A case of Acute necrotizing encephalopathy with SARS-CoV-2 R
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This report presents a case of COVID-19–related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice.

Although monocytes and protein levels in CSF were only marginally increased, and the patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem.

Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis.

The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset.

This case report demonstrates 2 important aspects of SARS-CoV-2: first, that the virus may have significant neurotropism, and second, that normal CSF cell counts and initial negative SARS-CoV-2 RNA PCR results in CSF do not exclude CNS engagement. This case also underscores the value of repeated CSF testing when CNS COVID-19 is suspected.

Source: https://n.neurology.org/content/95/10/445?rss=1
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