Neurological Disorders

The Case of Acute Necrotizing Encephalopathy in an Adolescent with COVID-19

Abstract

Ling Liu, Rong Ou, ZongWen Chen, Wen Zhong and Hongxia Chen*

Introduction: Acute Necrotizing Encephalopathy (ANE) is a rare severe disease with high mortality or severe neurological sequelae characterized by rapid onset of consciousness disturbance and symmetric bilateral thalamic necrosis shown on imaging. To date, there have been limited investigations on SARS-CoV-2-related ANE, mainly in the form of case reports.
Case presentation: A previously healthy 13-year-old girl presented with rapid deterioration of consciousness, status epilepticus, elevated aminotransferase, and symmetrical multi-focal brain lesions on MRI images during the Omicron pandemic. She accepted mechanical ventilation and had a good response to plasma exchange and continuous blood purification, intravenous immunoglobulin and high-dose methylprednisolone.
Conclusion: ANE is a rapidly progressing disease that necessitates prompt detection through a combination of clinical presentation and imaging modalities. It is of paramount importance to enhance the awareness and knowledge of pediatricians regarding SARS-CoV-2-related encephalopathy. Upon diagnosis, treatment with high-dose intravenous methylprednisolone and IVIG should be contemplated. Additionally, plasma exchange and continuous blood purification could help alleviate liver damage in patients with ANE.