Disclosures: Michael W. Chung, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 65-year-old woman who developed multiple system atrophy as a sequelae of COVID-19 infection

Case Description or Program Description: The patient developed progressive dizziness, blurriness, and unsteady gait immediately following hospitalization for COVID-19 infection. Formal evaluation noted rightward nystagmus, mild resting tremor of the right hand, slowed finger tapping test bilaterally, overshooting on right finger to nose, and shuffling gait. MRI of the brain revealed moderate cerebellar and pontine volume loss with crossed hyperintensity of the pons, or “hot cross bun sign”, raising suspicion for degenerative disease. Lumbar puncture analysis was normal. The patient was diagnosed with multiple system atrophy with parkinsonism features and started on a trial of amantadine and carbidopa/levodopa. Videonystagmography confirmed cerebellar etiology of her symptoms. Vestibular rehabilitation and meclizine was initiated with subsequent improvement in dizziness and functionality.

Setting: Acute inpatient rehabilitation facility.

Assessment/Results: After 20 days of acute inpatient rehabilitation including vestibular therapy, amantadine, carbidopa/levodopa, and meclizine, there was improvement of dizziness, dysarthria, tremor, weakness, and gait. The therapy team noted good progress since admission regarding performance of self-care tasks as well as transfers and mobility. The patient was discharged home with outpatient vestibular therapy.

Discussion (relevance): This is a case of newly diagnosed multiple system atrophy associated with “hot cross buns sign” on MRI with COVID19 infection as the implicated etiology. To our knowledge, this is the first case of central cerebellopontine degeneration associated with COVID19.

Conclusions: New onset multiple system atrophy may be a sequelae of COVID19 infection.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cerebellopontine-degeneration-after-covid-19-infection-a-case-report/