Fulminant encephalitis as a sole manifestation of COVID-19
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COVID-19
Fulminant encephalitis as a sole manifestation of COVID-19 Masoud Etemadifar 1 & Mehri Salari 2,3
&
Aditya Ashok Murgai 4 & Somayeh Hajiahmadi 5
Received: 6 August 2020 / Accepted: 4 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Novel coronavirus (SARS-CoV-2) occurred in December 2019 in Wuhan, China, and has become a global health emergency. Coronavirus primarily is a respiratory virus, but it has been detected in the brain and cerebrospinal fluid of infected individuals. The present report describes a case of fulminant encephalitis in a patient affected by COVID-19. Keywords COVID-19 . Encephalitis . Fulminant . Sole presentation
Introduction Novel coronavirus (SARS-CoV-2) occurred in December 2019 in Wuhan, China, and has become a global health emergency [1]. Coronavirus primarily is a respiratory virus, but it has been detected in the brain and cerebrospinal fluid of infected individuals [2]. Neurological manifestations can be mild resulting in headache and agitation or more severe causing seizures, encephalitis, stroke, and encephalomyelitis [2]. Neurological and psychiatric consequences of COVID-19 are likely multifactorial due to infection of brain, immunological response, and procoagulant state or due social isolation [3]. * Mehri Salari [email protected] Masoud Etemadifar [email protected] Aditya Ashok Murgai [email protected] Somayeh Hajiahmadi [email protected] 1
Department of Functional Neurosurgery Medical School, Isfahan University of Medical Science, Isfahan, Iran
2
Functional Neurosurgery Research Center, Shohada Tajrish Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3
Department of neurology, Shohada-e-Tajrish Hospital, Tehran 1989934148, Iran
4
Zydus hospital, Ahmedabad, India
5
Department of Radiology, Isfahan University of Medical Science, Isfahan, Iran
The present report describes a case of fulminant encephalitis in a patient affected by COVID-19.
Case presentation A 51-year-old male, an emergency medicine specialist, presented to the emergency department with 3 days history of headaches and drowsiness. His headaches were episodic, bilateral, and associated with nausea and vomiting. He progressively became drowsy and was brought in the emergency department. He denied history of fever but has dry cough for a week. His past medical history revealed hypothyroidism and migraine. He also gave history of intubating a COVID-19 patient a week back. His examination revealed conjunctivitis, blood pressure of 90/50 mmHg, heart rate of 100 beats per minute, oxygen saturation of 98%, and body temperature of 37.6 °C. He was drowsy; following commands, there was no neck stiffness or focal neurological deficit. Electrocardiogram and echocardiography were normal. In the emergency room he had an episode of generalized tonic-clonic seizure followed by a cardiac arrest. He was successfully resuscitated, intubated, and shifted to ICU for further management. His repeated neurological examination
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