| | | The coronavirus disease 2019 (COVID-19) pandemic is caused by the SARS-CoV-2 coronavirus, which is transmitted from human to human through respiratory droplets.
Per our understanding as of July 2020, the inhaled virus attaches primarily to angiotensin-converting enzyme 2 (ACE2) receptors (although other receptors likely also play a role), which is followed by intracellular penetration, replication, maturation, and finally release. The ACE2 receptor expression is high in the lungs, heart, blood vessels, ileum, kidney, and bladder but is also present in other tissues, including the brain. In addition, the coronavirus infection elicits a strong immune reaction called cytokine storm, which may damage multiple organ systems. Thus, although pneumonia is the most common manifestation, COVID-19 commonly results in multisystemic involvement, which is not completely understood and remains under active investigation.
Documented neurological sequelae of COVID-19 include thromboembolic infarct and leukoencephalopathy. Leukoencephalopathies are a group of white matter disorders, frequently divided into inherited and acquired categories, with the latter including infectious, inflammatory, toxic-metabolic, hypoxic-ischemic, and traumatic etiologies. Although the exact mechanism is unclear, COVID-19 leukoencephalopathy is thought to be most likely due to the cytokine storm–related immunological damage to the white matter (either directly or through a small vessel endotheliitis) and less likely from direct viral infection, since the ACE2-receptor expression is relatively low in the brain. In severe cases acute demyelinating encephalomyelitis and acute hemorrhagic encephalomyelitis develop with multiple reports of severe hemorrhage.
In the current case, the patient with COVID-19 pneumonitis/acute respiratory distress syndrome was found to have profound altered mental status. Although the presentation/findings are nonspecific, eventually the diagnosis of COVID-19 leukoencephalopathy was made by likelihood and exclusion. The patient did not recover. COVID-19 leukoencephalopathy is an important differential diagnosis in COVID-19–positive patients with altered mental status or neurological deficits.
IT's NO HOAX |
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