Chief Resident Hofstra Northwell School of Medicine Manhasset, New York
Rationale: Seizures are an infrequent and serious neurological complication of SARS-CoV-2 infection with limited data describing the etiology and clinical context in which these occur, or the associated electrographic and imaging findings. This series details four cases of seizures occurring in patients with COVID-19 with distinct time points, underlying pathology, and proposed physiological mechanisms. An enhanced understanding of seizure manifestations in COVID-19 and their clinical course may allow for earlier detection and improved patient management. Methods: This is a retrospective case series of four patients with COVID-19 and acute seizures, with review of their clinical presentation, relevant laboratory, electrographic and radiographic findings. Results: The cases describe four scenarios of seizures occurring in association with COVID-19, illustrating the remarkable variety of neurological complications accompanying this disease. Case 1 presented with seizures during the acute phase of infection, with elevated inflammatory markers, and FLAIR changes in the temporal region on MRI indicative of focal inflammation. She notably responded well to immunotherapy, with good neurological outcome. In case 2, seizures resulted from acute venous thrombosis, highlighting hypercoagulability associated with COVID-19. Seizures observed in Case 3 manifested in the setting of PRES, raising concern for COVID-19 effects on endothelial cell function and vascular permeability. The last patient was determined to have seizures later in her course along with persistent altered mentation and radiographic findings suggestive of immune mediated necrotizing encephalopathy. Conclusions: Seizures are a serious neurological manifestation of COVID-19. Their occurrence may be an indicator of direct viral involvement, autoimmune mediated inflammation of the brain, or other potential complications including vascular or autoregulatory causes. Funding: Please list any funding that was received in support of this abstract.: None
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