Late neurological consequences of a SARS-CoV-2 infection

Background Persistent neurological late symptoms of SARS-CoV-2 infection are common and require regular follow-up treatment. In order to establish uniform therapy concepts, it is necessary to evaluate individual therapeutic approaches for long COVID and post-COVID-19 syndrome. Anamnese A 62-year-old patient was admitted to our rehab clinic for follow-up treatment after severe SARS-CoV-2 infection with neurological symptoms. The initially extensive laboratory and imaging investigation did not reveal any organic cause for the sometimes apoplectiform, complex clinical picture, so that the patient was transferred directly to our rehabilitation clinic in the event of everyday restrictions and rollator dependency. Examination and findings Clinically, there was a reduced general condition and the mood was depressed. Neurological symptoms were gait ataxia, hand tremor, amnesic aphasia and reduced ability to concentrate. PET / CT showed no evidence of tumor or inflammation. Therapy and progress A multimodal therapy program consisting of physiotherapy and occupational therapy as well as psychological support was carried out. In addition, off-label therapy with oral glucocorticoids and colchicine was initiated. In the course of the disease, there was a clear reduction in all symptoms with little residual hand tremor. Conclusions Whole body and brain FDG PET can be helpful in long COVID and post-COVID-19 syndrome patients with neurological symptoms of unknown origin. These patients benefit from systematic rehabilitation. Glucocorticoids and colchicine appear to accelerate symptom reduction. The rehabilitative therapy should be continued on an outpatient basis.