Neurology Resident University of Manitoba Winnipeg, Manitoba, Canada
Rationale: The Coronavirus Disease 2019 (COVID-19) has become a worsening global pandemic, with up to 67% of severe COVID-19 patients having neurological manifestations of the disease, including seizures and transient ischemic events. Methods: Case study. Results: A 69-year-old woman presented with acute visual disturbance. Her past medical history included developmental delay, childhood polio, and CREST syndrome. Left-sided neglect was noted. When her left eye was covered, she had difficulty reaching for objects. On brain CTA, left internal carotid artery occlusion and reconstitution in the ophthalmic segment were seen. Within hours, the patient was back to baseline, and amaurosis fugax was suspected. However, brain MRI the next day for left-sided neglect revealed right parietooccipital cortical hyperintensity (Figure 1). Over the next two days, the patient developed diarrhea in addition to depth perception issues. The next day, she was brought to our hospital’s emergency department with new abdominal pain. Vital signs were initially unremarkable, but the patient became hypoxic. Within hours, she required ten liters of oxygen. Both eyes were deviated to the left, and she intermittently followed commands. She had a witnessed generalized tonic-clonic seizure that spontaneously resolved within one minute. Over the next few hours, EEG captured several focal right parietooccipital seizures with impaired awareness and left gaze deviation (Figure 2). She was started on levetiracetam and phenytoin, as well as empiric antibiotics and acyclovir. Over the next three days, her level of consciousness decreased, and hypothermia developed. On day 7, a three-day course of intravenous methylprednisolone was started. By day 12, she was able to sit up in bed and speak appropriately. Throughout hospitalization, there was episodic diarrhea, fluctuating respiratory status, and arrhythmia. On day 21, she was swabbed for COVID-19, which was positive, after an outbreak was identified on the patient’s ward. While COVID-19 testing was performed late, the patient had systemic symptoms consistent with COVID-19 preceding hospitalization. Conclusions: Overall, the case illustrated neurological symptoms associated with acute COVID-19 infection through two suspected mechanisms: neuronal hyperexcitability and ischemia. To our knowledge, this is the first described case of new onset occipital seizures presenting as COVID-19. This case therefore illustrates the importance of considering new occipital seizures in patients with visual phenomena accompanied by COVID-19 symptoms. This may be of particular therapeutic significance, as seizures may be a highly treatable manifestation of the infection. Funding: Please list any funding that was received in support of this abstract.: None. Click here to view image/table
