Cerebellar and Occipital Alterations in Brain Perfusion in a Patient With Post-acute COVID-19 Encephalopathy Misdiagnosed As Primary Psychotic Disorder.

Publication date: Jan 01, 2024

We describe the case of an unvaccinated 21-year-old Japanese male who experienced psychotic symptoms attributed to encephalopathy, known as post-acute COVID-19 syndrome (PACS). One week after his discharge following the remission of a SARS-CoV-2 infection, he experienced hyperactive delirium and unexpected movements of his limbs. As COVID-19-associated encephalopathy was suspected as a cause of the psychotic symptoms, he was admitted to the Department of Neurology. He received antiviral and steroid pulse therapy, but his psychiatric symptoms did not improve completely. Consequently, he was admitted to our psychiatric ward with a diagnosis of a primary psychotic disorder. Although he did not take psychopharmacotherapy, he gradually achieved a remission of psychiatric symptoms. At three months post-SARS-CoV-2 infection, single-photon emission computed tomography (SPECT) revealed hypoperfusion in the bilateral cerebellar dentate nuclei and occipital lobes. However, no abnormal findings were observed on fluorine-18 fluoro-deoxy-glucose positron emission tomography (F-FDG PET) at six months after the infection. This case indicates that (1) brain perfusion SPECT can be effective for detecting functional alterations in post-acute COVID-19-associated encephalopathy, and (2) it is necessary to carefully monitor patients’ progress instead of quickly diagnosing a primary psychotic disorder.

Concepts Keywords
Hyperactive covid-19
Japanese encephalopathy
Months post-acute covid-19
Psychopharmacotherapy post-covid-19


Type Source Name
disease MESH COVID-19
disease MESH Encephalopathy
disease MESH Psychotic Disorder
disease VO unvaccinated
disease MESH post-acute COVID-19 syndrome
pathway REACTOME SARS-CoV-2 Infection
disease MESH delirium
drug DRUGBANK Fluorine F-18
drug DRUGBANK Dextrose unspecified form
disease MESH infection
disease VO effective
drug DRUGBANK Fludeoxyglucose F-18

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