Myoclonus and Cerebellar Ataxia Associated with SARS-CoV-2 Infection: Case Report and Review of the Literature
  • Nadia Mariagrazia Giannantoni
    Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland
  • Elia Rigamonti
    Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland
  • Francesca Irene Rampolli
  • Lorenzo Grazioli-Gauthier
    Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland
  • Gilles Allali
    Department of Clinical Neurosciences, Division of Neurology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Switzerland; Department of Neurology, Division of Cognitive and Motor Aging, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY, USA
  • Gianluca Vanini
    Department of Internal Medicine, Ospedale Regionale di Lugano, Switzerland


SARS-CoV-2 infection, myoclonus, ataxia, differential diagnoses


The current SARS-CoV-2/COVID-19 pandemic has led to a global health crisis. The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic infection to critical illness affecting almost every organ including the central and peripheral nervous systems. Myoclonus, a less expected and relatively unusual neurological complication, together with ataxia, has lately been associated with SARS-CoV-2 infection. We describe the case of a 67-year-old male patient, admitted to our hospital for interstitial bilateral pneumonia due to SARS-CoV-2 infection, who progressively developed general myoclonus and later cerebellar ataxia and gait disturbance. Given the timeline from COVID-19 systemic symptoms to neurological manifestations and the normal results of extensive and non-conclusive diagnostic work-up (blood test, lumbar puncture, EEG, cerebral MRI), a para-infectious encephalopathy related to SARS-CoV-2 was contemplated and a high dose of methylprednisolone was started with prompt symptom improvement. 
Further investigation and neuroepidemiological studies are needed to help define the mechanism of neuroinvasion and the entire spectrum of neurological manifestations of SARS-CoV-2 infection, even in mildly affected patients, in terms of prevention, treatment and possible neurological sequelae.



  • Hu B, Guo H, Zhou P, Shi ZL. Characteristics of SARS-CoV-2 and COVID-19. Nat Rev Microbiol 2021;19(3):141–154. doi: 10.1038/s41579-020-00459-7.
  • Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239–1242.
  • Gupta A, Madhavan MV, Sehgal K, Nair N, Mahajan S, Sehrawat TS, et al. Extrapulmonary manifestations of COVID-19. Nat Med 2020;26:1017–1032.
  • Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al. Neurological associations of COVID-19. Lancet Neurol 2020;19:767–783.
  • Paterson RW, Brown RL, Benjamin L, Nortley R, Wiethoff S, Bharucha T, et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain 2020;143:3104–3120.
  • Sharifian-Dorche M, Huot P, Osherov M, Wen D, Saveriano A, Giacomini PS, et al. Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci 2020;417:117085.
  • Anand P, Zakaria A, Benameur K, Ong C, Putman M, O'Shea S, et al. Myoclonus in patients with coronavirus disease 2019: a multicenter case series. Crit Care Med 2020;48(11):1664–1669.
  • Latorre A, Rothwell JC. Myoclonus and COVID-19: a challenge for the present, a lesson for the future. Mov Dis Clin Pract 2020;7(8):888–890.
  • Foucard C, San-Galli A, Tarrano C, Chaumont H, Lannuzel A, Roze E. Acute cerebellar ataxia and myoclonus with or without opsoclonus: a para-infectious syndrome associated with COVID-19. Eur J Neurol 2021 Jan 25;10.1111/ene.14726. doi: 10.1111/ene.14726.
  • Pilotto A, Odolini S, Masciocchi S, Comelli A, Volonghi I, Gazzina S, et al. Steroid-responsive encephalitis in Covid-19 disease. Ann Neurol 2020;88(2):423–427. doi: 10.1002/ana.25783.
  • Pugin D, Vargas MI, Thieffry C, Schibler M, Grosgurin O, Pugin J, et al. COVID-19–related encephalopathy responsive to high-dose glucocorticoids. Neurology 2020;95(12):543–546.
  • Allen AM, O'Callaghan E, Mendelsohn F, Chai S. Neuronal angiotensin. In: Squire LR, editor. Encyclopedia of neuroscience. New York: Academic Press; p. 697–702.
  • Geyer HL, Kaufman DM, Parihar RK, Mehler MF. Movement disorders in COVID-19: whither art thou? Tremor Other Hyperkinet Mov (N Y) 2020;10:25.
  • Eberhardt O, Topka H. Myoclonic disorders. Brain Sci 2017;7(8):103.
  • Dijkstra F, Van den Bossche T, Willekens B, Cras P, Crosiers D. Myoclonus and cerebellar ataxia following COVID-19. Mov Dis Clin Pract 2020;7(8):974–976.
  • Schellekens MMI, Bleeker-Rovers CP, Keurlings PAJ, Mummery CJ, Bloem BR. Reversible Myoclonus-Ataxia as a Postinfectious Manifestation of COVID-19. Mov Dis Clin Pract. 2020;7(8):977-979.
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    Published: 2021-05-06
    Issue: 2021: Vol 8 No 5 (view)

    How to cite:
    Giannantoni NM, Rigamonti E, Rampolli FI, Grazioli-Gauthier L, Allali G, Vanini G. Myoclonus and Cerebellar Ataxia Associated with SARS-CoV-2 Infection: Case Report and Review of the Literature. EJCRIM 2021;8 doi:10.12890/2021_002531.

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