Mild Encephalopathy with Reversible Splenium Lesion Associated with SARS-CoV-2 Infection
Background:
Encephalopathy secondary to SARS-CoV-2 infection has been previously reported, although neuroimaging in many of these patients is typically unremarkable. There are only a few reported cases of patients with SARS-CoV-2 infection associated with mild encephalopathy with a reversible splenial lesion (MERS) on imaging. MERS has a monophasic course of encephalopathy, marginal pleocytosis in the cerebrospinal fluid, and a characteristic MRI finding of a reversible lesion in the splenium of the corpus callosum.
Results:
A 68-year-old woman presented to the hospital with altered mental status. The patient was found unresponsive during a welfare check at home. Initial neurological evaluation revealed that the patient was awake, alert, and oriented to name and age but not date and time. Speech was fluent with intact naming, repetition, and comprehension. Polymerase chain reaction for SARS-CoV-2 was positive, and history revealed that patient was not vaccinated. CT of the head was unrevealing. MRI of the brain revealed increased signal in the corpus callosum on FLAIR with low diffusivity on diffusion-weighted imaging. The patient was given tocilizumab, dexamethasone, remdesivir, and ceftriaxone to treat superimposed bacterial pneumonia. Encephalopathy improved gradually throughout the hospital course, and the patient was transitioned to an inpatient rehabilitation facility. Repeat brain MRI five weeks from initial imaging showed resolution of the hyperintensity and focus of low diffusivity in the splenium.
Conclusions:
This is a rare case of MERS triggered by SARS-CoV-2 in a patient who presented with encephalopathy. This case expands the clinical spectrum of neurological manifestations associated with SARS-CoV-2 and adds to the already existing literature. Further investigation is imperative for a better understanding of the pathophysiology and management of this entity to avoid unnecessary invasive diagnostic and therapeutic interventions.