Editors' Note: Acute Hypokinetic-Rigid Syndrome After SARS-CoV-2 Infection

In their case report, Dr. Méndez-Guerrero and colleagues add to the growing literature suggesting the neuroinvasive potential and neurologic sequelae of infection with the novel human coronavirus, SARS-CoV-2. Supported by dopamine transporter-SPECT imaging and negative testing for other known precipitants of Parkinsonism, this case exemplifies a rapidly improving postinfectious hypokinetic-rigid syndrome with associated generalized myoclonus and opsoclonus in a critically ill patient with coronavirus disease 2019 (COVID-19). The authors go on to imply that their case is reminiscent of the infamous encephalitis lethargica described by Constantin von Economo in 1917. Dr. Joseph Berger, neurovirologist and authority on von Economo’s encephalitis, contests the relationship between SARS-CoV-2 and the clinical/radiologic observations made by the authors. Instead, Dr. Berger posits, the observations may be the consequence of hypoxic ischemic injury. In addition, the cases originally described by von Economo were observed years (not days) after an infectious illness. Dr. Shubhakaran recounts similar experiences with 2 patients who developed acute movement disorders after a viral prodrome; however, one was not tested for SARS-CoV-2 and the second tested negative by PCR. The authors maintain that their patient’s oxygenation while intubated remained sufficient and would not have resulted in hypoxic ischemic injury. Furthermore, that the patient improved quickly and significantly would not be congruous with anoxic brain damage. The authors add credence to their argument by citing 2 related case reports of post-COVID-19 Parkinsonism that have been recently published. Nonetheless, we still need more clinical-pathological material to determine how neuroinvasive SARS-CoV-2 really is.

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