First motor seizure as presenting symptom of SARS-CoV-2 infection
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COVID-19
First motor seizure as presenting symptom of SARS-CoV-2 infection Antonio Fasano 1,2
&
Francesco Cavallieri 1,2
&
Elena Canali 2 & Franco Valzania 2
Received: 15 April 2020 / Accepted: 7 May 2020 # Fondazione Società Italiana di Neurologia 2020
Dear Sir, The SARS-CoV-2 pandemic is currently causing concern in the medical community as the virus is rapidly spreading around the world [1]. Since its identification in late December 2019 in China, the epidemiological picture is changing on a daily basis: in the last month, Italy has been the center of the European outbreak with a growing number of infected patients. Although patients with SARS-CoV-2 disease typically present with respiratory symptoms, pieces of information suggest that the virus may also have neurological manifestations [2]. We report a case of first motor seizure as presenting symptom of SARS-CoV-2 infection. The present case further underscores that initial manifestations of novel Coronavirus infection might be non-specific and it highlights the need for physicians to consider potential neurological manifestations of SARS-CoV-2 infection.
Case report On February 28, 2020, a 54-year-old firefighter was admitted to our emergency room (ER) after a single seizure characterized by clonic movements in the right arm and loss of consciousness. His * Antonio Fasano [email protected]; [email protected]; [email protected] Francesco Cavallieri [email protected]; [email protected] Elena Canali [email protected] Franco Valzania [email protected] 1
Clinical and Experimental Medicine, University of Modena and Reggio Emilia, L.go del Pozzo, 71, 41124 Modena, Italy
2
Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Viale Risorgimento 80, 42123 Reggio Emilia, Italy
relatives reported a sudden onset of involuntary and rhythmic movements involving the right hand and arm lasting about 1 or 2 min; after that, it was reported that the patient appeared generally stiffened and he lost consciousness. When he awakened, he was confused for about 30 min. At the ER admission, he reported suffering from conjunctivitis in the last 10 days and mild fever in the past week. He had no remote medical or neurological history; he had been taking ophthalmic steroids during the previous days but he was not under regular medications; there was no history of drug use. Vital parameters, peripheral oxygen saturation, and EKG were normal (body temperature 36.5 °C); neurological examination showed no focal deficits. Serum laboratory tests revealed neutrophilia (85.5%, NR 40–75%), normal white blood cell count (6.38 × 1000/μL, NR 4.0–10.0), lymphopenia (0.69 × 1000/μL, NR 0.8–4.0), normal serum sodium (140.8 mmol/L, NR 132.0–146.0), slightly elevated CRP (1.29 mg/dL, NR 0– 0.5), and AST and ALT enzymes (57 and 59 UI/L respectively, NR 2–40 and 4–49). Head CT scan was unremarkable (Fig. 1a). Chest X-ray showed a single lingular disventilatory band (Fig. 1b). Urinalysis t
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