Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy

Original Article: Filatov A, Sharma P, Hindi F, et al. (March 21, 2020) Neurological Complications of Coronavirus Disease (COVID-19): Encephalopathy. Cureus 12(3): e7352.

Author of summary: Maria Tappatà (Neurologia Osp. Bellaria, Bologna); Reviewer: Irene Salgarella

Original Article Published on March 21st, 2020

A case is reported of a 74-year-old male patient who travelled from Europe to the United States and presented with encephalopathy and Covid-19.  His medical history revealed the presence of comorbid diseases, among which Parkinson’s Disease and chronic obstructive pulmonary disease (COPD). The patient presented consciousness impairment, altered EEG, and characteristic signs of a Covid-19 infection at Chest X-ray examination, and tested positive for Covid-19. The patient was started on a prophylactic antiepileptic therapy, hydroxychloroquine, lopinavir/ritonavir, and on broad-spectrum antibiotics. The patient currently remains in the ICU.

This article is a case report of a 74-year-old male patient who presented with encephalopathy and COVID-19.

A medical history reported that the patient had been diagnosed with:

• Parkinson’s Disease;
• stroke of the left temporal lobe, secondary to Atrial Fibrillation;
• chronic obstructive pulmonary disease (COPD);
• cellulitis.

The clinical presentation included headache, altered mental status, fever, and cough. At the neurological examination the patient was nonverbal and unable to follow any commands; however, he was able to move all his extremities and was reacting to noxious stimuli.

Therefore, he underwent several investigations:

• Chest X-ray and CT of the chest, which revealed pneumonia, suspect for Covid-19;
• Covid-19 test, which was positive;
• CT scan of the brain, which showed an encephalomalacia on the left temporal lobe, coherent with the history of stroke;
• EEG, showing bilateral slowing and focal slowing in the left temporal region with sharply countered waves;
• lumbar puncture, which was normal (4 white blood cells), also excluding other virological diseases.

An antiepileptic therapy was started in prophylaxis [the drug is not specified in the paper], as well as the Covid-19 therapy with hydroxychloroquine, lopinavir/ritonavir, based on anecdotal evidence, and on broad-spectrum antibiotics. Nonetheless, the patient worsened and was transferred to the ICU for respiratory failure.

Conclusions: Covid-19 can be associated with a consciousness impairment in up to 15% of the patients. Health-care providers should be aware that patients with COVID-19 can present with encephalopathy in the acute setting and during hospitalization.