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VOLUME 24 , ISSUE 10 ( October, 2020 ) > List of Articles
Subhash Kumar, Binod K Pati, Chandramani Singh, Asim Sarfraz
Keywords : Acute necrotizing encephalitis, Altered sensorium, Computed tomography, COVID case report, Coronavirus disease 2019 in India, Encephalopathy, Magnetic resonance imaging
Citation Information : Kumar S, Pati BK, Singh C, Sarfraz A. Acute Necrotizing Encephalitis as a Probable Association of COVID-19. Indian J Crit Care Med 2020; 24 (10):991-994.
License: CC BY-NC 4.0
Published Online: 30-10-2020
Copyright Statement: Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.
Background: Meanwhile, over 50 lakh people have now been affected by coronavirus disease 2019 (COVID-19) across the globe. There are various reports on neurological manifestations of COVID-19, which have attracted broad attention. Acute necrotizing encephalopathy (ANE) is a rare complication of influenza and other viral infections and has been related to intracranial cytokine storm, which results in breach in blood–brain barrier leading to encephalitis like presentation. We report an unusual case of acute necrotizing encephalitis as a solitary presentation of COVID-19. Case description: We report a case of 35-year-old man from Bihar, presented to our emergency department in unconscious state, with high-grade fever and vomiting since last 5 days. Previous magnetic resonance imaging (MRI) brain showed a left parasellar-middle cranial fossa mass looks most likely like an invasive meningioma. Urgent non contrast computed tomography scan (NCCT) brain showed that mass as well as hypodensities in both thalami and left caudate nucleus. As per our institutional protocol, clinical management of raised intracranial pressure was initiated. As there is no current evidence from any randomized control trails (RCTs) to recommend any specific treatment for suspected or confirmed patients with COVID-19 with acute necrotizing encephalitis. Conclusion: Our case highlights the importance of identifying encephalitis as a presenting sign of COVID-19 based on NCCT findings with normal cerebrospinal fluid (CSF) and normal chest X-ray (CXR) findings.
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