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Postinfectious brainstem encephalitis associated with SARS-CoV-2
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  1. Anthony Khoo1,
  2. Benjamin McLoughlin1,
  3. Sanjay Cheema1,
  4. Rimona S Weil1,2,
  5. Christian Lambert1,
  6. Hadi Manji1,
  7. Michael S Zandi1,3,
  8. Jasper M Morrow1
  1. 1 Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
  2. 2 Dementia Research Centre, University College London, London, UK
  3. 3 Queen Square Institute of Neurology, University College London, London, UK
  1. Correspondence to Dr Anthony Khoo, Department of Neurology, University College London Hospitals NHS Foundation Trust National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, UK; anthony.khoo{at}sa.gov.au

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Introduction

Immune-mediated neurological sequelae following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are becoming increasingly evident, and can affect both the peripheral and central nervous system.1 2 We report a postinfectious brainstem syndrome in a patient with COVID-19 who presented with generalised myoclonus, ocular flutter with convergence spasm and acquired hyperekplexia. Clinical improvement was seen following corticosteroids, highlighting this as a possible treatment in patients where a post-COVID-19 autoimmune encephalitis is suspected.

Case presentation

A 65-year-old woman presented with a 1-week history of widespread involuntary movements, diplopia and cognitive decline having experienced fever, cough and myalgias the week before.

She had a medical history of presumed Alzheimer’s disease, osteoarthritis and gastro-oesophageal reflex disease. The diagnosis of Alzheimer’s disease had been made 3 years earlier on the basis of a 12-month history of amnestic symptoms including repetitive questioning and navigational difficulties. At her functional baseline, she could mobilise unaided, leave the house independently and wash without assistance. She was fluent in English, but her native language was Arabic. Mini-Mental State Examination score 8 months prior to presentation was 20/24. Regular medications included a rivastigmine patch 4.6 mg/24 hours, omeprazole and solifenacin.

Collateral information from her son reported that 2 weeks prior to presentation she had developed non-productive cough, fever and myalgias. She had also experienced 2 days of diarrhoea which spontaneously resolved. Her son suffered from similar symptoms …

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