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LETTER TO EDITOR
Year : 2022  |  Volume : 70  |  Issue : 4  |  Page : 1734--1735

Cerebellar Ataxia can be a Rare but not Unique Complication of a SARS-CoV-2 Infection

Daniel Matovu1, Josef Finsterer2,  
1 Departamento de Neurologia e Neurocirurgia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Braszil
2 Neurology and Neurophysiology Center, Vienna, Austria

Correspondence Address:
Josef Finsterer
Postfach 20, 1180 Vienna
Austria




How to cite this article:
Matovu D, Finsterer J. Cerebellar Ataxia can be a Rare but not Unique Complication of a SARS-CoV-2 Infection.Neurol India 2022;70:1734-1735


How to cite this URL:
Matovu D, Finsterer J. Cerebellar Ataxia can be a Rare but not Unique Complication of a SARS-CoV-2 Infection. Neurol India [serial online] 2022 [cited 2022 Nov 30 ];70:1734-1735
Available from: https://www.neurologyindia.com/text.asp?2022/70/4/1734/355126


Full Text



Sir,

We read with interest the article by Mudabbir et al.[1] about a 49-year-old male patient who developed cerebellar ataxia 14 days after their complete recovery from a SARS-CoV-2 infection. The authors claim that this case is the first ever reported patient with cerebellar ataxia following a SARS-CoV-2 infection.[1] The study is appealing but raises concerns that need to be discussed.

We disagree with the conclusion that the index case is the first with post-SARS-CoV-2 ataxia.[1] At least 16 patients have been reported with myoclonus ataxia syndrome as a manifestation of long COVID.[2] These patients presented with myoclonus in addition to cerebellar ataxia.[2] Isolated post-infectious cerebellar ataxia has been reported in a 13-year-old male who developed lethargy, headache, vomiting, clumsiness of both hands, nystagmus, dysarthria, impaired finger-to-nose testing, dysdiadochokinesia and ataxic gait after recovery from COVID-19.[3] Furthermore, a 62-year-old male developed subacute cerebellar syndrome one day after recovery from a mild COVID-19 infection.[4]

We also disagree with the statement in the introduction that “neurological involvement in COVID-19 patients occurs commonly in the form of arterial or venous strokes due to hypercoagulable states, hypoxic-ischemic encephalopathy due to hypoxia, seizures due to significant hyponatremia, and critical illness polyneuropathy/myopathy”.[1] The most common neurological manifestations of neuro-COVID are hypogeusia, hyposmia and headache. Vascular events are rare, although few systematic studies have been carried out to assess the frequency of strokes, bleeding, vasoconstriction syndrome or venous sinus thrombosis among SARS-CoV-2 patients.

Missing is the determination of cytokines or chemokines in the cerebrospinal fluid (CSF). Several studies have shown that central and peripheral nervus system disease associated with COVID-19 can go along with elevation of interleukins (ILs) in the CSF. Thus, we should be informed if IL-6, IL-8 or tumor necrosis factor (TNF)-alpha was elevated in the CSF of the index patient.

The index patient developed cerebellar ataxia, but CSF investigations and MRI did not explain the condition. Resolution of ataxia upon steroids suggests that it was immune-mediated. We should be told if magnetic resonance venography (MRV), perfusion-weighted imaging (PWI), magnetic resonance (MR) spectroscopy or fluorodeoxyglucose positron emission tomography (FDG-PET) had been carried out to demonstrate a perfusion or metabolic abnormality in the cerebellum or its draining veins.

Overall, the interesting study has some limitations and inconsistencies that call the results and their interpretation into question. Clarifying these weaknesses would strengthen the conclusions and could add value to the study.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Mukheem Mudabbir MA, Goyal S, Mirche K, Singh MK, Karur PS. The first case of post coronavirus disease (COVID-19) acute cerebellar ataxia: A case report. Neurol India 2022;70:448-50.
2Przytuła F, Błądek S, Sławek J. Two COVID-19-related video-accompanied cases of severe ataxia-myoclonus syndrome. Neurol Neurochir Pol 2021;55:310-3.
3Tomar LR, Shah DJ, Agarwal U, Batra A, Anand I. Acute post-infectious cerebellar ataxia due to COVID-19. Mov Disord Clin Pract 2021;8:610-2.
4Werner J, Reichen I, Huber M, Abela IA, Weller M, Jelcic I. Subacute cerebellar ataxia following respiratory symptoms of COVID-19: A case report. BMC Infect Dis 2021;21:298. doi: 10.1186/s12879-021-05987-y.