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Título

Amyloid-β Related Angiitis as a neurocovid manifestation?

RESUMO

A previously independent 75-years-old woman was admitted in April of 2021 to a neurological department in the city of Fortaleza, Brazil. She presented a three week report of progressive speech impairment, difficult interaction and comprehension associated with right hemiparesis and sphincter incontinence.She had an unremarkable medical history.
Upon neurological examination, it was additionally observed mutism, hyperreflexia, clonus and babinski sign. On further work up, a magnetic resonance imaging (MRI) exhibited numerous microbleeds on SWI surrounded by vasogenic edema on T2 sequences. RT-PCR test for COVID-19 was revealed to be positive.She had been experiencing mild dyspnea one week prior to first evaluation.
Cerebrospinal Fluid Evaluation revealed normal opening pressure, 40 RBC/mm, 2 WBC/mm, Protein level of 126 mg/dl, Glucose 80 mg/dl. It was negative pathogens.
After initial approach the diagnosis was considered to be probably ABRA (Amyloid-β Related Angiitis), she was submitted to therapy with a 5 day course of methylprednisolone evolving with progressive clinical improvement. Was discharged in a few days and was followed at the outpatient care. She remained at follow up with motor aphasia and a slight upper right limb weakness with relatively independence requiring little assistance to daily routine.
Discussion: Neurological symptoms associated with COVID‐19 have been described with manifold aetiologies, such as ischaemic stroke, hemorrhagic encephalopathy and others.
The largest published autopsy series of COVID‐19 neuropathology reported microthrombi and acute hemorrhagic infarction in a significant number of patients, while another more recent study found evidence of lymphocytic encephalitis and meningitis. Endotheliitis of the brain and extraneural organs has been shown in Sars‐CoV‐infected patients. Amyloid-beta related angiitis is a predominantly granulomatous angio-destructive inflammatory mediated disease affecting leptomeningeal and cortical vessels characterized by meningeal lymphocytosis and abundant amyloid-beta deposition within the vessel walls.
The pathophysiology of ABRA is not fully understood. One theory suggests an immunologic response toward amyloid-beta, resulting in leptomeningeal and parenchymal inflammation. Reports of rare cases such as this one of amyloid-β related Angiitis associated with COVID infection, may help to clarify roles of immune response,its triggers and incite further questions in the scientific community.

Palavras Chave

Área

Neuroimunologia