{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T15:22:17Z","timestamp":1786980137280,"version":"build-2736575974"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T00:00:00Z","timestamp":1680480000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Universit\u00e4tsklinik M\u00fcnchen"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Neurol"],"published-print":{"date-parts":[[2023,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Encephalitis and myelitis have been linked to both COVID-19 vaccination and infection, causing symptoms such as reduced consciousness, mental state alterations and seizures. Remarkably, most cases do not show significant structural alterations on MRI scans, which poses a diagnostic challenge.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We present the diagnostic workup and clinical course of a patient who developed a progressive brainstem syndrome two weeks after COVID-19 vaccination and subsequent infection. We used translocator protein (TSPO)-PET scans for the first time to investigate COVID-related neuroinflammation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The patient developed oculomotor disorder, dysarthria, paresthesia in all distal limbs and spastic-atactic gait. CSF analysis revealed mild lymphocytic pleocytosis with normal protein levels. Brain and spinal cord MRI scans were negative, but TSPO\/PET scans showed increased microglia activity in the brainstem, which correlated with the clinical course. Steroid treatment led to clinical improvement, but relapse occurred during prednisone taper after four weeks. Plasmapheresis had no significant effect; however, complete remission was achieved with cyclophosphamide and methotrexate, with normal TSPO signal ten months after onset.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>TSPO-PET can be a valuable tool in the diagnostic and therapeutic monitoring of COVID-19-related encephalitis, particularly in cases where MRI scans are negative. Aggressive immunosuppressive therapy can lead to sustained remission.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00415-023-11691-5","type":"journal-article","created":{"date-parts":[[2023,4,3]],"date-time":"2023-04-03T13:02:31Z","timestamp":1680526951000},"page":"2853-2856","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["Translocator protein (TSPO)-PET as diagnostic and monitoring tool in COVID-19 related MRI-negative brainstem encephalitis: a case report"],"prefix":"10.1007","volume":"270","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0653-943X","authenticated-orcid":false,"given":"Johannes","family":"Wischmann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura M.","family":"Bartos","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthias","family":"Brendel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie L.","family":"Albert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Forbrig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Straube","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ilias","family":"Masouris","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2023,4,3]]},"reference":[{"issue":"3","key":"11691_CR1","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1002\/ana.26182","volume":"90","author":"F Zuhorn","year":"2021","unstructured":"Zuhorn F et al (2021) Postvaccinal encephalitis after ChAdOx1 nCov-19. Ann Neurol 90(3):506\u2013511","journal-title":"Ann Neurol"},{"issue":"10","key":"11691_CR2","doi-asserted-by":"publisher","first-page":"3491","DOI":"10.1111\/ene.14913","volume":"28","author":"I Siow","year":"2021","unstructured":"Siow I et al (2021) Encephalitis as a neurological complication of COVID-19: a systematic review and meta-analysis of incidence, outcomes, and predictors. Eur J Neurol 28(10):3491\u20133502","journal-title":"Eur J Neurol"},{"issue":"9","key":"11691_CR3","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1016\/S1474-4422(20)30221-0","volume":"19","author":"MA Ellul","year":"2020","unstructured":"Ellul MA et al (2020) Neurological associations of COVID-19. Lancet Neurol 19(9):767\u2013783","journal-title":"Lancet Neurol"},{"issue":"6","key":"11691_CR4","doi-asserted-by":"publisher","first-page":"2827","DOI":"10.1007\/s00415-022-11050-w","volume":"269","author":"H Ari\u00f1o","year":"2022","unstructured":"Ari\u00f1o H et al (2022) Neuroimmune disorders in COVID-19. J Neurol 269(6):2827\u20132839","journal-title":"J Neurol"},{"issue":"5","key":"11691_CR5","doi-asserted-by":"publisher","DOI":"10.1111\/bpa.12997","volume":"31","author":"TE Poloni","year":"2021","unstructured":"Poloni TE et al (2021) COVID-19-related neuropathology and microglial activation in elderly with and without dementia. Brain Pathol 31(5):e12997","journal-title":"Brain Pathol"},{"key":"11691_CR6","doi-asserted-by":"publisher","first-page":"2","DOI":"10.17879\/freeneuropathology-2021-2993","volume":"2","author":"JJ Lou","year":"2021","unstructured":"Lou JJ et al (2021) Neuropathology of COVID-19 (neuro-COVID): clinicopathological update. Free Neuropathol 2:2. https:\/\/doi.org\/10.17879\/freeneuropathology-2021-2993","journal-title":"Free Neuropathol"},{"issue":"4","key":"11691_CR7","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1007\/s13365-021-00986-w","volume":"27","author":"RMC Abrams","year":"2021","unstructured":"Abrams RMC et al (2021) MRI negative myelopathy post mild SARS-CoV-2 infection: vasculopathy or inflammatory myelitis? J Neurovirol 27(4):650\u2013655","journal-title":"J Neurovirol"},{"key":"11691_CR8","doi-asserted-by":"crossref","unstructured":"Serrano GE et al (2021) Mapping of SARS-CoV-2 brain invasion and histopathology in COVID-19 Disease. medRxiv 2021.02.15.21251511","DOI":"10.1101\/2021.02.15.21251511"},{"issue":"2","key":"11691_CR9","doi-asserted-by":"publisher","first-page":"165","DOI":"10.2967\/jnumed.114.141713","volume":"57","author":"L Vivash","year":"2016","unstructured":"Vivash L, O\u2019Brien TJ (2016) Imaging microglial activation with TSPO PET: lighting up neurologic diseases? J Nucl Med 57(2):165\u2013168","journal-title":"J Nucl Med"},{"key":"11691_CR10","first-page":"163","volume":"3","author":"G Giannotta","year":"2018","unstructured":"Giannotta G, Giannotta N (2018) Vaccines and Neuroinflammation. Int J Pub Health Safe 3:163","journal-title":"Int J Pub Health Safe"},{"key":"11691_CR11","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2021.656700","volume":"12","author":"R Mishra","year":"2021","unstructured":"Mishra R, Banerjea AC (2021) SARS-CoV-2 spike targets USP33-IRF9 axis via exosomal miR-148a to activate human microglia. 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