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COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report

BACKGROUND: Several cases of coronavirus disease 2019 (COVID-19)-associated leukoencephalopathy have been reported. Although most cases involve hypoxia, the pathophysiological mechanism and neurologic outcomes of COVID-19-associated leukoencephalopathy remain unclear. CASE PRESENTATION: We report a...

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Autores principales: Kojima, Hiroki, Sakamoto, Naoya, Kosaka, Atsushi, Kobayashi, Masayoshi, Amemiya, Mitsuo, Washino, Takuya, Kuwahara, Yusuke, Ishida, Takuto, Hikone, Mayu, Miike, Satoshi, Oyabu, Tatsunori, Iwabuchi, Sentaro, Nakamura-Uchiyama, Fukumi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086412/
https://www.ncbi.nlm.nih.gov/pubmed/35538434
http://dx.doi.org/10.1186/s12879-022-07426-y
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author Kojima, Hiroki
Sakamoto, Naoya
Kosaka, Atsushi
Kobayashi, Masayoshi
Amemiya, Mitsuo
Washino, Takuya
Kuwahara, Yusuke
Ishida, Takuto
Hikone, Mayu
Miike, Satoshi
Oyabu, Tatsunori
Iwabuchi, Sentaro
Nakamura-Uchiyama, Fukumi
author_facet Kojima, Hiroki
Sakamoto, Naoya
Kosaka, Atsushi
Kobayashi, Masayoshi
Amemiya, Mitsuo
Washino, Takuya
Kuwahara, Yusuke
Ishida, Takuto
Hikone, Mayu
Miike, Satoshi
Oyabu, Tatsunori
Iwabuchi, Sentaro
Nakamura-Uchiyama, Fukumi
author_sort Kojima, Hiroki
collection PubMed
description BACKGROUND: Several cases of coronavirus disease 2019 (COVID-19)-associated leukoencephalopathy have been reported. Although most cases involve hypoxia, the pathophysiological mechanism and neurologic outcomes of COVID-19-associated leukoencephalopathy remain unclear. CASE PRESENTATION: We report a case of COVID-19-associated leukoencephalopathy without severe hypoxia in a 65-year-old woman diagnosed with pyelonephritis. After the initiation of intravenous ceftriaxone, her fever resolved, but she developed an altered state of consciousness with abnormal behavior and, subsequently, a relapse fever. She was diagnosed with COVID-19 pneumonia and was intubated. Lung-protective ventilation with deep sedation and neuromuscular blockade were used for treatment. After cessation of sedative administration, her mental status remained at a Glasgow Coma Scale score of 3. COVID-19 was assumed to have caused leukoencephalopathy due to the absence of severe hypoxia or other potential causes. She subsequently showed gradual neurologic improvement. Three months after the COVID-19 diagnosis, she regained alertness, with a Glasgow Coma Scale score of 15. CONCLUSION: Clinicians should consider leukoencephalopathy in the differential diagnosis of consciousness disorders in patients with severe COVID-19, even in the absence of severe hypoxia. Gradual neurologic improvement can be expected in such cases.
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spelling pubmed-90864122022-05-10 COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report Kojima, Hiroki Sakamoto, Naoya Kosaka, Atsushi Kobayashi, Masayoshi Amemiya, Mitsuo Washino, Takuya Kuwahara, Yusuke Ishida, Takuto Hikone, Mayu Miike, Satoshi Oyabu, Tatsunori Iwabuchi, Sentaro Nakamura-Uchiyama, Fukumi BMC Infect Dis Case Report BACKGROUND: Several cases of coronavirus disease 2019 (COVID-19)-associated leukoencephalopathy have been reported. Although most cases involve hypoxia, the pathophysiological mechanism and neurologic outcomes of COVID-19-associated leukoencephalopathy remain unclear. CASE PRESENTATION: We report a case of COVID-19-associated leukoencephalopathy without severe hypoxia in a 65-year-old woman diagnosed with pyelonephritis. After the initiation of intravenous ceftriaxone, her fever resolved, but she developed an altered state of consciousness with abnormal behavior and, subsequently, a relapse fever. She was diagnosed with COVID-19 pneumonia and was intubated. Lung-protective ventilation with deep sedation and neuromuscular blockade were used for treatment. After cessation of sedative administration, her mental status remained at a Glasgow Coma Scale score of 3. COVID-19 was assumed to have caused leukoencephalopathy due to the absence of severe hypoxia or other potential causes. She subsequently showed gradual neurologic improvement. Three months after the COVID-19 diagnosis, she regained alertness, with a Glasgow Coma Scale score of 15. CONCLUSION: Clinicians should consider leukoencephalopathy in the differential diagnosis of consciousness disorders in patients with severe COVID-19, even in the absence of severe hypoxia. Gradual neurologic improvement can be expected in such cases. BioMed Central 2022-05-10 /pmc/articles/PMC9086412/ /pubmed/35538434 http://dx.doi.org/10.1186/s12879-022-07426-y Text en © The Author(s) 2022 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Case Report
Kojima, Hiroki
Sakamoto, Naoya
Kosaka, Atsushi
Kobayashi, Masayoshi
Amemiya, Mitsuo
Washino, Takuya
Kuwahara, Yusuke
Ishida, Takuto
Hikone, Mayu
Miike, Satoshi
Oyabu, Tatsunori
Iwabuchi, Sentaro
Nakamura-Uchiyama, Fukumi
COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
title COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
title_full COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
title_fullStr COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
title_full_unstemmed COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
title_short COVID-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
title_sort covid-19-associated leukoencephalopathy in the absence of severe hypoxia with subsequent improvement: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9086412/
https://www.ncbi.nlm.nih.gov/pubmed/35538434
http://dx.doi.org/10.1186/s12879-022-07426-y
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