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The symptoms of COVID-19 include fever, fatigue and respiratory illness ranging from cough to acute respiratory distress syndrome (ARDS).1 Neurological complications, such encephalopathy, are more and more reported. They can result from direct viral invasion, hypoxic, toxic or immune-mediated injury. In this report, we describe a patient with posterior reversible encephalopathy syndrome (PRES) associated with SARS-CoV-2 infection.
The patient is a 69-year-old woman, with history of coronary artery disease, an endometrial cancer, in remission since 2006 and a right breast cancer without anticancer treatment and in remission since 2018, and no history of hypertension. She presented to the stroke unit, in the end of March 2020, few days before the epidemic peak in France, for three generalised seizures, mutism and delirium, and 7 days’ history of unusual asthenia. Temperature was 37°C, blood pressure at 200/116 mm Hg and oxygen saturation was 95% while she was breathing ambient air. The pulmonary examination was normal. Neurological examination found no focal motor or sensor deficit. Brain MRI, performed 5 hours after the onset of seizures, showed bilateral and symmetric T2 and fluid-attenuated inversion recovery imaging hyperintensities located mainly in the temporal and occipital lobes with increased apparent diffusion coefficient values and leptomeningeal enhancement in the same areas in 3D T1 gadolinium sequence (figure 1). There were no signs of intracranial haemorrhage in susceptibility weighted imaging (images not shown). The vessel’s imaging was normal. The electroencephalogram showed intermittent focal slow delta waves in posterior …
Contributors AD, HH and LS contributed to the conception of the work, the acquisition, analysis and interpretation of data. AD and HH revised the original form critically for important intellectual content and provided responses to reviewers’ comments. AD had a substantial contribution to drafting the work and worked out all the revised form. HH supervised the original manuscript and revised form. SC and LCL contributed to reviewing the original manuscript. Our acknowledgements to all the people who have contributed to the care of our patient.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Parental/guardian consent obtained.
Provenance and peer review Not commissioned; externally peer reviewed.