Το μεταφράζω στα Αγγλικά από το εβδομαδιαίο Σουηδικό Ιατρικό Περιοδικό Läkartidningen.20 July 2021, Läkartidningen.
Janet L Cunningham, Associate Professor, Psychiatrist, Academic Hospital; Department of Neuroscience, Uppsala University.Self-report. We have recently described a case of acute catatonia with excitatory symptoms, which developed within 24 hours into malignant catatonia with autonomic instability, in a previously healthy man a few days after he recovered from PCR-verified sars-cov-2 infection [1] .
The patient developed an autoimmune encephalitis a few days after mild covid-19 with respiratory symptoms subsided. This was manifested as malignant catatonia - a life-threatening condition. DT and MRI examinations of the brain were normal, EEG showed general slowing with a slow basic rhythm and focal slowing frontotemporally on the left side. Cerebrospinal fluid analysis gave only subtle indications of inflammation. PET with fluoro-18-fluorodeoxyglucose (FDG) showed high striatum uptake bilaterally compared to cortex. Indirect immunohistochemical staining with the patient's cerebrospinal fluid cerebrospinal fluid revealed the presence of autoantibodies to neuronal structures in the hippocampus, thalamus, striatum, and cortex. Autonomic instability included elevated temperature, recurrent episodes of fluctuating heart rate and arterial blood pressure, and short periods of decreased oxygen saturation. Early treatment with plasmapheresis and corticosteroid reversed disease progression and may have prevented neurological damage to a greater extent. At follow-up examinations, a relatively lower T2 signal was seen in the striatum and a normalization of FDG uptake.
Katatoni med excitatoriska symtom betraktas som en allvarlig form i katatonispektrumet, men är kanske mindre igenkänd än den typiska formen med orörlighet, vaxartad flexibilitet och mutism. En genomgång av litteraturen i Lancet Psychiatry 2019 identifierade 124 fall av katatoni i samband med infektioner, där 38 procent var virala. I 45 av 47 sådana fall hade de identifierade virusen neurotropa egenskaper. Katatoni kan förekomma hos patienter utan psykiatrisk historia och förekommer samtidigt med flera autoimmuna tillstånd, särskilt NMDA-receptorencefalit. I det aktuella patientfallet är de immunhistokemiska analyserna, den kliniska bilden och radiologin kongruenta med ett synaptiskt mål som är rikligt förekommande i striatum, där bindning resulterar i ett ökat excitationstillstånd. Möjliga mekanismer innefattar disinhibition eller aktivering av excitatoriska receptorer samt störning av excitatoriskt neurotransmittorupptag eller interferens med jonhomeostasen.
Our latest results indicate that sars-cov-2 is another neurotropic virus that can stimulate autoimmunity against the brain, which can manifest itself in mental symptoms. We have also detected IgG antibodies to spike protein in cerebrospinal fluid in several of these cases [2]. Symptoms such as agitation, changes in behavior and speech, and autonomic instability should be considered as a potential autoimmune manifestation of covid-19 or other neurotropic virus. Prodromal symptoms of infection, although mild and diminished, may be relevant for diagnosis
References:
1) Mulder J, et al. Am J Psychiatry. 2021;178 (6):485-9.
2) Cunningham JL, et al. J Infect Dis. Epub 21 mar 2021. doi: 10.1093/infdis/jiab153.
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Θέμα: Κορονοϊός ( COVID-19 ) (Αναγνώστηκε 305278 φορές)
24 Απριλίου 2020, 01:44:56