Disclosures: Devon M. Zorn, MD: No financial relationships or conflicts of interest

Case Diagnosis: SARS-CoV2 Encephalitis

Case Description: A 53-year-old healthy man presented to an outside hospital in January for two days of persistent headache, vomiting, and fever. He was found to be positive for SARS-CoV2 via PCR. Lumbar puncture showed pleocytosis and pan-negative cultures. He became obtunded and required intubation. Brain MRI revealed T2 enhancement in the left parietal cortex, bilateral thalami, and pons. Working diagnosis was encephalitis related to SARS-CoV2 infection. He was treated with a five-day course of remdesevir, empiric antibiotics, IV dexamethasone, and plasma exchange, after which he showed marginal improvement in mentation and was extubated. At time of acute hospital discharge, his mentation had improved to alert and oriented to self. He had hypophonia, confused speech, and balance deficits. He was discharged to acute inpatient rehabilitation.

Setting: Acute Hospital and Acute Inpatient Rehabilitation HospitalAssessment/

Results: Rehab admission MoCA score of 22/30 improved to 25/30 seventeen days later, with improvements in memory, verbal fluency, and visuospatial abilities. He was discharged to home at a supervision level with moderate cues for IADLs and persistent inattention, planning, and processing deficits.

Discussion: There is limited but increasing data about SARS-CoV2 presenting as an encephalitis with altered consciousness [ 2, 3, 4]. The pathophysiology may be a result of edema from inflammatory injury versus direct viral infection [1]. Little is known about the long-term impact of this diagnosis. With treatment, time, and supportive care, our patient’s level of consciousness and cognition improved drastically. He demonstrated functional breakdowns including inattention and impulsivity, while maintaining good mobility and preserved memory. His work within a structured brain injury program was crucial in maximizing his return to independence.

Conclusion: Encephalitis in the setting of SARS-CoV2 infection may present with deficits in attention and impulsivity while sparing memory and general mobility. This patient benefitted from the structured brain injury acute rehabilitation program as he recovered.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/sars-cov2-encephalitis-spares-memory-affects-language-and-attention/