Comparison between SARS-CoV-2-Associated Acute Disseminated Encephalomyelitis and Acute Stroke: A Case Report
Abstract
:1. Introduction
2. Detailed Case Description
3. Discussion
4. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Item | Result | Unit | Normal Range |
---|---|---|---|
White blood cells | 5280 | /μL | 4800–10,800 |
C-reactive protein | 0.57 | mg/dL | <0.5 |
Procalcitonin | <0.05 | ng/mL | <0.07 |
Triglyceride | 72.3 | mg/dL | 21–175 |
Total cholesterol | 131.3 | mg/dL | 110–200 |
LDL cholesterol | 84.9 | mg/dL | <100 |
Prothrombin time | 11.4 | s | 9.4–12 |
Activated partial thromboplastin time | 31.2 | s | 25.3–32.3 |
ESR | 21 | mm/1 h | <29 |
ANA | Negative | ||
Anti-ds DNA | Negative | ||
Rheumatoid factor | <10 | IU/mL | <14 |
cANCA | Negative | ||
pANCA | Negative | ||
C3 | 82.9 | mg/dL | 87–200 |
C4 | 36.5 | mg/dL | 19–52 |
Anti-cardiolipin IgM | Negative | ||
Anti-cardiolipin IgG | Negative | ||
Anti-phospholipid antibody IgG | Negative | ||
Anti-β2 glycoprotein IgG | Negative | ||
Protein C | 75.5 | % | 70–140 |
Protein S | 81.8 | % | 63.5–149 |
Antithrombin III | 94.7 | % | 83–128 |
SARS-CoV-2 PCR | Positive, cycle threshold value 14 | ||
Anti-HIV test | Nonreactive | ||
RPR | Nonreactive | ||
TPPA/TPHA test | Negative | ||
Anti-HCV | Nonreactive | ||
HBsAg | Nonreactive | ||
Herpes simplex virus 1 IgM | Negative | ||
Herpes simplex virus 2 IgM | Negative | ||
Cytomegalovirus IgM | Negative | ||
Epstein-Barr virus IgM | Negative |
Item | Result | Unit | Normal Range |
---|---|---|---|
pH | 7.103 | ||
White blood cells | <5 | /μL | |
Red blood cells | 25 | /μL | |
Total protein | 30.5 | mg/dL | 15–45 |
Glucose | 57.39 | mg/dL | 40–70 |
LDH | 25.5 | U/L | |
Chloride | 127.9 | mmol/L | |
IgG index | 0.62 | 0–0.7 | |
Gram stain | No bacteria | ||
CSF culture | No bacteria | ||
Indian ink | Not found | ||
Acid-fast stain | Not found | ||
TB PCR DNA | Negative | ||
TB culture | Negative | ||
VDRL | Non-Reactive | ||
Cytomegalovirus PCR | Not detected | ||
Herpes simplex virus 1 PCR | Not detected | ||
Herpes simplex virus 2 PCR | Not detected | ||
Human herpesvirus 6 PCR | Not detected | ||
Human parechovirus PCR | Not detected | ||
Enterovirus PCR | Not detected | ||
Varicella zoster virus PCR | Not detected | ||
Cryptococcus neoformans/gattii PCR | Not detected | ||
Neisseria meningitidis | Not detected | ||
Listeria monocytogenes | Not detected | ||
Streptococcus agalactiae | Not detected | ||
Streptococcus pneumoniae | Not detected | ||
Escherichia coli K1 | Not detected | ||
Haemophilus influenzae | Not detected |
Clinical Characteristics | COVID-19-Associated ADEM [6] | COVID-19-Associated Stroke [20] |
---|---|---|
Incidence | The incidence of classic ADEM is approximately 2–5 per million per year in children. | Pooled incidence of 1.4% |
However, the incidence of COVID-19-associated ADEM and ADEM in adults is not clear due to the lack of standardized reporting of cases. | ||
Age | Advanced age (nearly half are >50 years old) | Median 65.3 years |
In contrast to classic ADEM, COVID-19-associated ADEM occurs more in adults than children. | In comparison to stroke patients without COVID-19, people with COVID-19 and stroke were younger. | |
Duration since COVID-19 symptom onset | Usually occurring within 15–30 days | Median 8.8 days |
Neurologic signs | Encephalopathy Focal motor deficits (paraparesis, quadriparesis) Cranial nerve deficits (oculomotor deficits, dysarthria) Focal sensory deficits Seizure Aphasia | Unilateral numbness or weakness of the face, arm or leg Aphasia Dysarthria Disorientation Ataxia Median NIHSS † 15 |
Radiological features | T2 FLAIR: diffuse, multifocal hyperintensities in the supratentorial and infratentorial white matter, but may also involve gray matter and/or the spinal cord. DWI: increased diffusivity ADC: decreased values in the acute stage; increased values in the subacute stage [16]. Some patients (42%) had evidence for hemorrhage on brain MRI, significantly higher than classic ADEM (2% in prior studies) [6]. | Large vessel occlusion Multiple vascular territory infarction |
Treatment | IV methylprednisolone IV immunoglobulin Plasmapheresis COVID-19-directed therapies | Antiplatelet therapy IV thrombolysis Endovascular thrombectomy |
Prognosis | mRS ‡ score 6 (mortality): 20% mRS score 4–5 (severe disability): 20% mRS score 0–1 (no disability): 11% | In-hospital death: 31.5% Discharged to rehabilitation facilities: 25.7% Discharged home: 19.1% |
Acute Disseminated Encephalomyelitis | Multiple Sclerosis | Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease | Neuromyelitis Optica Spectrum Disorder | |
---|---|---|---|---|
Clinical features | Acute and fulminant encephalopathy with multifocal neurologic findings; monophase; typically follows a prodromal viral illness | Chronic inflammation and demyelination; relapsing–remitting course; the multiphase; may not follow a prodromal viral illness | Central nervous system demyelination including ADEM, ON, TM; the most common is ON; monophasic or relapsing | ON, TM, area postrema syndrome; typically relapsing |
Radiographic features | Poorly marginated lesions with larger bilateral but asymmetric white matter abnormalities in MRI | Ovoid plaques MRI lesions; hypointense T1-weighted lesions (black holes); Dawson fingers on sagittal views | ADEM-like MRI; enhancement of optic nerve MRI | Enhancement of optic nerve MRI |
CSF analysis | Variable; nonspecific | Presence of oligoclonal bands; elevated proteins | Oligoclonal bands are typically absent; MOG-IgG autoantibody (+) in CSF | Variable; nonspecific |
Serum autoantibodies | No specific biomarkers | No specific biomarkers | MOG-IgG autoantibody (+) | Anti-AQP4-IgG antibody (+) |
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© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Jiang, Y.-X.; Chen, M.-H.; Lin, Y.-Y.; Kao, Y.-H.; Liao, T.-W.; Chiu, C.-C.; Hsiao, P.-J. Comparison between SARS-CoV-2-Associated Acute Disseminated Encephalomyelitis and Acute Stroke: A Case Report. Reports 2024, 7, 18. https://doi.org/10.3390/reports7010018
Jiang Y-X, Chen M-H, Lin Y-Y, Kao Y-H, Liao T-W, Chiu C-C, Hsiao P-J. Comparison between SARS-CoV-2-Associated Acute Disseminated Encephalomyelitis and Acute Stroke: A Case Report. Reports. 2024; 7(1):18. https://doi.org/10.3390/reports7010018
Chicago/Turabian StyleJiang, Yu-Xuan, Ming-Hua Chen, Yen-Yue Lin, Yung-Hsi Kao, Ting-Wei Liao, Chih-Chien Chiu, and Po-Jen Hsiao. 2024. "Comparison between SARS-CoV-2-Associated Acute Disseminated Encephalomyelitis and Acute Stroke: A Case Report" Reports 7, no. 1: 18. https://doi.org/10.3390/reports7010018