(Kiosk 6) covid-19 Complications in a 16-year-old Requiring Inpatient Rehabilitation: A Case Study

Case Diagnosis: The patient became a ventilator dependent tetraplegic after complications from Covid-19.

Case Description or Program Description: A 16 year old female with no significant past medical history presented to the emergency department (ED) with fever, diaphoresis, headache, facial asymmetry, and slurred speech. Initial laboratory studies and computed tomography (CT) scan in the ED were normal except for a sodium of 124. While in the ED, she began to experience altered mental status and severe abdominal pain, and later suffered cardiac arrest. She was intubated and found to be Covid-19 positive. Subsequent MRI showed an acute infarction in the right middle cerebral artery and a newly discovered Chiari I malformation. Further investigation found that she had an undiagnosed primary adrenal insufficiency and Hashimoto's thyroiditis. Her respiratory status continued to decline. She underwent a posterior fossa decompression for her Chiari malformation, which was complicated by an epidural hematoma causing myelomalacia at the level of C2.

Setting: After 60 days in acute care she was transferred to an inpatient rehabilitation unit in subacute care after being diagnosed with tetraplegia.

Assessment/Results: Once her condition stabilized, she underwent tracheostomy and became ventilator-dependent. After parental consent, she elected to have bilateral diaphragm phrenic nerve pacer placement, which allowed her to have short periods of time without ventilator assistance.

Discussion (relevance): The phrenic nerve pacers that were placed drastically benefited the patient. The time off the ventilator allowed her to have more freedom which helped ease her anxiety from being tetraplegic. It also aided in her therapies by allowing her to be more active during her sessions.

Conclusions: Understanding pre existing conditions and Covid-19 complications in the pediatric population may assist pediatric care providers in treating future patients with complications from Covid-19.