Recurrent Status Epilepticus and SARS-CoV-2 infection: the "perfect storm"

Abstract

Respiratory involvement is the most common clinical manifestation of COVID-19, but neurological symptoms and complications are increasingly being recognized. Seizures and status epilepticus (SE) have been described as possible consequences of hypoxia and metabolic derangements during SARS-CoV-2 infection, direct viral invasion of the central nervous system, or as para or post-infectious complications. Single episodes of SE have been described, occurring during the acute phase of COVID-19 or once the patients have been recovered. Herein, we present the case of a patient with a positive serology test for SARS-CoV-2 (IgG+, IgM-) and recurrent SE occurring within 36 days. Diagnostic work-up ruled out other known causes of SE. A post-COVID-19 infectious inflammatory/immune response is hypothesized as the possible trigger of SE.

Figure 1.

Electroencephalographic findings. First status epilepticus (SE): panel A showed a diffuse slow background activity, with high amplitude delta waves and spike-and-wave and sharp-and-slow-wave complexes on bilateral fronto-polar and fronto-basal regions with right prevalence. Second SE: panel B revealed a diffuse theta background activity with sub-continuous epileptiform discharges (sharp-waves and spikes) over the right parietal region and the vertex, that spread to ipsilateral and contralateral temporal regions.

Figure 2.

Radiological findings. Brain magnetic resonance imaging (MRI): diffusion-weighted imaging (DWI) images revealed mild signal restriction in frontoparietal paramedian regions with right prevalence and cortical distribution (A - white arrow), without gadolinium enhancement in T1-weighted sequences (B). After 16 days, follow-up MRI showed no alterations in DWI and fluid attenuated inversion recovery (FLAIR) sequences (D and C).