Encephalitis with status epilepticus and stroke as complications of non-severe COVID-19 in a young female patient: a case report

Background Neurological manifestations of COVID-19 are thought to be associated with the disease severity of COVID-19 and poor clinical outcomes. Dysregulated immune responses are considered to be mediating such complications. Our case illustrates multiple critical neurological complications simulta...

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Bibliographic Details
Published in:BMC neurology 2022-07, Vol.22 (1), p.1-253, Article 253
Main Authors: Koh, Seungyon, Kim, Yoon Seob, Kim, Min Hye, Choi, Young Hwa, Choi, Jun Young, Kim, Tae-Joon
Format: Article
Language:English
Subjects:
Antiviral agents
Case Report
Case studies
Cerebrospinal fluid
Coronaviruses
COVID-19
Electroencephalography
Encephalitis
Epilepsy
Immune response
Immunotherapy
Interleukin 6
Magnetic resonance imaging
Neurological complications
Patient outcomes
Patients
Pleocytosis
Pneumonia
Risk factors
Seizures
Status epilepticus
Stroke
Stroke (Disease)
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Summary:Background Neurological manifestations of COVID-19 are thought to be associated with the disease severity of COVID-19 and poor clinical outcomes. Dysregulated immune responses are considered to be mediating such complications. Our case illustrates multiple critical neurological complications simultaneously developed in a patient with non-severe COVID-19 and successful recovery with a multifaceted therapeutic approach. The cerebrospinal fluid (CSF) interleukin-6 (IL-6) level was temporally correlated with the clinical severity of the status epilepticus in our patient, suggesting a causal relationship. Case presentation A previously healthy 20-year-old female patient presented with a first-onset seizure. Concomitant non-severe COVID-19 pneumonia was diagnosed. CSF study showed lymphocytic pleocytosis with elevated IL-6 levels in CSF. During hospitalization under the diagnosis of autoimmune encephalitis, status epilepticus developed, and the seizure frequency was temporally correlated with the CSF IL-6 level. Furthermore, a new embolic stroke developed without a significant cardioembolic source. Contrary to the exacerbated COVID-19-associated neurological complications, COVID-19 pneumonia was cleared entirely. After treatment with antiseizure medications, antithrombotics, antiviral agents, and immunotherapy, the patient was discharged with near-complete recovery. Conclusion Active serological, and radiological evaluation can be helpful even in non-severe COVID-19, and multidimensional treatment strategies, including immunotherapy, can successfully reverse the neurological complication. Keywords: COVID-19, Status epilepticus, Encephalitis, Stroke, Interleukin-6
ISSN:1471-2377
1471-2377
DOI:10.1186/s12883-022-02782-3