Disclosures: Justin Chau, BS: No financial relationships or conflicts of interest

Case Diagnosis: Acute Necrotizing Hemorrhagic Encephalopathy Secondary to COVID-19 Infection

Case Description or Program Description: A 51-year-old previously healthy male had a hospitalization complicated by respiratory failure requiring intubation, acute renal failure, and sepsis due to COVID-19 pneumonia. His persistent encephalopathy and MRI showing cerebellar microhemorrhages were consistent with acute necrotizing hemorrhagic encephalopathy (ANHE) secondary to COVID-19 infection. He was transferred to acute inpatient rehabilitation after being weaned off his ventilator. Upon admission, the patient was unable to ambulate and required maximum assistance with bed mobility and dressing. His physical exam demonstrated 4/5 left upper extremity strength, 4/5 right lower extremity strength, 2/5 strength left hip flexion, and 1/5 strength left ankle dorsiflexion. Right knee flexion was limited to 5 degrees.

Setting: Acute Rehabilitation Hospital

Assessment/Results: The patient underwent 58 days of multidisciplinary inpatient rehabilitation. His respiratory status and dysphagia improved significantly. He was decannulated from his tracheostomy tube and had his percutaneous endoscopic gastrostomy tube removed. He was able to ambulate independently, climb stairs with supervision, and became independent with all activities of daily living. He was discharged home after 155 days of hospitalization.

Discussion (relevance): ANHE is a rare and disabling neurologic manifestation of COVID-19. Its pathophysiology is poorly understood, but hypothesized to be due to intracranial cytokine storm and/or brain hypoxia. Characteristic imaging features symmetric, multifocal lesions that appear hypoattentuating on head CT. T2/FLAIR MRI shows hyperintense signals with internal hemorrhage. To our knowledge, the role of rehabilitation in recovery from ANHE has not been previously described. Our patient was admitted to acute inpatient rehabilitation requiring maximum assistance for most activities of daily living. Despite his severe debility, he was able to transition home, requiring minimal assistance from his family.

Conclusions: It is important to consider ANHE as a neurological complication in patients with severe COVID-19 infection. Furthermore, physicians should recognize the role of rehabilitation in patient recovery.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2022

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/healthy-male-diagnosed-with-covid-19-related-acute-necrotizing-hemorrhagic-encephalopathy-anhe-with-positive-long-term-outcomes-a-case-report/