COVID Encephalitis Resulting in Focal Seizures with Subsequent Changes on MRI Imaging
Abstract number :
2.151
Submission category :
5. Neuro Imaging / 5A. Structural Imaging
Year :
2021
Submission ID :
1825513
Source :
www.aesnet.org
Presentation date :
12/5/2021 12:00:00 PM
Published date :
Nov 22, 2021, 06:44 AM
Authors :
Adena Shahinian, DO - University of Southern California (USC); Aleksandra Ferreira, DO - Valley Hospital Medical Center; Chee Lim, DO - Valley Hospital Medical Center; Gina Robinson, DO - Valley Hospital Medical Center; Jasmine Chopra, DO - Valley Hospital Medical Center; Trusha Mehta, DO - Valley Hospital Medical Center; Raveen Bakhru, DO - Valley Hospital Medical Center; Aroucha Vickers, DO - Valley Hospital Medical Center; Paul Janda, DO - Neurology Program Director, Valley Hospital Medical Center
Rationale: The neurologic manifestations associated with COVID-19 infection have been demonstrating increased clinical prevalence, with a presumed route of entry through the olfactory bulb leading to inflammation and demyelination (1,2). Of the common neurologic sequelae, seizures associated with SARS-COV have rarely been reported, and are hypothesized to occur as a result of acute systemic illness (2). Seizures with associated diffusion weighted imaging (DWI) restriction on MRI are an accepted consequence after a single seizure episode and may represent higher vulnerability (1). The majority of the reported DWI changes were associated with focal seizures (1).
Methods: Case was reviewed with associated literature review.
Results: A 52-year-old right-handed Caucasian female with a past medical history of relapsing remitting multiple sclerosis not currently on disease modifying medications who presented with altered mentation and 3 weeks of new onset recurrent left upper extremity focal aware seizures with associated EEG changes that correlated with the presentation. She subsequently also tested positive for COVID-19 and was found to have an MRI Brain that demonstrated right frontal restriction of diffusion on DWI with cortical ribboning. With the treatment of her focal seizures and her COVID-19 infection her clinical status and MRI imaging improved.
Conclusions: We present a rare case of COVID-19 encephalitis that resulted in focal aware seizures with associated DWI restriction with cortical ribboning thought to be the sequelae of post-ictal changes that correlate with the clinical presentation. It is also important to consider post-ictal changes on the differential diagnosis for restriction of diffusion on MRI imaging in the correct clinical setting.
References:
1. Hübers A, Thoma K, Schocke M, Fauser S, Ludolph AC, Kassubek J, Pinkhardt EH. Acute DWI Reductions In Patients After Single Epileptic Seizures - More Common Than Assumed. Front Neurol. 2018 Jul 25;9:550. doi: 10.3389/fneur.2018.00550. PMID: 30140246; PMCID: PMC6094998.
2. Asadi-Pooya AA. Seizures associated with coronavirus infections. Seizure. 2020 Jul;79:49-52. doi: 10.1016/j.seizure.2020.05.005. Epub 2020 May 11. PMID: 32416567; PMCID: PMC7212943.
Funding: Please list any funding that was received in support of this abstract.: None.
Neuro Imaging