Encephalitis associated with the SARS-CoV-2 virus: A case report

• Published in: Interdisciplinary neurosurgery : Advanced techniques and case management Vol. 22; p. 100821
• Main Authors: Vandervorst, Fenne, Guldolf, Kaat, Peeters, Ilse, Vanderhasselt, Tim, Michiels, Kathleen, Berends, Kinge Johanna, Van Laethem, Johan, Pipeleers, Lissa, Vincken, Stefanie, Seynaeve, Laura, Engelborghs, Sebastiaan
• Format: Journal Article
• Language: English
• Published: Elsevier B.V 01.12.2020; Published by Elsevier B.V; Elsevier
• Subjects: COVID-19; Encephalitis; Hydroxychloroquine; Letter to the Editor; Neurological complications; SARS-CoV-2; COVID-19; Encephalitis; SARS-CoV-2; Hydroxychloroquine; Neurological complications
• ISSN: 2214-7519; 2214-7519
• DOI: 10.1016/j.inat.2020.100821

•The SARS-CoV-2 virus is an RNA virus that uses the angiotensin-converting-enzyme 2 (ACE2) receptor to enter human cells.•The fact that ACE2 receptors are expressed by glial cells and neurons, makes them potential targets for infection with the SARS-CoV-2 virus.•Recent observations suggest neurological complications of COVID-19, including a first report of suspected viral encephalitis with confirmed presence of SARS-CoV-2 virus in the cerebrospinal fluid.•In case of suspected meningo-encephalitis in patients suffering from COVID-19, additional exams should be performed such as brain MRI scan, long-term EEG monitoring, and lumbar puncture.•The absence of the typical CSF profile of viral meningitis/encephalitis as well as the negativity of PCR for SARS-CoV-2-virus in CSF, makes diagnosing encephalitis linked to SARS-CoV-2-virus less obvious. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) usually causes fever, respiratory symptoms, malaise and myalgia. Recent observations suggested possible neurological complications of COVID-19, including the first report of suspected viral encephalitis. We report a case of a 29-year-old male with -on nasopharyngeal testing- confirmed SARS-CoV-2 infection with severe respiratory symptoms, followed by clinical and radiological signs of encephalitis. Magnetic resonance imaging (MRI) of the brain showed an asymmetric FLAIR-hyperintensity of the left medial temporal cortex associated with mild gyral expansion. Lumbar puncture was normal and PCR’s for SARS-CoV-2 virus on CSF were negative. Clinicians treating SARS-CoV-2 infected patients should be aware of possible neurological complications, like encephalitis. The diagnosis of SARS-CoV-2 encephalitis is difficult as CSF analysis may be normal.