title: Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus (MERS-CoV).
abstract: BACKGROUND
  Since the identification of the first case of infection with the Middle East respiratory syndrome corona virus (MERS-CoV) in Saudi Arabia in June 2012, the number of laboratory-confirmed cases has exceeded 941 cases globally, of which 347 died. The disease presents as severe respiratory infection often with shock, acute kidney injury, and coagulopathy. Recently, we observed three cases who presented with neurologic symptoms. These are so far the first reported cases of neurologic injury associated with MERS-CoV infection.
  
  
  METHODS
  Data was retrospectively collected from three patients admitted with MERS-CoV infection to Intensive Care unit (ICU) at King Abdulaziz Medical City, Riyadh. They were managed separately in three different wards prior to their admission to ICU.
  
  
  RESULTS
  The three patients presented with severe neurologic syndrome which included altered level of consciousness ranging from confusion to coma, ataxia, and focal motor deficit. Brain MRI revealed striking changes characterized by widespread, bilateral hyperintense lesions on T2-weighted imaging within the white matter and subcortical areas of the frontal, temporal, and parietal lobes, the basal ganglia, and corpus callosum. None of the lesions showed gadolinium enhancement.
  
  
  CONCLUSIONS
  CNS involvement should be considered in patients with MERS-CoV and progressive neurological disease, and further elucidation of the pathophysiology of this virus is needed.
authors.affiliation: Intensive Care Department, MC-1425, Respiratory Services, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center (KAIMRC), P.O. Box 22490, Riyadh, 11426, Kingdom of Saudi Arabia, yaseenarabi@yahoo.com.
authors.forename: Y M
authors.initials: YM
authors.lastname: Arabi
authors.forename: A
authors.initials: A
authors.lastname: Harthi
authors.forename: J
authors.initials: J
authors.lastname: Hussein
authors.forename: A
authors.initials: A
authors.lastname: Bouchama
authors.forename: S
authors.initials: S
authors.lastname: Johani
authors.forename: A H
authors.initials: AH
authors.lastname: Hajeer
authors.forename: B T
authors.initials: BT
authors.lastname: Saeed
authors.forename: A
authors.initials: A
authors.lastname: Wahbi
authors.forename: A
authors.initials: A
authors.lastname: Saedy
authors.forename: T
authors.initials: T
authors.lastname: AlDabbagh
authors.forename: R
authors.initials: R
authors.lastname: Okaili
authors.forename: M
authors.initials: M
authors.lastname: Sadat
authors.forename: H
authors.initials: H
authors.lastname: Balkhy
mesh_terms: D000368:Aged; D018352:Coronavirus Infections / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D065207:Middle East Respiratory Syndrome Coronavirus / Q000302:isolation & purification; D009422:Nervous System Diseases / Q000175:diagnosis / Q000473:pathology / Q000821:virology*; D012529:Saudi Arabia