Myoclonus and Cerebellar Ataxia Associated with SARS-CoV-2 Infection: Case Report and Review of the Literature

Nadia Mariagrazia Giannantoni; Elia Rigamonti; Francesca Irene Rampolli; Lorenzo Grazioli-Gauthier; Gilles Allali; Gianluca Vanini

doi:10.12890/2021_002531

Myoclonus and Cerebellar Ataxia Associated with SARS-CoV-2 Infection: Case Report and Review of the Literature

Eur J Case Rep Intern Med. 2021 May 6;8(5):002531. doi: 10.12890/2021_002531. eCollection 2021.

Authors

Nadia Mariagrazia Giannantoni¹, Elia Rigamonti¹, Francesca Irene Rampolli¹, Lorenzo Grazioli-Gauthier¹, Gilles Allali^{2

3}, Gianluca Vanini¹

Affiliations

¹ Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland.
² Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland.
³ Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA.

Abstract

The current SARS-CoV-2/COVID-19 pandemic has led to a global health crisis. The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic infection to critical illness affecting almost every organ including the central and peripheral nervous systems. Myoclonus, a less expected and relatively unusual neurological complication, together with ataxia, has lately been associated with SARS-CoV-2 infection. We describe the case of a 67-year-old male patient, admitted to our hospital for interstitial bilateral pneumonia due to SARS-CoV-2 infection, who progressively developed general myoclonus and later cerebellar ataxia and gait disturbance. Given the timeline from COVID-19 systemic symptoms to neurological manifestations and the normal results of extensive and non-conclusive diagnostic work-up (blood test, lumbar puncture, EEG, cerebral MRI), a para-infectious encephalopathy related to SARS-CoV-2 was contemplated and a high dose of methylprednisolone was started with prompt symptom improvement. Further investigation and neuroepidemiological studies are needed to help define the mechanism of neuroinvasion and the entire spectrum of neurological manifestations of SARS-CoV-2 infection, even in mildly affected patients, in terms of prevention, treatment and possible neurological sequelae.

Learning points: SARS-CoV-2 infection can be related to neurological symptoms and sequelae.Myoclonus, specifically when associated with ataxia, might represent the expression of COVID-19-related encephalopathy.Myoclonus associated with SARS-CoV-2 infection mostly responds to treatment with steroids.

Keywords: SARS-CoV-2 infection; ataxia; differential diagnoses; myoclonus.