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Título

MIOCLONUS-OPSOCLONUS-ATAXIA SYNDROME POST COVID-19 INFECTION: CASE REPORT

RESUMO

CASE PRESENTATION: A 65-year-old man attended the outpatient clinic referring tremors for 30 days. The condition progressed with dizziness, malaise, vomiting, aphasia, opsoclonus and myoclonus, which were presented 9 days after confirmed Covid-19 infection. Denies vertigo, seizures and history of cerebral vascular accident (CVA). Neurological examination showed bilateral dysmetria, dysdiadochokinesia in left upper limb and involuntary coarse movement with chorea and athetosis, in addition to muscle contraction. The cerebral magnetic resonance revealed global atrophy and microangiopathy. Requested electroencephalogram (EEG), which showed normal activity with the presence of rapid eye movement artifacts, in addition to laboratory tests for paraneoplasia and other possible etiologies screening (CA 19.9, antigen carcinoembryonic (ACE), ESR, PCR, occult blood test, ammonia, ANA, anti-beta2-glycoprotein, homocysteine, vitamin B12 and vitamin E dosage, folic acid, Pil, anticardiolipin, ALT and AST, AP and GGT, HbsAg, anti-HCV, Elisa HIV, VDRL and FTA-ABS). The results did not show paraneoplasms or infections, thus closing the diagnosis of Kinsbourne Syndrome. A lumbar puncture was made to evaluate the cerebrospinal fluid in addition to a high dose methylprednisolone pulse therapy. At the return visit, the patient showed a significant improvement in the clinical status. DISCUSSION: The Kinsboume Syndrome or Opsoclonus Myoclonus Ataxia syndrome is a rare neuroinflammatory disorder with a variable combination of opsoclonus, myoclonus, and ataxia¹. The etiology may be paraneoplastic, such as for neoblastoma, parainfectious (after viral or bacterial infections), toxic/metabolic or idiopathic². The exact pathogenesis is not fully known, however, in recent years, the emergence of neurological disorders, such as Kinsbourne syndrome itself, after COVID-19 infection has been reported in several studies¹. The syndrome is believed to be an inflammatory phenomenon mediated by the autoimmune system, being secondary to the Sars-Cov 2 infection². FINAL COMMENTS: Although it is a rare disease, the diagnosis of Kinsbourne syndrome by the neurologist, in the present case, was verified from the permanence of sequelae, mainly related to motricity and persistence of opsoclonus, as reported in the literature, in addition to the exclusion of occult neuroblastoma and other conditions.

Palavras Chave

Opsoclonus-Myoclonus Syndrome, COVID-19, Ataxia