{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:57:58Z","timestamp":1781528278472,"version":"3.54.1"},"reference-count":15,"publisher":"BMJ","issue":"6","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:p>Painful tonic spasms (PTS) are paroxysmal, stereotyped, painful episodes of involuntary posturing typically associated with demyelinating or structural lesions within the corticospinal tract. We report a case of PTS in temporal association with a COVID-19 infection, most likely attributable to post-infectious neuroinflammation. A woman in her 40s developed frequent, disabling, painful spasms of the left extremities 2\u2009weeks after a COVID-19 infection. An MRI of the brain revealed a solitary contrast-enhancing T2\/fluid-attenuated inversion recovery hyperintense ovoid lesion in the right cerebral peduncle. Comprehensive cerebrospinal fluid and serum evaluation, including demyelinating and autoimmune panels, was unremarkable. A 24-hour electroencephalogram capturing three episodes showed no electrographic abnormalities. Symptoms resolved following a short course of high-dose intravenous methylprednisolone and long-term oxcarbazepine. Serial imaging over 2 years demonstrated an interval decrease in lesion size and complete resolution of contrast enhancement, most consistent with a monophasic post-infectious inflammatory aetiology.<\/jats:p>","DOI":"10.1136\/bcr-2026-273874","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T12:40:16Z","timestamp":1781527216000},"page":"e273874","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Post-coronavirus inflammatory cerebral peduncle lesion presenting as painful tonic spasms"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0014-3958","authenticated-orcid":false,"given":"Jin Kyung","family":"Kim","sequence":"first","affiliation":[{"name":"Neurology, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"de Santis","sequence":"additional","affiliation":[{"name":"Neurology, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachelle","family":"Dugue","sequence":"additional","affiliation":[{"name":"Neurology, Stanford University, Stanford, California, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,6,15]]},"reference":[{"key":"2026061505400940000_19.6.e273874.1","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-025-08632-9","article-title":"Central nervous system and systemic inflammatory networks associated with acute neurological outcomes in COVID-19","volume":"15","author":"Freitas","year":"2025","journal-title":"Sci Rep"},{"key":"2026061505400940000_19.6.e273874.2","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1515\/revneuro-2021-0082","article-title":"Central neuroinflammation in Covid-19: a systematic review of 182 cases with encephalitis, acute disseminated encephalomyelitis, and necrotizing encephalopathies","volume":"33","author":"Zamani","year":"2022","journal-title":"Rev Neurosci"},{"key":"2026061505400940000_19.6.e273874.3","article-title":"Dystonia","volume":"2014","author":"Snaith","year":"2014","journal-title":"BMJ Clin Evid"},{"key":"2026061505400940000_19.6.e273874.4","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1016\/j.yebeh.2015.12.015","article-title":"Reappraisal of epileptic pain as a rare symptom of seizures","volume":"55","author":"Kulo\u011flu Pazarc\u0131","year":"2016","journal-title":"Epilepsy Behav"},{"key":"2026061505400940000_19.6.e273874.5","doi-asserted-by":"crossref","unstructured":"Nambakkam M , Landazuri P , Khan M , et al . 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