A 55-year-old man with severe coronavirus disease 2019 (COVID-19) required ventilation and hemofiltration. Central venous catheter thrombosis necessitated heparin infusion. On day 20 postadmission, impaired conscious level, complex ophthalmoplegia, and hyperreflexia prompted noncontrast neuroimaging, demonstrating corpus callosal and right subinsular hemorrhage with diffuse white matter signal change (figure). CSF analysis was not performed due to clinical concerns regarding raised intracranial pressure. Administration of high-dose corticosteroids led to clinical and radiologic improvement (figure).
Initial MRI and CT with arrows highlighting peripheral low signal on T2* (A), abnormal diffusion (B), high T1 (C), and increased attenuation (D) within the corpus callosum splenium. Confluent high FLAIR (E) and T2 (F and G) abnormality and low attenuation (H) are noted within the deep cerebral white matter. Improved appearances at 2 weeks are seen (I–L).
The differential diagnosis of infective splenial lesions is presented (table).1 We consider the likely diagnosis to be acute disseminated encephalomyelitis with hemorrhage, adding to the clinical spectrum of neurologic complications of COVID-19 and highlighting the possibility of favorable outcome.2
Differential Diagnosis for Infective splenial Lesions
Study Funding
No targeted funding reported.
Disclosure
The authors report no disclosures relevant to the manuscript. Go to Neurology.org/N for full disclosures.
Appendix Authors
Footnotes
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
↵* These authors contributed equally to this work.
Teaching slides links.lww.com/WNL/B251
- © 2020 American Academy of Neurology
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