key: cord-0903250-r9mb5zuu authors: Mazrouei, Safaa Saeed Al; Saeed, Ghufran Aref; Al Helali, Abeer Ahmed; Ahmed, Manzoor title: COVID 19 associated encephalopathy: Neurological manifestation of COVID-19 date: 2020-07-07 journal: Radiol Case Rep DOI: 10.1016/j.radcr.2020.07.009 sha: a5e285a758091a34dcb238635558bee8df9f1ddd doc_id: 903250 cord_uid: r9mb5zuu Covid-19 is a viral disease, also known as SARS-Cov-2, was first reported in Wuhan China, December 2019. Respiratory manifestations from the induced acute lung injury were the most common reported findings. Few cases showed extrapulmonary manifestations. Covid-19 associated neurological manifestations have not been widely reported. In this report, we describe a case of encephalopathy in a patient with Covid-19 infection. Abbreviations: SARS-Cov-2, severe acute respiratory syndrome coronavirus 2; COVID-19, coronavirus disease 2019;; RT-PCR, Reverse transcription polymerase chain reaction; ED, emergency department; ICU, intensive care unit; GCS, Glasgow Coma Scale; HRCT, high resolution computed tomography; CT, computed tomography; MRI, magnetic resonance imaging; FLAIR, fluid attenuated inversion recovery; ADC, apparent diffusion coefficient; DWI: diffusion weighted imaging; CNS, central nervous system. showing signal changes of brain parenchyma including bilateral dorsal frontal lobes, insula and thalamus with restricted diffusion involving also globus pallidus. Encephalopathy can be attributed to several causes, though severe infection is a considerable one 11 . Acute necrotizing encephalopathy has been related to influenza virus causing intracranial cytokine storm 5, 7 . Recently, the number of reported cases of COVID 19associated encephalopathy is increasing 9 . Different neurological symptoms can be manifested, and categorized as: 1-central nervous system symptoms such as headache, dizziness, and impaired consciousness, 2-peripheral nervous system symptoms with hypogeusia and hyposmia as examples, and skeletal muscular symptoms 2,4 . Neurological symptoms associate with COVID 19 infection can be due to systemic illness or viral invasion of the CNS 1,6 . Although the exact neuro-invasive potential by which COVID 19 penetrates the central nervous system has not yet been established, two pathways have been suggested: hematogenous spread of the virus to cerebral circulation and neural retrograde dissemination through the cribriform plate and olfactory bulb 6,10,11 . Several studies described the potential effect of the virus to induce disseminated intravascular coagulation and venous thromboembolism as well, causing cerebrovascular manifestations like cerebral thrombosis and hemorrhage 8 . On the other hand, some studies suggested that COVID-19 does not cross the blood-brain barrier and does not cause meningitis or encephalitis 2,3 . Data shows increasing evidence of extra pulmonary manifestations of COVID 19 infection, particularly critical illness-related encephalopathy. Although the definite mechanism is still uncertain, the causation effect should be considered. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy. Cureus Neurologic Features in Severe SARS-CoV-2 Infection Neurological Manifestations of Hospitalized Patients with COVID-19 in Wuhan, China: A Retrospective Case Series Study Rare Encephalopathy Seen in COVID-19 Case COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features Influenza virus associated encephalopathy Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy First Case of Encephalitis Linked to COVID-19 Reported Encephalitis as a clinical manifestation of COVID-19 Encephalopathy in patients with COVID-19: 'Causality or coincidence?