A healthy 40-year-old man experienced flu-like symptoms for four days and sought hospital care due to presenting progressive paresthesias in the extremities, mild headache, and visual turbidity. He had used only ivermectin and azithromycin. In the neurological examination, the patient presented a decrease in visual acuity in the left eye. The COVID-19 test using the nasal swab reverse transcription-polymerase chain reaction (RT-PCR) technique was positive. There were no metabolic disorders. The symptoms improved within seven days. Magnetic resonance imaging (MRI) demonstrated an ovoid lesion in the splenium of the corpus callosum with fluid-attenuated inversion recovery (FLAIR) hyperintensity, restricted diffusion and no gadolinium enhancement (Figure 1), which disappeared in a follow-up MRI one month later (Figure 2). Transient lesions of the splenium of the corpus callosum can be caused by other viruses11. Tetsuka S. Reversible lesion in the splenium of the corpus callosum. Brain Behav. 2019 Nov;9(11):e01440. https://doi.org/10.1002/brb3.1440
https://doi.org/https://doi.org/10.1002/...
,22. Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic lesions of the corpus callosum that show restricted diffusion: mechanisms, causes, and manifestations. Radiographics. 2017 Mar;37(2):562-76. https://doi.org/10.1148/rg.2017160085
https://doi.org/https://doi.org/10.1148/...
, but to our knowledge this is the first report of association with COVID-1933. Munhoz RP, Pedroso JL, Nascimento FA, De Almeida SM, Barsottini OGP, Cardoso FEC, Teive HAG. Neurological complications in patients with SARS-CoV-2 infection: a systematic review. Arq Neuropsiquiatr. 2020 May;78(5):290-300. https://doi.org/10.1590/0004-282X20200051
https://doi.org/https://doi.org/10.1590/...
,44. Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G, et al. Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci. 2020 Aug;41(8):2029-31. https://doi.org/10.1007/s10072-020-04525-z.
https://doi.org/https://doi.org/10.1007/...
,55. Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci. 2020 Jul;41(7):1667-71. https://doi.org/10.1007/s10072-020-04486-3.
https://doi.org/https://doi.org/10.1007/...
.
Magnetic resonance imaging demonstrating an ovoid lesion in the splenium of the corpus callosum with fluid-attenuated inversion recovery hyperintensity (A) and restricted diffusion (B, C).
References
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1Tetsuka S. Reversible lesion in the splenium of the corpus callosum. Brain Behav. 2019 Nov;9(11):e01440. https://doi.org/10.1002/brb3.1440
» https://doi.org/https://doi.org/10.1002/brb3.1440 -
2Starkey J, Kobayashi N, Numaguchi Y, Moritani T. Cytotoxic lesions of the corpus callosum that show restricted diffusion: mechanisms, causes, and manifestations. Radiographics. 2017 Mar;37(2):562-76. https://doi.org/10.1148/rg.2017160085
» https://doi.org/https://doi.org/10.1148/rg.2017160085 -
3Munhoz RP, Pedroso JL, Nascimento FA, De Almeida SM, Barsottini OGP, Cardoso FEC, Teive HAG. Neurological complications in patients with SARS-CoV-2 infection: a systematic review. Arq Neuropsiquiatr. 2020 May;78(5):290-300. https://doi.org/10.1590/0004-282X20200051
» https://doi.org/https://doi.org/10.1590/0004-282X20200051 -
4Vacchiano V, Riguzzi P, Volpi L, Tappatà M, Avoni P, Rizzo G, et al. Early neurological manifestations of hospitalized COVID-19 patients. Neurol Sci. 2020 Aug;41(8):2029-31. https://doi.org/10.1007/s10072-020-04525-z.
» https://doi.org/https://doi.org/10.1007/s10072-020-04525-z -
5Niazkar HR, Zibaee B, Nasimi A, Bahri N. The neurological manifestations of COVID-19: a review article. Neurol Sci. 2020 Jul;41(7):1667-71. https://doi.org/10.1007/s10072-020-04486-3.
» https://doi.org/https://doi.org/10.1007/s10072-020-04486-3
Publication Dates
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Publication in this collection
30 Nov 2020 -
Date of issue
Nov 2020
History
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Reviewed
19 Aug 2020 -
Received
09 Sept 2020 -
Accepted
14 Nov 2020