RESUMEN
Coronavirus disease 2019 (COVID-19) infection has the potential for targeting the central nervous system, and several neurological symptoms have been described in patients with severe respiratory distress. Here, we described the case of a 60-year-old patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but only mild respiratory abnormalities who developed an akinetic mutism attributable to encephalitis. Magnetic resonance imaging was negative, whereas electroencephalography showed generalized theta slowing. Cerebrospinal fluid analyses during the acute stage were negative for SARS-CoV-2, positive for pleocytosis and hyperproteinorrachia, and showed increased interleukin-8 and tumor necrosis factor-α concentrations. Other infectious or autoimmune disorders were excluded. A progressive clinical improvement along with a reduction of cerebrospinal fluid parameters was observed after high-dose steroid treatment, thus arguing for an inflammatory-mediated brain involvement related to COVID-19. ANN NEUROL 2020;88:423-427.
Asunto(s)
Mutismo Acinético/fisiopatología , Antivirales/uso terapéutico , Infecciones por Coronavirus/tratamiento farmacológico , Encefalitis/tratamiento farmacológico , Glucocorticoides/uso terapéutico , Metilprednisolona/uso terapéutico , Neumonía Viral/tratamiento farmacológico , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/líquido cefalorraquídeo , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Combinación de Medicamentos , Electroencefalografía , Encefalitis/líquido cefalorraquídeo , Encefalitis/complicaciones , Encefalitis/fisiopatología , Humanos , Hidroxicloroquina/uso terapéutico , Interleucina-6/líquido cefalorraquídeo , Interleucina-8/líquido cefalorraquídeo , Lopinavir/uso terapéutico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/líquido cefalorraquídeo , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Ritonavir/uso terapéutico , SARS-CoV-2 , Resultado del Tratamiento , Factor de Necrosis Tumoral alfa/líquido cefalorraquídeo , Microglobulina beta-2/líquido cefalorraquídeo , Tratamiento Farmacológico de COVID-19RESUMEN
INTRODUCTION: neurofilament light chain (NfL) levels have been proposed as reliable biomarkers of neurodegeneration in Parkinson's disease (PD) but the relationship between plasma NfL, clinical subtypes of PD and motor progression is still debated. METHODS: plasma NfL concentration was measured in 45 healthy controls and consecutive 92 PD patients who underwent an extensive motor and non-motor assessment at baseline and after 2 years of follow-up. PD malignant phenotype was defined as the combination of at least two out of cognitive impairment, orthostatic hypotension and REM sleep behavior disorder. PD patients were divided according to the age-adjusted cut-offs of plasma NfL levels into high and normal NfL (H-NfL and N-NfL, respectively). A multivariable linear regression model was used to assess the value of plasma NfL as predictor of 2-years progression in PD. RESULTS: NfL was higher in PD patients than in controls (p = 0.037). H-NfL (n = 16) group exhibited more severe motor and non-motor symptoms, higher prevalence of malignant phenotype and worse motor progression (MDS-UPDRS-III 11.3 vs 0.7 points, p = 0.003) compared to N-NfL group (n = 76). In linear regression analyses plasma NfL emerged as the best predictor of 2-year motor progression compared to age, sex, disease duration, baseline motor/non-motor variables. CONCLUSION: increased plasma NfL concentration is associated with malignant PD phenotype and faster motor progression. These findings support the role of NfL assessment as a useful measure for stratifying patients with different baseline slopes of decline in future clinical trials of putative disease-modifying treatments.