94275 Le Kremlin‑Bicêtre, France
4
Department of Neuroradiology, Centre Hospitalo-Universitaire de Bicêtre, AP-HP, 94275 Le Kremlin‑Bicêtre, France
5
Department of Internal Medicine, Centre Hospitalo-Universitaire de Bichat, AP-HP, 75018 Paris, France
A 25-year-old woman was admitted to our stroke unit for acute confusion, transitory right facial palsy and sudden dysarthria. One month prior to admission, she had had fever, flu-like syndrome and anosmia. Although she was not tested with nasopharyngeal polymerase chain reaction (PCR) assay for SARS-CoV-2 (severe acute respiratory syndrome-coronavirus type 2) at this time, infection was later confirmed with serology testing. On stroke unit admission, she had cognitive—especially memory—dysfunction, so severe that the mini-mental state examination (MMSE) and montreal cognitive assessment (MoCa) could not be conducted. Magnetic resonance imaging (MRI) showed multiple acute and subacute ischaemic cortical strokes, in various arterial territories, associated with leptomeningeal enhancement (Fig. 1a–g). A second MRI scan was performed 4 days later because of a worsening of the facial palsy, associated with aphasia and cerebellar ataxia. It showed new strokes, especially in the corpus callosum. Cerebral arteriography was normal. The extensive workup search for usual causes of stroke in young adults was negative. This included HIV, HBV, HCV serology, lupus anticoagulant, anticardiolipin and anti-β2-glycoprotein IgG and
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