Leucoencefalopatía aguda necrotizante diseminada relacionada al COVID-19 (VANDAL): Reporte de caso

[Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19: Case report]

Alfredo Obando1, Iván Ávila1, Rolando Reyna1

1. Departamento de Diagnóstico, Servicio Imagenología, Hospital Santo Tomás, Panamá, Panamá.

Publicado: 2022-08-30

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Resumen

Se presenta el caso de un paciente masculino de 54 años, hipertenso, con prueba positiva para el virus del COVID-19 y síntomas de hipertensión Endo craneana, el cual ha cursado con lesión renal aguda, sepsis y deterioro neurológico, en su estancia en la sala de pacientes COVID-19 (15 días), con posterior estado comatoso. Se le realiza resonancia cerebral donde se observa extensa hiperintensidad en la secuencia FLAIR/T2 de la sustancia blanca periventricular/profunda de ambos hemisferios cerebrales, cerebelo, cápsulas externas, cápsulas internas, pedúnculos cerebelosos medios, pedúnculos cerebrales con extensión hacia los núcleos de la base y tálamos. Llama la atención la presencia de cavitaciones a nivel de la sustancia blanca comprometida de los hemisferios cerebrales y de predominio posterior. HhhHHay extensa restricción de la difusión e incontables microhemorragias a nivel supra e infratentorial.


Abstract

We present the case of a 54-year-old male with hypertension, with a positive test for COVID-19 virus and symptoms of intracranial hypertension, who has had acute kidney injury, sepsis and neurological deterioration during his hospitalization (15 days), with subsequent comatose state. A cerebral magnetic resonance was performed were extensive hyperintensity was observed in the FLAIR-T2 sequence of the periventricular/deep white matter of both cerebral hemispheres, cerebellum, external capsules, internal capsules, middle cerebellar peduncles, cerebral peduncles with extension towards the nuclei of the base and thalamus. There are cavitations at the level of the compromised white matter of the cerebral hemispheres, as well as extensive diffusion restriction and countless supra and infratentorial microbleeds.

Biografía del autor/a

Rolando Reyna, Departamento de Diagnóstico, Servicio Imagenología, Hospital Santo Tomás, Panamá, Panamá

Medico radiologo

Citas

[1] Agarwal, S; Conway, J; Nguyen, V. Serial Imaging of Virus-Associated Necrotizing Disseminated Acute Leukoencephalopathy (VANDAL) in COVID-19. American Journal of Neuroradiology. October 2020. DOI: https://doi.org/10.3174/ajnr.A6898

[2] Radmanesh, Alireza; Derman, Anna; Lui, Yvonne. COVID-19–associated Diffuse Leukoencephalopathy and Microhemorrhage. RSNA. October 2020. DOI: https://doi.org/10.1148/radiol.2020202040

[3] Freeman, Colbey W.; Masur, Jonathan; Hassankhani, Alvand. Coronavirus Disease (COVID-19)-Related Disseminated Leukoencephalopathy: A Retrospective Study of Findings on Brain MRI. American Journal of Roentgenology. Julio 2020. DOI: https://doi.org/10.2214/AJR.20.24364

[4] Lang, M.; Buch, K.; Li, M.D. Leukoencephalopathy Associated with Severe COVID-19 Infection: Sequela of Hypoxemia? American Society of Neuroradiology. Abril 2020. DOI: http://dx.doi.org/10.3174/ajnr.A6671

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