Possible affective cognitive cerebellar syndrome in a young
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COVID-19 is caused by the SARS-CoV-2, a beta-coronavirus with ability to infect humans similar to other viruses from the same group, the SARS-CoV and the Middle East respiratory syndrome coronavirus (MERS-CoV). The known modes of infection are through human to human contact and fomite; possible aerosol transmission in enclosed spaces with poor ventilation has been reported.

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%–6% of hospitalised patients. These are generally older patients with severe infection and comorbidities.

This reprt discusses the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts.

A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.

Learning points:
- Early brain imaging in COVID-19-positive patients with neuropsychiatric symptoms is of great importance to detect possible cerebrovascular events even in patients outside the ‘at risk’ group (younger patients without severe respiratory infection or underlying conditions).

- Acute cerebellar lesions may cause a neurobehavioural syndrome requiring psychiatric input and intensive neurorehabilitation.

- Neuropsychological/neuropsychiatric evaluation in patients of working age with COVID-19 with suspected central nervous system involvement is highly desirable to facilitate access to cognitive rehabilitation and vocational therapy, and increase the chances of a successful return to employment.

Source: https://casereports.bmj.com/content/13/10/e237926?rss=1
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