Hemorrhagic encephalopathy associated with COVID-19

Jonathan D Krett; Gordon A E Jewett; Charissa Elton-Lacasse; Kevin Fonseca; Christopher Hahn; Selena Au; Marcus W Koch

doi:10.1016/j.jneuroim.2020.577326

Hemorrhagic encephalopathy associated with COVID-19

J Neuroimmunol. 2020 Jul 14:346:577326. doi: 10.1016/j.jneuroim.2020.577326. Online ahead of print.

Authors

Jonathan D Krett¹, Gordon A E Jewett², Charissa Elton-Lacasse³, Kevin Fonseca⁴, Christopher Hahn², Selena Au³, Marcus W Koch⁵

Affiliations

¹ Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada. Electronic address: jonathan.krett1@ucalgary.ca.
² Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada.
³ Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
⁴ Department of Microbiology, Immunology, and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada.
⁵ Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada.

Abstract

The mechanisms for neurological complications of COVID-19, the disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), are not yet well understood. We present a critically ill man with a COVID-19-associated hemorrhagic encephalopathy. SARS-CoV-2 RNA was not detected in cerebrospinal fluid (CSF) or blood. CSF analyses suggested dysregulation of pro-inflammatory cytokine pathways, particularly tumor necrosis factor-α and interleukin-6, consistent with a cytokine release syndrome. The patient gradually recovered with supportive care and neurological rehabilitation. Awareness of this clinical entity may facilitate the identification of patients with a potentially remediable cause of encephalopathy in COVID-19.

Keywords: COVID-19; Coronavirus; Encephalopathy; Intracerebral hemorrhage; SARS-CoV-2.