case : Autoimmune encephalitis post covid

1. Neurology Department

2. 20years old man.
Employer.
Unmarried.
From Homs.
Smoking (5 baket/year)- doesn’t drink alcohol.

3. Main complain:
gait disorder.
•3 months ago, the patient complains of vertigo,
dysarthria, blurred vision and gait disorder which
development gradually over these months.
•No sensory symptoms or weakness.
•No dysphagia or dyspnea.
•No previous infection, vaccines, toxins exposure.

4. •he was conscious, oriented, and reactive.
•Cranial nerves: normal.
•Nystagmus: Multidirectional gaze-evoked nystagmus.
•Cerebellar signs: positive ( bilateral / upper and lower)
•Ataxic gait and dysarteria with trunk ataxia.
•Romberg sign: not detected.
•Planter reflex: bilateral flextion.
Iower left
Lower right
Upper left
Upper right
5/5
5/5
5/5
5/5
Strength
normal
normal
normal
normal
Tone
brisk
brisk
brisk
brisk
Reflexes

5. Cerebellar signs and symptoms
????

6. •Laboratory findings:
Cr
Ur
Esr
Plt
Mcv
Ht
Hb
Rbcs
l/n
Wbc
0.8
12
10
284
91
45
14.8
5
28/59
7.4
Ca
K
Na
Ast
Alt
Alb
Tp
Ck
Ldh
Glu
9.4
4.8
135
20
21
4.8
7.4
79
130
80
Tsh
ANA
Ua
B12
B9
Crp
Tg
Hdl
Ldl
Chol
1.2
Neg
4.6
354
4
0.3
132
60
81
139

7. Mri with contrast:

10. •Csf analysis:
Color/ colorless, appearance/ clear, wbc/25,
lympho/ 83%, neutro/ 9%, glu/70, pro/92,
lactate/22.
•VEP: neg.
•Ophthalmology consult: normal.
•MSCT: normal.

11. Management:
•Inflammatory demyelination disease(?)
•Methylprednisolone 1g for 5days with
little improvement.
•5 plasmapheresis sessions.

12. •Anti-mog: neg.
•Anti-aquaporine: neg.
•Ocb: neg.
•Anti-covid IGM:32 / anti-covid IGG:57

13. •The patient discharged with these
recommendations:
•Corticosteroid and tapering for about 2 months.
• Repeat consult and MRI after finishing
corticosteroid or when developing other
symptoms.

14. Follow up:
•4 months later, the same complain with some
relapse when he stopped corticosteroid.
•No other symptoms developed.
•We repeated MRI and csf aspiration.

18. •Csf analysis:
Color/ colorless, appearance/ clear,Wbc/ 9,
Rbc/ 15, glu/ 61, pro/174, lactate/11

19. •Methylprednisolone 1g for 5days again.
•Corticosteroid for about one month with
tapering again.
•Another relapse when corticosteroid
tapered
???/

20. Autoimmune encephalitis post covid 
We began Rituximab 500mg with follow up after 2weeks.