Complication of COVID-19: Mild Encephalopathy Syndrome with Reversible Splenial Lesion
- Authors: Matveeva T.V.1, Gaifutdinov R.T.1, Kamalova D.S.1, Fasakhova G.A.2
-
Affiliations:
- Kazan State Medical University
- Central City Clinical Hospital No. 18
- Issue: Vol 18, No 4 (2024)
- Pages: 110-116
- Section: Clinical analysis
- URL: https://ogarev-online.ru/2075-5473/article/view/282509
- DOI: https://doi.org/10.17816/ACEN.983
- ID: 282509
Cite item
Abstract
A syndrome of mild encephalopathy with reversible splenial lesion (MERS) was described in a post-COVID-19 male patient. The clinical manifestations included neuropsychiatric and visual abnormalities; when focusing separately on an object (one eye closed), the left eye perceived it as normal, but the right eye perceived it as multiple images moving diagonally into the distance. T2, FLAIR, and ADC magnetic resonance imaging (MRI) showed a splenial lesion that resolved rapidly without using corticosteroids. The patient was diagnosed with cerebral polyopia because he saw images arranged in ordered rows after focusing on an object. Differential diagnoses included astigmatism, palinopsia, and polyopic visual hallucinations. Monocular polyopia is explained by anomia associated with the patient's partial split-brain syndrome (the splenial lesion, neuropsychiatric abnormalities); involvement of the pathways from the frontal eye fields to the brainstem structures responsible for initiating extraocular eye movements. The association of neurological complications with prior COVID-19, rapid resolution of symptoms, and MRI lesions without initiating immunosuppressive therapy suggested endotheliopathy as the cause of COVID-19 complications.
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##article.viewOnOriginalSite##About the authors
Tatiana V. Matveeva
Kazan State Medical University
Email: gaifutdinov69@mail.ru
ORCID iD: 0000-0002-1889-0094
Dr. Sci. (Med.), Prof., Department of neurology, neurosurgery and medical genetics
Russian Federation, KazanRustem T. Gaifutdinov
Kazan State Medical University
Author for correspondence.
Email: gaifutdinov69@mail.ru
ORCID iD: 0000-0001-5591-7148
Cand. Sci. (Med.), Associate Professor, Department of neurology, neurosurgery and medical genetics
Russian Federation, KazanDinara S. Kamalova
Kazan State Medical University
Email: gaifutdinov69@mail.ru
ORCID iD: 0000-0002-3123-9546
neurologist, Central City Clinical Hospital No. 18
Russian Federation, KazanGulnaz A. Fasakhova
Central City Clinical Hospital No. 18
Email: gaifutdinov69@mail.ru
ORCID iD: 0009-0004-4843-6767
Head, Neurology department
Russian Federation, KazanReferences
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Supplementary files
Supplementary Files
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Fig. 1. This is how patient A saw when he fixes his gaze on something.
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Fig. 2. Axial brain FLAIR MRI of Patient A. A: day 1 of hospitalization; a single symmetric hyperintense splenial lesion with relatively smooth and clear contours; B: day 13 of hospitalization; lesion almost completely resolved.
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Fig. 3. ADC Map MRI of Patient A. A: day 1 of hospitalization, low signal intensity in the splenium projection; B: day 13 of hospitalization; average signal intensity in the splenium projection.
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Fig. 4. Sagittal brain FLAIR MRI of рatient A. A: day 1 of hospitalization; hyperintense splenial lesion; B: day 13 of hospitalization, decreased intensity of the lesion.
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