Back to Search Start Over

Translocator protein (TSPO)-PET as diagnostic and monitoring tool in COVID-19 related MRI-negative brainstem encephalitis: a case report

Authors :
Johannes Wischmann
Laura M. Bartos
Matthias Brendel
Nathalie L. Albert
Robert Forbrig
Andreas Straube
Ilias Masouris
Source :
Journal of Neurology. 270:2853-2856
Publication Year :
2023
Publisher :
Springer Science and Business Media LLC, 2023.

Abstract

Background Encephalitis and myelitis have been linked to both COVID-19 vaccination and infection, causing symptoms such as reduced consciousness, mental state alterations and seizures. Remarkably, most cases do not show significant structural alterations on MRI scans, which poses a diagnostic challenge. Methods We present the diagnostic workup and clinical course of a patient who developed a progressive brainstem syndrome two weeks after COVID-19 vaccination and subsequent infection. We used translocator protein (TSPO)-PET scans for the first time to investigate COVID-related neuroinflammation. Results The patient developed oculomotor disorder, dysarthria, paresthesia in all distal limbs and spastic-atactic gait. CSF analysis revealed mild lymphocytic pleocytosis with normal protein levels. Brain and spinal cord MRI scans were negative, but TSPO/PET scans showed increased microglia activity in the brainstem, which correlated with the clinical course. Steroid treatment led to clinical improvement, but relapse occurred during prednisone taper after four weeks. Plasmapheresis had no significant effect; however, complete remission was achieved with cyclophosphamide and methotrexate, with normal TSPO signal ten months after onset. Conclusions TSPO-PET can be a valuable tool in the diagnostic and therapeutic monitoring of COVID-19-related encephalitis, particularly in cases where MRI scans are negative. Aggressive immunosuppressive therapy can lead to sustained remission.

Subjects

Subjects :
Neurology
Neurology (clinical)

Details

ISSN :
14321459 and 03405354
Volume :
270
Database :
OpenAIRE
Journal :
Journal of Neurology
Accession number :
edsair.doi...........91025ac12d3a7af6337599ac7ae65b23