Case 1: 20-year-old female diagnosed with COVID-19. Patient presented with encephalopathy and other neurologic manifestations. MRI brain showed findings consistent with infectious versus post-infectious encephalitis. CSF studies revealed an elevated protein, marked pleocytosis and normal glucose. Despite no detection of COVID-19 on CSF PCR, a diagnosis of postinfectious COVID-19 encephalitis was made given absence of other underlying etiologies. Patient’s encephalopathy and other neurologic manifestations gradually improved with supportive care. 

Case 2: 42-year-old male was diagnosed with COVID-19 presented with focal seizure without secondary generalization or loss of awareness. Initially patient had fever, chills, cough and backache prior presentation. Patient then developed seizure and  was severely encephalopathic. MRI brain showed findings consistent with infectious versus post-infectious encephalitis. CSF studies revealed a mild elevation in glucose, otherwise unremarkable. Despite no detection of COVID-19 on CSF PCR, a diagnosis of postinfectious COVID-19 encephalitis was made given absence of other underlying etiologies and imaging findings. Patient’s symptoms of encephalopathy, gradually improved with supportive care.

These cases illustrate one of the major late neurologic complications of COVID-19 postinfectious encephalitis. Symptoms can manifest as fever, headache, confusion, and focal neurologic deficits. Multiple cases of COVID-19 involving the CNS was reported; in those with encephalitis, the majority have CSF demonstrating inflammation, pleocytosis, and lymphocytic predominance with no isolated COVID-19 via PCR. Recognition of COVID-19 in the setting of acute encephalitis is imperative, and necessitates that routine testing of CSF for COVID-19 be implemented for suspected COVID-19 encephalitis in the future.