COVID-19 News: UK Doctors Publish COVID-19 Case Report Showing SARS-CoV-2 Causing Drastic Cortical Damage In 17 year Old Patient!

COVID-19 News: Doctors and researchers from the pediatric neurology department, Royal London Hospital, Barts Health NHS Trust, Whitechapel-UK have published a new COVID-19 case report in the peer reviewed European Journal of Epilepsy, the Seizure, detailing an alarming  documented case of a patient suffering cortical damage as a result of a SARS-CoV-2 infection.


 
The case report by the team describes the condition of a 17-year old female with Cornelia de Lange syndrome and well controlled epilepsy, who sustained significant cortical injury during a COVID-19 associated multi-inflammatory syndrome.
https://www.seizure-journal.com/article/S1059-1311(20)30362-9/fulltext#%20
 
The current COVID-19 pandemic that started in China and spread across the world has now infected more than 69.1 million people globally and have resulted in the deaths of more than 1.57 million humans.
 
Every day there are new data and knowledge emerging through thousands of studies about the pathogenesis of the disease and also about the virus and factors that play a role in the disease progression.
 
Initially it was known that the COVID-19 disease causes problems with the respiratory tract and also gastrointestinal issues with typical symptoms like fever, cough, tiredness, shortness of breath, and in some cases, diarrhea.
 
However there is now increasing evidence of neurological manifestations that are associated with COVID-19 worldwide.
 
In one study it was reported that 7% of hospitalized patients in Wuhan, China and 69% of intensive care patients in France had developed encephalopathy. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(20)30221-0/fulltext
 
Many new case reports describe new-onset seizures in COVID-19, particularly in severe forms of the infection. Most of these report brief and self-limiting seizures in children, the impact of which seems to have been limited.
 
However in contrast, this case report case shows distinct seizures, caused most likely by severe systemic inflammation.
 
The study team reports a case of a 17-year-old female who sustained a significant cortical injury during COVID-19-associated multi-inflammatory syndrome.
 
The COVID-19 patient, a 17-year-old female had Cornelia de Lange syndrome and well-controlled epilepsy with infrequent brief tonic-clonic seizures.
 
Typically Cornelia de Lange syndrome is a genetic condition that leads to moderate to severe developmental growth disability.
 
In this case report, the study team believe that the neuro-disability was likely a contributing factor to the severity of the COVID-19. Prior to the 17-year-old’s COVID-19 symptoms, she was able to mobilize by shuffling her body from her seated position and communicate her needs non-verbally. The complete medical description of her condition is presented in the report
 
However when she had a cough, fever, and difficulty in breathing, she also developed sign s of medical distress. She was intubated and transferred to the pediatric critical care unit. With high signs of sepsis, the respiratory secretions were positive for SARS-CoV-2, Influenza-b, and Pseudomonas aeruginosa.
 
Due to an increasing oxygen requirement she was initially started on high flow oxygen but continued to require FiO2 80 % to maintain SaO2 above 94 %. In view of her work of breathing and oxygen requirement a decision was made to intubate and transfer to the pediatric critical care unit. She showed signs of sepsis (spiking fevers, HR 120−130bpm, BP systolic 120 mmHg, capillary refill time <2 s). Her bloods showed CRP 275 mg/L, ferritin 2091 microgram/liter, deranged clotting (PT 13.4 s, INR 1.3, APTT 38 s, fibrinogen 3.75 g/L) and bone marrow failure (Hb 73 g/L, plt 51 × 10ᴧ9/L, WCC 2.7 × 10ᴧ9/L). A chest x-ray showed bilateral hilar consolidation.


Serial contrast enhanced MRI brain performed prior to illness and at 3 time points during current illness. Previous MRI f: supra- and infra-tentorial neuroparenchymal volume loss (arrows).Initial MRI(a, d, e,) multifocal areas cortical swelling in both cerebral hemispheres.(b) abnormal signal change in the thalami (arrow).(d,e) mild restricted diffusion.(c) There were no microhaemorrhages on SWI sequence.Repeat MRI performed 7 days later. FLAIR and DWI sequences (g-h) demonstrated similar areas of cortical signal change and signal change in the thalami (i). Normal appearances of the spinal cord (images not shown).Follow up MRI performed 23 days later. k: reduced signal change in the cortices and thalami with volume loss and high T1 signal in some of the affected cortices suggestive of laminar necrosis (arrow).There is increased widening of the sulci and enlargement of ventricles indicating interval parenchymal volume loss (l).

Even with persistent fevers, her condition improved and she was extubated on day 20.
 
But, she suffered a sudden respiratory deterioration requiring re-intubation. Her inflammatory markers increased significantly. Going from CRP 127 to CRP 345 mg/liter (the C-reactive protein levels), her condition fulfilled the criteria for Paediatric Multi-Inflammatory Syndrome temporally related to COVID (PIMS-TS).
 
Repeat testing showed that she was negative for bacterial and viral screening.
 
The patient had episodes of tachycardia and tachypnoea. EEG observations showed seizure activity was distinct to the patient’s usual epileptic seizures.
 
A detailed time-dependent brain MRI before illness, during illness, repeat, and follow-up showed widespread bilateral cortical, cerebellar and thalamic signal change and swelling; persistent multifocal areas of neuroparenchymal signal change; and evolving laminar necrosis in the areas previously affected. Further episodes of suspected seizures persisted intermittently.
 
The study team hypothesized that severe systemic inflammation has played a key role in exacerbating both her epilepsy and the resulting brain injury as the pattern of injury was not typical of that seen in uncontrolled status epilepticus.
 
Presently, seven months into her illness, she is tracheostomy-ventilated and undergoing long-term neurorehabilitation.
 
The study team reports she can respond consistently to environmental cues, though she remains well below her prior functional level.
 
Possibilities of SARS-CoV-2 coronavirus-induced neuropathology caused by misdirected host immune response have been postulated. Many studies show that COVID-19 patients in ICU develop neurological symptoms.
 
The COVID-19 is reported to cause neurological symptoms in only 36% of the infected cases. However seizures and cortical injury are rarely associated with COVID-19.
 
The study team claims that this is the first case report showing this pattern of evolving cortical brain damage in association with late-onset seizures and PIMS-TS.
 
This is a significant case report where the researchers describe the case of a 17-year-old female with Cornelia de Lange syndrome and well-controlled epilepsy with a sustained significant cortical injury during a COVID-19 associated multi-inflammatory syndrome.
 
The study team warns that early recognition and treatment of seizures in children with COVID-19 and PIMS-TS may be important to minimize damage and optimize outcomes.
 
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