Abstracts

Rationale: During recent pandemic due to COVID-19, variety of neurological manifestations are noted. They include anosmia/dysosmia, extreme fatigue, stroke, seizures, encephalitis, isolated GBS, headache, insomnia, etc. The details of full spectrum of the neurological manifestation is not well known. We present patients with status epilepticus in association with acute COVID-19 infection.

Methods: Retrospective review of clinical records of patient admitted at a tertiary care facility with acute COVID 19 infection who were also found to be in status epilepticus during that admission. All relevant clinical, imaging, laboratory and neurophysiologic information was reviewed.

Results: Total of 4 cases of status epilepticus recognized. Two of the patients developed hypoxic encephalopathy following cardiac arrest in one and respiratory failure on the other. Both patients developed status epilepticus (nonconvulsive status epilepticus in one and myoclonic status epilepticus in another). Both of these patients died shortly after. Of the other two patients, one was a 68-year-old woman presenting with altered mental status found to be in left temporal non-convulsive status epilepticus with MRI findings consistent with left mesial temporal lobe encephalitis in the setting of COVID-19 infection. Her CSF was negative for infectious etiology (including COVID-19 PCR) and extensive work-up for autoimmune encephalitis was unyielding. She had a prolonged hospital course and was discharged to skilled nursing facility. The last patient was a 50-year-old man who had illness consistent with COVID infection and his nasal RT-PCR was positive for COVID. He was treated at home with supportive care. Two weeks later he presented to the ED after a car accident due to convulsive seizures. He was found to be in non-convulsive status epilepticus and imaging revealed a small left PCA territory infarct and irregularity of the left PCA. He was treated and recovered with only a quadrantanopia.

Conclusions: Status epilepticus appears to be rarely associated with COVID-19 infection and when present, it is secondary to another neurological insult. The prognosis is dependent upon the underlying cause. A larger prospective study is needed to understand the full spectrum of COVID-19 neurological manifestations.

Funding: Please list any funding that was received in support of this abstract.: No funding was received in support of this abstract.