自2019年冠状病毒(COVID-19)爆发以来,各种罕见的运动障碍和认知变化已被认为是潜在的神经系统并发症。其中一些的早期治疗可以快速恢复;因此,我们必须及时诊断这些表现。我们描述了一名感染严重急性呼吸道综合症冠状病毒2的76岁男子的病例,他出现了混乱和幻觉,并在症状发作14天后入院。一天后,他出现了广泛性肌阵鸣,构音障碍和共济失调,和强直阵挛性癫痫发作,并被送入重症监护室。磁共振成像显示的边缘系统改变支持了COVID-19相关的自身免疫性脑炎的诊断,其特征是边缘叶脑炎和免疫介导的急性小脑共济失调和肌阵挛症。脑电图显示的侧向放电,脑脊液(CSF)中的蛋白质水平略有升高,和CSF中的间接免疫荧光,自身抗体与小脑和海马的解剖结构结合。患者通过2周的皮质类固醇治疗和4次血浆置换得到改善。我们目前的案例研究描述了一例罕见的COVID-19相关的边缘叶脑炎,伴有免疫介导的急性小脑共济失调和肌阵挛症(ACAM综合征),并加强了对基于组织的测定(TBA)的需求,以筛查高度怀疑患有自身免疫性脑炎的患者的血清和/或CSF。我们认为及时诊断和靶向侵袭性免疫治疗是患者完全恢复的主要原因。
Since the outbreak of coronavirus (COVID-19) in 2019, various rare movement disorders and cognitive changes have been recognized as potential neurological complications. The early treatment of some of these allows rapid recovery; therefore, we must diagnose these manifestations in a timely way. We describe the
case of a 76-year-old man infected with severe acute respiratory syndrome coronavirus-2 who presented with confusion and hallucinations and was admitted to our hospital 14 days after the onset of symptoms. One day later, he developed generalized myoclonus, dysarthria and ataxia, and tonic clonic seizures and was admitted to the intensive care unit. A diagnosis of COVID-19-associated autoimmune encephalitis with characteristics of limbic encephalitis and immune-mediated acute cerebellar ataxia and myoclonus syndrome was supported by alterations in the limbic system shown in magnetic resonance imaging, lateralized discharges shown in electroencephalography, a slightly elevated protein level in the cerebrospinal fluid (CSF), and indirect immunofluorescence in the CSF with autoantibody binding to anatomical structures of the cerebellum and hippocampus. The patient improved with 2 weeks of corticosteroid treatment and four sessions of plasmapheresis. Our current
case study describes a rare
case of COVID-19-related limbic encephalitis with immune-mediated acute cerebellar ataxia and myoclonus syndrome (ACAM syndrome) and strengthens the need for tissue-based assays (TBAs) to screen the serum and/or CSF of patients highly suspected to have autoimmune encephalitis. We believe that the timely diagnosis and targeted aggressive immunotherapy were mainly responsible for the patient\'s total recovery.