Dados do Trabalho

Título

Post Covid-19 steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) presenting as a new onset refractory status epilepticus (NORSE) responsive to treatment

RESUMO

Introduction: Neurological symptoms after Covid-19 are common, as seizures.1,2 In addition, refractory status epilepticus has also been described after Covid-19.3 This article aims to describe a patient with steroid-responsive encephalopathy associated with autoimmune thyroiditis (SREAT) after Covid-19, presenting as a new onset refractory status epilepticus (NORSE), with good response therapy. Discussion: Our patient presented with NORSE.7 The most common etiologies of NORSE were ruled out, such as structural damage, vascular, infectious, toxic and metabolic causes. Markers for autoimmune encephalitis were negative. However, thyroid autoantibodies raised the hypothesis of SREAT. The diagnosis of SREAT is currently a diagnosis of exclusion. The clinical picture usually involves encephalopathy, cognitive impairment, tremor, and other symptoms (such as seizures).5 The patient in the present case met criteria for this disease.8 The treatment of this condition involves immunotherapy with methylprednisolone and/or immunoglobulin.5 The relationship between Covid-19 and the subsequent appearance of SRAT may be due to the autoimmunity triggered by SARS-CoV-2, as already described in other conditions (referencia NMDA covid). The presentation of SREAT with NORSE is rare and, after Covid-19, it is unprecedented.9 The treatment of NORSE, in turn, involves the control of seizures, with anticonvulsants and anesthetic drugs.10 In addition, immunotherapy should always be used, attempted when autoimmune causes are part of the diagnostic hypothesis.8 Although other causes were investigated and excluded, the relationship between Covid-19 and SRAT may have been a fortuitous finding. The present case showed improvement after the attempt with the addition of ketamine to propofol and midazolam aiming at suppression burst with inter-surge intervals longer than 5 seconds, for 48 hours and after immunotherapy with IVIG and MPIV. Conclusion: Our case illustrates an unprecedented case of NORSE by SREAT after Covid-19 with excellent therapeutic response.

Palavras Chave

COVID-19, NORSE, SREAT