Prolonged confusional state as first manifestation of COVID-19

Abstract

A 77-year-old gentleman, normally fit and well, was admitted with acute confusion. On admission, Glasgow Coma Scale (GCS) was 14/15, vital signs were within the normal limits and bilateral crepitation at the lung base. Head CT scan was normal. CXR showed some air space opacification. Investigations revealed hyponatraemia, raised CRP, and positive for COVID-19. Treated with antibiotics and intravenous saline, sodium returned to normal. Delirium remained unchanged 4 weeks post-incidence. Neurological manifestations were documented in patients with COVID-19; however no report has shown delirium as a primary manifestation. This case illustrates acute confusion may be the only presenting symptom of COVID-19 without overt lung disease.

Figure 1

Plain CT head—there are mild chronic small vessel ischaemic changes seen. No cerebral atrophy. Basal ganglia, thalami, and brainstem structures are within normal limits. CSF drainage pathways are within normal limits. Brainstem and posterior fossa structures are within normal limits

Figure 2

Chest X‐ray—air space opacification in the right lower zone and left peripheral mid and upper zone