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Título

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

Resumo

CASE PRESENTATION: A 65-year-old man came to the outpatient clinic reporting tremors for 30 days. The condition progressed with dizziness, feeling of malaise, vomiting, scant speech, opsoclonus and myoclonus, which were presented nine days after the mild coronavirus disease (COVID-19) was confirmed. He denies vertigo, convulsive crisis and history of cerebrovascular accident (CVA). Neurological examination showed bilateral dysmetria, dysdiadochokinesia, dyssynergia, myoclonus, truncal ataxia, astasia and abasia. Brain Magnetic Resonance Imaging (MRI) revealed mild global atrophy and microangiopathy. An electroencephalogram (EEG) was requested, which showed normal baseline activity with the presence of multidirectional rapid eye movement artifacts, in addition to laboratory tests to screen for paraneoplasia and possibles etiologies (CA 19.9, carcinoembryonic antigen, ESR, CRP, occult blood test, ANA, homocysteine, vitamin B12, vitamin E, folic acid, negative antiphospholipid antibodies, liver enzimes, hepatitis B virus, Hepatitis C virus, HIV Elisa, VDRL and FTA-ABS, chest and abdomen tomography). The results did not show paraneoplasms or other infections, thus concluding the diagnosis of Kinsbourne Syndrome. Lumbar puncture was performed to assess cerebrospinal fluid (CSF), cultures for bacteria, fungi and tuberculosis were negative and pulse therapy with high-dose methylprednisolone. The patient showed complete improvement of the clinical picture. DISCUSSION: Kinsbourne Syndrome or Opsoclonus Myoclonus Ataxia Syndrome is a rare neuroinflammatory disease with a variable combination of opsoclonus, myoclonus and ataxia¹. The etiology can be paraneoplastic, such as neoblastoma, parainfectious, after viral or bacterial infections, toxic and 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. It is believed that the syndrome may be an inflammatory phenomenon mediated by the autoimmune system, secondary to infection by the coronavirus². FINAL COMMENTS: Despite being a rare disease, the diagnosis of Kinsbourne syndrome by the neurologist, in the present case, was verified from the neurological physical examination, mainly related to motricity and persistence of opsoclonus, as reported in the literature, in addition to a broad diagnosis differential.

Palavras Chave

Opsoclonus-Myoclonus Syndrome; COVID-19; Ataxia.