Treatment-Refractory Headache in the Setting of COVID-19 Pneumonia: Migraine or Meningoencephalitis? Case Report.
Treatment-Refractory Headache in the Setting of COVID-19 Pneumonia: Migraine or Meningoencephalitis? Case Report.
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DOI：
10.1007/s42399-020-00369-y
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发表时间：
2020-01-01
期刊：
影响因子：
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通讯作者：
Starling, Amaal J
中科院分区：
文献类型：
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作者：
Arca, Karissa N;Starling, Amaal J
导致COVID-19大流行的冠状病毒SARS-2-CoV最常涉及呼吸道；然而，更严重的病例被发现有多器官受累，包括中枢神经系统。头痛已被记录为COVID-19的主要症状，这可能促使人们进行神经病学咨询。迄今为止，确诊的COVID-19脑膜炎病例很少，但对于头痛和发烧患者，必须将其作为鉴别诊断。一名58岁女性，芬戈莫德治疗多发性硬化症，fremanezumab治疗控制良好的慢性偏头痛，脑血管疾病表现为发烧和呼吸道症状，以及急性难治性头痛，伴有颈部僵硬和一过性行为异常。虽然没有脑脊液检测证实，但我们怀疑该患者患有COVID-19脑膜脑炎，强调需要考虑冠状病毒感染患者的继发性头痛，即使是慢性偏头痛患者。我们在COVID-19大流行期间为急性难治性继发性头痛提供轶事治疗建议，并为咨询神经科医生提供指导。
The coronavirus responsible for the COVID-19 pandemic, SARS-2-CoV, most commonly involves the respiratory tract; however, more severe cases have been found to have multi-organ involvement, including the central nervous system. Headache has been documented as a presenting symptom of COVID-19, which may prompt neurology consultation. To date, few cases of COVID-19 meningitis have been confirmed, but it must remain in the differential diagnosis for patients with headache and fever. A 58-year-old female with multiple sclerosis on fingolimod, chronic migraine well-controlled on fremanezumab, and cerebrovascular disease presented with fevers and respiratory symptoms, as well as acute treatment-refractory headache with associated neck stiffness and transient behavioral abnormalities. Although not confirmed with cerebrospinal fluid testing, we suspect this patient had COVID-19 meningoencephalitis, highlighting the need to consider secondary headaches in patients with coronavirus infection, even in the setting of chronic migraine. We offer anecdotal treatment recommendations for acutely refractory secondary headache and guidance for the consulting neurologist during the COVID-19 pandemic.