Disclosures: Breonna E. Holland, MD: No financial relationships or conflicts of interest

Case Diagnosis: Previously healthy 21 year old male recently diagnosed with SARS-CoV-2 (COVID-19) infection

Case Description: Emergency Medical Services (EMS) was called 5 days after COVID-19 diagnosis due to altered mental status. Seizure activity was noted after EMS arrived. At the hospital he was intubated and sedated due to status epilepticus. MRI showed diffuse leptomeningeal enhancement without signs of vascular occlusion or infarct. EEG showed encephalopathy with several subclinical seizures. Cerebrospinal fluid (CSF) studies were negative for known infectious or autoimmune pathology. CSF COVID-19 testing was not available. He was diagnosed with COVID-19 meningoencephalitis.

Setting: tertiary academic medical centerAssessment/

Results: His MRI and EEG findings resolved over the course of 8 weeks, but he remained with significant cognitive and communicative impairments. His hospital course was prolonged due to agitation and ongoing intermittent seizures requiring multiple medication adjustments. Eventually, he was able to be admitted to inpatient rehab. Throughout his rehab course he demonstrated catatonia and overall had very inconsistent performance making visual and auditory impairments difficult to evaluate despite clinical concern. However, his respiratory status improved and he had his tracheostomy decannulated. His dysphagia also improved and feeding tube removal was being considered. His inpatient rehab course remained in progress at time of submission.

Discussion: Seizures have not been commonly reported findings during the COVID-19 pandemic. This patient’s initial hospitalization was prompted due to altered mentation and status epilepticus. Despite resolution of imaging findings, cognitive communication deficits and neurobehavioral dysfunction remained more than 3 months after infection. It is interesting to consider this case in light of the “long haulers” who experience negative effects from the virus long after they have cleared the infection.

Conclusion: While there have been reports of neurological involvement with COVID-19 infection, this case demonstrates unique severe and prolonged neurocognitive impairment in a previously healthy, young individual.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/status-epilepticus-and-prolonged-neurocognitive-impairment-after-sars-cov-2-infection-in-previously-healthy-21-year-old-a-case-report/