(Kiosk 7) Acute Encephalopathy Secondary to COVID-19 Induced Ventriculitis: A Case Report

Case Diagnosis: Acute Encephalopathy Secondary to COVID-19 Induced Ventriculitis

Case Description or Program Description: A 54-year-old female was admitted for a subarachnoid hemorrhage from a ruptured left posterior communicating aneurysm. Initial treatment included placement of an external ventricular drain (EVD), which was complicated by Serratia ventriculitis requiring antibiotics, left hemicraniectomy, wound washout, and EVD replacement. Her rehab course was complicated by Coronavirus Disease 19 (COVID-19) diagnosis, which led to a sudden non-verbal presentation and novel ataxia. Imaging was notable for increasing hydrocephalus and ventriculomegaly. Patient underwent a lumbar puncture, which was suggestive of bacterial infection. Further infectious workup including meningitis panel and cerebrospinal fluid gram stain and culture was negative. Given the otherwise negative infectious workup, the patient's ventriculitis was attributed to COVID-19 infection. Patient was managed with empiric antibiotics and Remdesivir with improvement of mentation.

Setting: Acute Inpatient Rehabilitation (IPR)

Assessment/Results: COVID-19 induced ventriculitis hampered her functional gains during her IPR course from contact guard level ambulation to 2-person dependent ambulation and communication difficulties.

Discussion (relevance): COVID-19 is known to primarily affect the respiratory system. However, recent studies have shown that COVID-19 can also manifest with neurological complications, such as encephalitis and Guillain-Barre syndrome. Common neurological symptoms reported include decreased level of consciousness and seizures. Other less common presentations include ataxia and aphasia, which was the case with our patient. This case also showcased evidence of ventriculitis on imaging, not traditionally seen in COVID-19 patients. Literature regarding neurological findings of COVID-19 has been documented, however evidence of COVID-19 induced ventriculitis remains scarce.

Conclusions: The profound, widespread impacts of COVID-19 continue to create sequela of enigmatic origins, even 3 years after the onset of the pandemic, as evidenced by this case of worsening functional status due to ventriculitis. It is imperative to be cognizant of the clinical status of all patients in order to maximize functional gain during their IPR course.