(Kiosk 7) COVID-19 Induced Encephalopathy in a Young Healthy Patient: A Case Report

Case Diagnosis: Encephalopathy secondary to COVID-19 virus.

Case Description or Program Description: 21-year-old male with a history of L4 pars fracture presented with generalized weakness and inability to walk several hours after finishing a gym workout. The patient subsequently tested positive for COVID-19. The patient was started on remdesivir and solumedrol. MRI of the brain, cervical, thoracic, and lumbar regions showed no acute abnormalities. His cardiac workup was unremarkable as well.

Setting: Acute Inpatient Rehabilitation Facility

Assessment/Results: Initially patient had severe lower extremity weakness bilaterally with generalized lethargy. Bed mobility and transfers were with minimal assistance. The patient was able to ambulate 10ft with a rolling walker with contact guard assist. During acute rehab stay, the patient was able to ambulate 50 feet with a straight cane and transfer from bed to chair independently. The patient was discharged to follow up for rehab in an outpatient setting.

Discussion (relevance): Throughout the past few years, around 103 million COVID-19 cases were diagnosed in America. 36.4% of those had neurological manifestations, sometimes in the absence of respiratory symptoms. Rare neurological complications like Guillain Barre, and encephalopathy have also been reported. COVID-19 induced encephalopathy is most common in critically ill patients with multiple comorbidities. However, our patient was a young male with no comorbid conditions, making this an unusual presentation. Our patient made significant neurological recovery after receiving remdesivir for 5 days and IV solumedrol for 4 days. Due to lack of acute findings on imaging, the diagnosis of COVID-19 induced encephalopathy is supported.

Conclusions: Encephalopathy is a severe manifestation of COVID-19 that can often present without evidence of any respiratory symptoms. Our study suggests glucocorticoid may play a role in treating COVID-19 encephalopathy. However more studies are needed to understand pathophysiology and treatment of neurologic symptoms caused by COVID-19.