Dados do Trabalho

Título

POST-COVID LEUKOENCEPHALOPATHY WITHOUT SEVERE HYPOXIA WITH EARLY TREATMENT

RESUMO

A 44-year-old male patient sought medical evaluation due to concentration and memory deficits initiated three months before He also referred nausea, excessive irritability, dizziness, and a moderate-intensity headache in the period.
His medical history disclosed a previuous mild covid-19 about 5 months before, confirmed by polymerase chain reaction (PCR). The patient did not present hypoxia or great respiratory symptoms in the period that needed further care. He had taken, 1 month before the infection, the first dose of Astrazeneca vaccine and the second dose, 3 months after the disease. There was no evidence of drug and alcohol abuse, intoxication with exogen substances, radiation exposition or chemotherapy. Physical and mental examination did not show any alteration during tests.
An encephalic Magnetic Resonance Imaging (MRI) revealed coalescent hyperintense signal abnormalities in white matter of corona radiata, periventricular, frontoparietal and subcortical temporal lobes in both hemispheres. In addition, in T2/FLAIR sequence, small oval hyperintense abnormalities after contrast in both thalami, cerebellum’s white matter, pons, amygdala, and dentate nucleus. There were no hippocampi alterations. Blood count, cerebrospinal fluid analysis and serologies were performed, showing no alterations or plausible causes for the findings.
Considering the possible causes and the exclusion of the majority of plausible causes, the diagnostic was given as Acute Diffuse Leukoencephalopathy secondary to Covid-19. Based on previous reports, it was initiated treatment with corticotherapy. After 10 days of treatment, the patient referred great improvement of symptoms, with remission of dizziness.
This pathology is mostly related to microhemorrhages, severe hypoxia and, during the pandemic, associated with long term hospitalization and mechanical ventilation. In this case, the patient showed demyelinating patterns associated with a rare complication of sars-cov2 infection with direct lesions of the nervous cells of the brain. The diagnostic of this pathology and timely treatment is difficult, considering negative findings in physical and mental exams as well as laboratorial testing.
Most patients do not have access to MRI and probably will not receive an appropriate diagnostic. The probability of certain medical care is lowered even more if examinators restrict the occurrence of the pathology only in critical ill patients with long exposure to hypoxia.

Palavras Chave

LEUKOENCEPHALOPATHY COVID