Pearls & Oy-sters: Bilateral globus pallidus lesions in a patient with COVID-19
Catherine V. Kulick‐Soper, Jillian L. McKee, Ronald L. Wolf, Suyash Mohan, Joel M. Stein, Jonathan Masur, Jillian W. Lazor, D.G. Dunlap, John E. McGinniss, Michael David, Ross N. England, Aaron Rothstein, Michael Gelfand, Brett Cucchiara, Kathryn A. Davis
Abstract
Neurologic complications are occurring in coronavirus disease 2019 (COVID-19), and these patients should be monitored for neurologic symptoms.c When evaluating abnormal imaging findings in patients with COVID-19, the presence and specific pattern of deep gray structure involvement can be an important clue to etiology. Oy-sters cBrain imaging should be considered in the context of patients with COVID-19 with neurologic symptoms, even in the absence of focal findings on neurologic examination.c Given the dissociation between degree of hypoxemia and clinical symptoms that can be seen in patients with COVID-19, it is possible that unusual presentations of hypoxicischemic brain injury may emerge.COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was originally described as a viral infection primarily affecting the respiratory tract.Neurologic complications are emerging, and have been reported in 36% of patients hospitalized with COVID-19 and in 46% of those with severe respiratory involvement. 1 The most common neurologic manifestations reported are dizziness, headache, impaired consciousness, dysgeusia, and hyposmia.An increased risk of stroke has also been identified.We report the case of a 52-year-old woman with bilateral globus pallidus lesions in the setting of COVID-19.The patient had a history of hypertension and newly diagnosed, poorly controlled type II diabetes mellitus (hemoglobin A1c of 17.4).She developed bilateral hand paresthesias the week prior to presentation, followed by dyspnea, cough, headache, and confusion.She presented to the emergency department and was afebrile, but tachycardic (115 beats per minute), hypertensive (220/118 mm Hg), and hypoxemic (oxygen saturation 49% on room air).She was alert and conversant, with no focal neurologic deficits.She had refractory hypoxemia despite 20 L/min supplemental oxygen.She was intubated and placed on mechanical ventilation for hypoxemic respiratory failure within 1 hour of presentation.SARS-CoV-2 was detected by rapid, real-time reverse-transcriptase polymerase chain reaction on the Cepheid GeneXpert system from a nasopharyngeal swab sample.Chest CT scan showed extensive bilateral, patchy, peripheral-predominant ground glass opacities with consolidation.Head CT demonstrated symmetric hypoattenuation in the bilateral globi pallidi with surrounding small foci of hyperattenuation (figure, A).Carboxyhemoglobin was not elevated and urine toxicology screen was negative.