Response to [Time zero alignment in target trial emulation of VMAT2 inhibitors versus anticholinergics for tardive dyskinesia].

Coronavirus disease 2019 (COVID-19), an infectious disease induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), could affect multiple organs and systems. Neurological manifestations associated with COVID-19 have also been reported, including hypoxic‐ischemic brain injury, encephalitis, and neuromuscular dysfunction []. Specifically, encephalitis could lead to severe outcomes and significantly increase the mortality rates []. Therefore, timely identification of COVID-19-associated encephalitis is essential for clinicians. Herein, we reported a case of a Chinese male presenting with fever, abnormal psychiatric behaviors, and concomitant subdural hematoma. There were little evidences of SARS-CoV-2 infection in initial examinations. Further metagenomic sequencing supported the diagnosis of probable COVID-19-associated encephalitis. The case highlights the importance of detecting potential pathogen infections in cerebrospinal fluid (CSF) samples and performing cranial imaging promptly to identify concomitant brain lesions. A 61-year-old Chinese male first suffered from a fever, and was admitted to community hospital for probable upper respiratory tract infection. On the 5th day, he presented abnormal psychiatric symptoms including disorganized speech, delirium, hostility toward family members, and even brief episodes of striking the head against the ground. This patient was then transferred to our hospital. Before admission, the long-term medications the patient took were anti-hypertensive and anti-diabetic drugs (enalapril and metformin), with no anticoagulant or antiplatelet drugs. He and his immediate family members had no past history of psychiatric disorders. On admission, the temperature of the patient was 37.9 °C, and other vital signs were normal. Positive neurological symptoms included cognitive confusion, memory deficits, and diminished language function, along with involuntary tremors in bilateral upper extremities. Laboratory test results were as follows: C-reactive protein (CRP) 16.8 mg/L, neutrophil percentage 77.0%, platelet count 185*10^9/L, international normalized ratio (INR) 1.05, prothrombin time (PT) 12.6 s, activated partial thromboplastin time (APTT) 27.3 s, and D-dimer 4.70 mg/L. Blood tests also revealed elevated levels of SARS-CoV-2 immunoglobulin (Ig) G antibodies (139.30 AU/mL), interleukin (IL)−6 (6.8 pg/mL), and tumor necrosis factor (TNF) (10.1 pg/mL). Other parameters, including leukocytes, serum electrolytes, complete blood count, erythrocyte sedimentation rate (ESR), and liver and kidney function, were within normal ranges. Meanwhile, routine blood culture and SARS-CoV-2 ribonucleic acid detection via naso-oropharyngeal swab yielded negative results. Chest computed tomography (CT) imaging revealed no obvious inflammatory foci in either lung. However, brain CT images demonstrated a left subdural hematoma appearing as a crescent-shaped area of high density. The major axis, minor axis, and number of lesion layers were 12 cm, 1.3 cm, and 20, respectively, with a layer thickness of 5 mm. Brain magnetic resonance imaging (MRI) (Fig. ) further suggested that the subdural hematoma might be surrounded by an edematous band. His electroencephalogram (EEG) monitoring showed diffused 3–6 Hz slow wave discharges with low amplitudes symmetrically in both hemispheres. Given the presence of a left subdural hemorrhage, lumbar puncture was deferred. Based on the clinical presentation and examination findings, intracranial infection was considered the primary diagnostic possibility. The patient was empirically treated with ganciclovir (0.25 g/q12h), vancomycin hydrochloride (1 g/q12h), and meropenem (1 g/q12h). On the 10th day, the patient’s psychiatric symptoms persisted, and body temperature remained elevated at approximately 38 °C. Magnetic resonance imaging of the brain on admission. Axial T1-weighted (), T2-weighted (), T2-weighted fluid attenuated inversion recovery (), and apparent diffusion coefficient () sequences of the brain magnetic resonance imaging (MRI) on admission revealed left subdural hemorrhage