Subacute cerebellar ataxia following respiratory symptoms of COVID-19: a case report

Abstract

Background Severe acute respiratory syndrome virus 2 (SARS-CoV-2) is spreading globally and causes most frequently fever and respiratory symptoms, i.e. Coronavirus disease 2019 (COVID-19), however, distinct neurological syndromes associated with SARS-CoV-2 infection have been described. Among SARS-CoV-2-infections-associated neurological symptoms fatigue, headache, dizziness, impaired consciousness and anosmia/ageusia are most frequent, but less frequent neurological deficits such as seizures, Guillain-Barré syndrome or ataxia may also occur. Case presentation Herein we present a case of a 62-year-old man who developed a subacute cerebellar syndrome with limb-, truncal- and gait ataxia and scanning speech 1 day after clinical resolution of symptomatic SARS-CoV-2 infection of the upper airways. Apart from ataxia, there were no signs indicative of opsoclonus myoclonus ataxia syndrome or Miller Fisher syndrome. Cerebral magnetic resonance imaging showed mild cerebellar atrophy. SARS-CoV-2 infection of the cerebellum was excluded by normal cerebrospinal fluid cell counts and, most importantly, absence of SARS-CoV-2 RNA or intrathecal SARS-CoV-2-specific antibody production. Other causes of ataxia such as other viral infections, other autoimmune and/or paraneoplastic diseases or intoxication were ruled out. The neurological deficits improved rapidly after high-dose methylprednisolone therapy. Conclusions The laboratory and clinical findings as well as the marked improvement after high-dose methylprednisolone therapy suggest a post-infectious, immune-mediated cause of ataxia. This report should make clinicians aware to consider SARS-CoV-2 infection as a potential cause of post-infectious neurological deficits with an atypical clinical presentation and to consider high-dose corticosteroid treatment in case that a post-infectious immune-mediated mechanism is assumed.

Acute post‐infection cerebellar ataxia following SARS‐CoV‐2 infection: A case report

“…But evidence suggests, according to the onset of neurological manifestations after recovery from COVID‐19 contamination and the perfect response of these symptoms to immunotherapy, this phenomenon can be immune‐mediated 6 . Thus, coronavirus probably activates excessive immune system with cytokine storm, or cause immune response cross‐reactive to cerebellar autoantigen to hurt cerebellum 8 . Consequently, these neurological disorders occur even after recovery from COVID‐19 infection, and they can be treated with immunological medications such as steroids.…”

“…Even though ataxia following SARS‐CoV‐2 infection is reported in adults, 6 , 7 , 8 there are just two case reports of APCA after COVID‐19 before age 18. 9 , 10 Ataxia is usually a cerebellar disorder with an acute or chronic presentation.…”

“…However, these children are at risk of developing seizures, meningeal signs, and encephalopathy, with variable severity. 1 There are also some reports of children with encephalitis 2,3 and acute disseminated encephalomyelitis (ADEM) 4,5 post-COVID-19 infection.Even though ataxia following SARS-CoV-2 infection is reported in adults, [6][7][8] there are just two case reports of APCA after COVID-19 before age 18. 9,10 Ataxia is usually a cerebellar disorder with an acute or chronic presentation.…”

2 Years into the Pandemic: What Did We Learn About the COVID-19 and Cerebellum?

“…Post-COVID cerebellar ataxia was described in one patient who had appendicular and trunk ataxia along with dysarthria 1 day after the resolution of respiratory symptoms [24]. MRI revealed mild cerebellar atrophy.…”

Post‐infectious cerebellar ataxia following COVID‐19 in a patient with epilepsy

“… 2 But ataxia as a post‐COVID‐19 manifestation has rarely been described (<1% of patients). 3 These include acute cerebellar ataxia, ataxia due to Miller Fisher syndrome, opsoclonus myoclonus ataxia syndrome, and ataxia associated with encephalopathy as described in the literature. 4 We describe a very unusual case of a 70‐year‐old man with known epilepsy who developed cerebellar ataxia 5 weeks after documented SARS‐CoV‐2 infection.…”