# Cerebellar and Occipital Alterations in Brain Perfusion in a Patient With Post-acute COVID-19 Encephalopathy Misdiagnosed As Primary Psychotic Disorder

## TL;DR

A young man with post-COVID-19 encephalopathy showed brain perfusion changes, highlighting the need to consider this condition before diagnosing a primary psychotic disorder.

## Contribution

Demonstrates the utility of SPECT in detecting post-acute COVID-19 encephalopathy and the importance of careful monitoring for accurate diagnosis.

## Key findings

- SPECT revealed hypoperfusion in cerebellar dentate nuclei and occipital lobes three months post-infection.
- No abnormalities were found on 18F-FDG PET six months post-infection.
- Psychiatric symptoms resolved without psychopharmacotherapy, suggesting a non-primary disorder.

## Abstract

We describe the case of an unvaccinated 21-year-old Japanese male who experienced psychotic symptoms attributed to encephalopathy, known as post-acute COVID-19 syndrome (PACS). One week after his discharge following the remission of a SARS-CoV-2 infection, he experienced hyperactive delirium and unexpected movements of his limbs. As COVID-19-associated encephalopathy was suspected as a cause of the psychotic symptoms, he was admitted to the Department of Neurology. He received antiviral and steroid pulse therapy, but his psychiatric symptoms did not improve completely. Consequently, he was admitted to our psychiatric ward with a diagnosis of a primary psychotic disorder. Although he did not take psychopharmacotherapy, he gradually achieved a remission of psychiatric symptoms. At three months post-SARS-CoV-2 infection, single-photon emission computed tomography (SPECT) revealed hypoperfusion in the bilateral cerebellar dentate nuclei and occipital lobes. However, no abnormal findings were observed on fluorine-18 fluoro-deoxy-glucose positron emission tomography (18F-FDG PET) at six months after the infection. This case indicates that (1) brain perfusion SPECT can be effective for detecting functional alterations in post-acute COVID-19-associated encephalopathy, and (2) it is necessary to carefully monitor patients' progress instead of quickly diagnosing a primary psychotic disorder.