Cerebrospinal fluid confirmed COVID-19-associated encephalitis treated successfully

Abstract

The COVID-19 pandemic that attracted global attention in December 2019 is well known for its clinical picture that is consistent with respiratory symptoms. Currently, the available medical literature describing the neurological complications of COVID-19 is gradually emerging. We hereby describe a case of a 31-year-old COVID-19-positive patient who was admitted on emergency basis. His clinical presentation was primarily neurological, rather than the COVID-19's classical respiratory manifestations. He presented with acute behavioural changes, severe confusion and drowsiness. The cerebrospinal fluid analysis was consistent with COVID-19 encephalitis, as well as the brain imaging. This experience confirms that neurological manifestations might be expected in COVID-19 infections, despite the absence of significant respiratory symptoms. Whenever certain red flags are raised, physicians who are involved in the management of COVID-19 should promptly consider the possibility of encephalitis. Early recognition of COVID-19 encephalitis and timely management may lead to a better outcome.

Keywords: global health; infection (neurology); infectious diseases; medical management; neuroimaging.

Figure 1

(A, B) Initial CT of the brain without contrast axial image revealing bilateral symmetrical hypodensities in the bifrontal lobes.

Figure 2

(A, B) Repeated CT of the brain without contrast axial image after 24 hours still revealing hypodensities in the bifrontal lobes.

Figure 3

(A, B) MRI of the brain diffusion-weighted images axial image revealing rather symmetrical diffusion restriction in the anteromedial temporal lobes bilaterally, and (C) areas of diffusion restriction in the parasagittal frontal lobes bilaterally.

Figure 4

MRI of the brain T2-weighted axial image revealing hyperintense signals in the temporal lobe cortex bilaterally.

Figure 5

MRI of the brain T2-fluid attenuated inversion recovery axial image revealing hyperintense, rather symmetrical, signals in the anteromedial temporal lobes bilaterally.