Indeed, while all patients with anti-LGI-1 related disease experience cognitive impairment, the presence of other features such as seizures, MRI abnormalities and CSF pleocytosis is more variable [11]

Indeed, while all patients with anti-LGI-1 related disease experience cognitive impairment, the presence of other features such as seizures, MRI abnormalities and CSF pleocytosis is more variable [11]. any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as Roburic acid the COVID-19 resource centre remains active. This article has been cited by other articles in PMC. Associated Data Supplementary MaterialsThe following are the supplementary data related to this article.Video 1 Day 7 of illness. There is marked opsoclonus and myoclonus, more prominent on the non-paretic left side. The patient is encephalopathic and unable to speak. mmc1.mp4 (12M) GUID:?3C52D137-C032-4D55-A300-4CE3C8FB640C Video 2 Following a prolonged course of steroids, Roburic acid the patient is able to speak appropriately and easily follows commands. There is now no opsoclonus, and myoclonus is minimal. mmc2.mp4 (9.5M) GUID:?AE7CFDBA-AE51-4441-A94C-A1F889E3DBC8 Dear editor Neurological complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are now well-recognized. Commonly reported syndromes include cerebrovascular disease, encephalopathy, acute disseminated encephalomyelitis, and para/post-infectious encephalitis [1]. Herein, we report a case of post-COVID-19 opsoclonus-myoclonus syndrome and encephalopathy associated with leucine-rich glioma-inactivated 1 (LGI-1) antibodies. 1.?Case report A 50-year-old left-handed male with no significant past medical history presented in RFXAP November 2020 following a large cryptogenic left middle cerebral artery (MCA) territory infarction, later complicated by malignant MCA syndrome requiring hemicraniectomy. He underwent thrombectomy for a distal left M1 occlusion, and thereafter remained on clopidogrel 75?mg daily and atorvastatin 40?mg daily. Following the infarct he Roburic acid had residual right hemiparesis and right homonymous hemianopia, and required rehabilitation. He had been making good progress Roburic acid with therapy, was communicating normally and could tolerate a normal diet. In late January 2021 he was exposed to SARS-CoV-2. Four days later he became febrile (temperature 38.5?C), and SARS-CoV-2 was identified on RT-PCR of a nasopharyngeal swab specimen. On day 5 of his illness he became tachypnoeic (respiratory rate 24/min) and hypoxaemic (oxygen saturations 89%); C-reactive protein was raised at 230?mg/L and lymphocyte count was 0.7??109/L. A CT pulmonary angiogram showed bilateral consolidation and no pulmonary embolism. He was treated with low-flow oxygen, dexamethasone 6?mg daily and piperacillin/tazobactam. On day 7, he developed abnormal eye movements and jerks of the non-paretic left upper and lower limbs. On examination he was confused, distressed and unable to speak or follow commands. Opsoclonus and limb myoclonus was evident (Video 1) and a provisional diagnosis of COVID-19 related encephalitis with opsoclonus-myoclonus syndrome (OMS) was made. He was treated with levetiracetam 750?mg twice daily, clonazepam 1?mg daily and 3?days of intravenous methylprednisolone 1?g daily. Brain MRI showed changes in keeping with prior MCA infarction, with Wallerian degeneration extending into the left internal capsule and brainstem (Fig. 1 ). Cerebrospinal fluid (CSF) was acellular, with protein?=?0.566?g/L (0.15C0.45) and glucose?=?4.3?mmol/L (serum 7.3?mmol/L). CSF PCR was negative for herpes simplex virus, varicella zoster virus, enterovirus and SARS-CoV-2. Antibodies to em N /em -methyl-d-aspartate receptor (NMDA-R), LGI-1 and contactin-associated specific-protein 2 (CASPR-2) were requested on both serum and CSF. Antibodies to gamma-aminobutyric acid-B (GABA-B), alpha-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor 1 and 2, glycine receptor, glutamic acid decarboxylase (GAD), Hu, Yo, Ri and gangliosides were requested on serum. An electroencephalogram showed left frontotemporal slow waves and no epileptiform discharges. CT of the chest, abdomen and pelvis showed no evidence of malignancy. Open in a separate window Fig. 1 MRI brain performed following onset of opsoclonus-myoclonus. Fluid attenuated inversion recovery (FLAIR) sequences in the axial (A-C) and coronal (D) planes show the chronic left MCA territory infarct, with Wallerian degeneration involving the corticospinal tract within the internal capsule and brainstem (arrows). Over the following 11?days, the opsoclonus and myoclonus resolved, and he became able to intermittently follow simple commands. On day 27 however, the opsoclonus and myoclonus recurred, and he became more confused. On the same day,.