Dados do Trabalho

Título

COVID-19-associated myoclonic encephalopathy - report of a 79-year-old patient

RESUMO

Presentation. A 79-year-old male patient with RT-PCR confirmed COVID developed jerky movements in his trunk, face, and limbs on the eighth day of symptoms, preventing him from walking. He developed dysarthria and dysphagia, which led to the need for a feeding tube. Fourteen days after COVID symptoms started, he was transferred to the hospital, for supplemental oxygen, without intubation. The neurologic examination showed mild somnolence, temporal disorientation, and generalized myoclonus, with positive and negative jerks, predominantly involving all four limbs, trunk, and proximal musculature. CSF analysis and brain MRI were both unremarkable. Under the hypothesis of COVID-associated myoclonus, methylprednisolone (MP) 1000mg/day for five days was used, with mild improvement of dysphagia and, to a lesser extent, dysarthria. Immunoglobulin IV 0,4g/Kg/day for five days was used with improvement in walking, confusion, and myoclonus. He was discharged with Levetiracetam, Clonazepam, and Valproate. He gradually improved, weaning off his medications over the following months. He was released from the outpatient service without any prescription, remaining without myoclonus and with complete recovery of motor and cognitive function.
Discussion. Myoclonus is a condition with multiple etiologies and topographies, most commonly secondary to medical illness. SARS-Cov-2 potential to cause myoclonus has been explored in recent reports and probably shares mechanisms with other viruses under the hypothesis of an immune-mediated condition. Other myoclonus causes were extensively sought but were dismissed. The patient didn’t undergo severe hypoxia nor use myoclonus-inducing drugs, and there were no metabolic disorders.
Final comments. In this case, we present an unusual manifestation of a severe generalized myoclonic encephalopathy due to COVID. Some limitations should be cited: despite the significant improvement, it’s unclear whether this was a result of immunotherapy or the natural evolution of this poorly understood disease; finally, EEG and EMG weren’t performed due to logistical difficulties aggravated by the pandemic.

Palavras Chave

COVID-19, myoclonic encephalopathy.

Área

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