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Título

Atypical neurological manifestations post-COVID-19: A case series

Resumo

Introduction: SARS-COV-2 infection has affected millions of individuals to date. This disease has variable manifestations from an asymptomatic condition up to a rapidly evolving severe. Moreover, this infection may lead to multisystemic involvement, including the central and peripheral nervous systems. We report below three cases of atypical neurological manifestations post- COVID-19 and their clinical follow-up.

Case presentation: 27-years-old male patient, previously healthy, who had symptoms of COVID-19 confirmed by oropharyngeal and nasopharyngeal swab tests. On the tenth day of symptoms, the patient started to experience acute paraparesis, urinary retention, constipation, and hypoesthesia, up to T4 level. The second patient is a 50-years-old male, previously healthy, who had symptoms of the flu-like syndrome. The diagnosis of COVID-19 infection was confirmed by oropharyngeal and nasopharyngeal swab test. On the tenth day of symptoms, the patient started to experience paraparesis, urinary incontinence, and hypoesthesia up to T6 level. The neuroimaging and cerebrospinal fluid (CSF) analysis of both patients confirmed acute transverse myelitis, after COVID-19 infection. High-dose corticosteroid therapy was started, and both patients showed rapid recovery from their deficits. The third patient is a 45-year-old male patient who presented an 8-month history of progressive gait disorder and cognitive impairment after being hospitalized for SARS-CoV-2 infection. Magnetic resonance imaging (MRI) was compatible with NPH. A spinal tap test was positive and there was a progressive improvement after shunting, with complete resolution of symptoms after 30 days of follow-up.

Conclusion: We reported two cases of patients who developed acute transverse myelitis after COVID-19 infection that had a good and rapid response to high doses of methylprednisolone, unlike the previous reports. The differences in the doses and the treatment time may explain this. The third patient is a previously healthy patient who developed NPH two months after the COVID19 infection. Given the significance of this condition as a cause of reversible dementia, it is important to consider the possibility of a causal association with COVID19.

Palavras Chave

SARS-CoV-2; Coronavirus; COVID-19; Neurologic Manifestations; Normal Pressure Hydrocephalus; Acute Transverse Myelitis.