Reversible Intracranial Cytotoxic Edema Associated with COVID-19: A Case Report

Title:Reversible Intracranial Cytotoxic Edema Associated with COVID-19: A Case Report

Volume: 20

Author(s): Güngör Çakmakci*, Mustafa Çeti̇ner, Gönül Akdağ, Fatma Akkoyun Arikan and Sibel Canbaz Kabay

Affiliation:

• Department of Neurology, Faculty of Medicine, Kütahya Health Sciences University, Kütahya, Turkey

Keywords: COVID-19, Delta, Reversible, Cytotoxic edema, Seizure, Magnetic resonance imaging.

Abstract:

Background: It is well-known that COVID-19 causes pneumonia and acute respiratory distress syndrome, as well as pathological neuroradiological imaging findings and various neurological symptoms associated with them. These include a range of neurological diseases, such as acute cerebrovascular diseases, encephalopathy, meningitis, encephalitis, epilepsy, cerebral vein thrombosis, and polyneuropathies. Herein, we report a case of reversible intracranial cytotoxic edema due to COVID-19, who fully recovered clinically and radiologically.

Case Report: A 24-year-old male patient presented with a speech disorder and numbness in his hands and tongue, which developed after flu-like symptoms. An appearance compatible with COVID-19 pneumonia was detected in thorax computed tomography. Delta variant (L452R) was positive in the COVID reverse-transcriptase polymerase chain reaction test (RT-PCR). Cranial radiological imaging revealed intracranial cytotoxic edema, which was thought to be related to COVID-19. Apparent diffusion coefficient (ADC) measurement values in the magnetic resonance imaging (MRI) taken on admission were 228 mm2/sec in the splenium and 151 mm2/sec in the genu. During the follow-up visits of the patient, epileptic seizures developed due to intracranial cytotoxic edema. ADC measurement values in the MRI taken on the 5th day of the patient's symptoms were 232 mm2/sec in the splenium and 153 mm2/sec in the genu. ADC measurement values in the MRI taken on the 15th day were 832 mm2/sec in the splenium and 887 mm2/sec in the genu. He was discharged from the hospital on the 15th day of his complaint with a clinical and radiological complete recovery.

Conclusion: Abnormal neuroimaging findings caused by COVID-19 are quite common. Although not specific to COVID-19, cerebral cytotoxic edema is one of these neuroimaging findings. ADC measurement values are significant for planning follow-up and treatment options. Changes in ADC values in repeated measurements can guide clinicians about the development of suspected cytotoxic lesions. Therefore, clinicians should approach cases of COVID-19 with CNS involvement without extensive systemic involvement with caution.

Cite this article as:

Çakmakci Güngör*, Çeti̇ner Mustafa, Akdağ Gönül, Arikan Akkoyun Fatma and Kabay Canbaz Sibel, Reversible Intracranial Cytotoxic Edema Associated with COVID-19: A Case Report, Current Medical Imaging 2024; 20 : e150523216893 . https://dx.doi.org/10.2174/1573405620666230515090534