COVID 19 Cerebritis

Clinically: A known case of COVID 19 positive admitted for fever and breathlessness.

After five days of hospital admission developed sinusitis, headache and started worsening repidly. Subjected for MRI due to sudden onset loss of consciousness and neurological examination revealed new onset ophthalmoplegia. 

MRI shows bilateral geographic shaped patchy T2 hyperintensities involving frontal lobes with diffusion restriction at the floor of anterior cranial fossa. Mild lepto meningeal enhancement on post contrast. 

An associated marked bilateral paranasal sinusitis.

Possibility of COVID 19 Cerebritis, Neuro invasiveness by transnasal route suggested and can be attributed to known Neurotropism of the virus. 

Neurotropism of Covid 19

Neuronal pathway is one of important way of spread of neuropathic viruses like Cov to enter central nervous system. These viruses can migrate with the help of sensory as well as motor nerve endings and have ability of retrograde as well as antegrade spread along the olfactory nervous system due to the unique anatomical organisation of olfactory nerves and olfactory bulb in the nasal cavity and fore brain. As a result, Cov after paranasal sinus infection can enter brain through olfactory tract in early stages of infection rapidly, within seven days of infection as in our case.