Abstract

Introduction: Initially recognized as a disease of respiratory system, the information about COVID-19 has evolved gradually and is well established that beyond the respiratory system, as it damages other organs as well. Majority of the COVID-19 patients admitted in hospitals may develop neurological signs and symptoms. We report an interesting case of a 52-year-old male with COVID-19 disease, who presented with symptoms of cardiac / respiratory involvement, but had signs of encephalitis and neuro cognitive impairment. Presentation of Case: 52-year-old male patient presented with chest pain, shortness of breath, shivering and sweating. He was tested positive for SARS-CoV-2 (COVID-19) 10 days prior to the presentation. He is known to have hypertension, type 2 diabetes, dyslipidaemia, asthma and congenital nystagmus. He appeared unwell and slightly confused with hesitant speech. Neurological examination revealed hesitant speech, horizontal nystagmus in all directions, myoclonic jerks, ataxia and tremor. Developed seizures during the hospital stay and was started on anti-convulsants. MRI Brain showed nonspecific white matter hyper intensities / small vessel disease and a lumbar puncture returned with a moderately high glucose only while being negative for meningitis/encephalitis multiplex polymerase chain reaction tests. EEG was done to concede theta frequency background slowing waves. Patient was started on pulsed high dose methylprednisolone therapy for cognitive impairment. A 5 day course of intravenous immunoglobulins was then prescribed which allowed resolution of the jerks with marked improvement in his cognitive and motor responses. Patient was discharged home on oral medication on his 19th admission day with regular occupational and physiotherapy sessions as part of his rehabilitation. Discussion: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), now known as COVID-19 was primarily a disease of the respiratory system. Over the period of time, the virus has invaded the cardiac and the neurovascular system. There is lack of evidence with regards to the exact pathophysiology and the extent of involvement of the central and peripheral nervous system. The exact mechanism and pathophysiology of the neurological manifestation of COVID-19 is less understood and studies are in progress.