The radial linear perivascular emphasis in COVID-19-associated acute disseminated encephalomyelitis (ADEM)

• Published in: Clinical and Experimental Neuroimmunology 2021
• Main Authors: Tanaka, Ryo, Nukui, Takamasa, Ratna Dini Haryuni, Mori, Makoto, Hayashi, Shigeru, Noguchi, Kyo, Nakatsuji, Yuji
• Format: Report
• Language: English
• DOI: 10.1111/cen3.12668

A 62-year-old woman who has a history of chronic hepatitis B and hypertension, presented to a local hospital with cough and fever and was admitted on day 3. Since her chest CT revealed bilateral ground-glass opacities, and SARS-Cov-2 saliva PCR was positive, she was diagnosed with COVID-19 pneumonia and was treated with favipiravir. On day 7, she was in a relatively good condition, as she was afebrile with a little cough. However, on day 18, she became coma which was followed with convulsive seizures, prompting administration of diazepam and levetiracetam. Afterwards, she was then transferred to our hospital, presenting with erythema of the extremities and trunk on admission. Moreover, she was in a coma (GCS 7), with isocoric pupils and normal light reflex. She also did not show meningeal signs, such as nuchal rigidity or Kernig’s sign. The patient’s extremities were flaccid, deep tendon reflexes were increased, and Babinski’s sign was positive.