Teaching Neuroimages: COVID-19-Associated Acute Disseminated Encephalomyelitis With Corpus Callosal Hemorrhage

摘要

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). The differential diagnosis of infective splenial lesions is presented (table). 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 2 outcome.