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Abstract Details

Refractory Focal Status Epilepticus as Presenting Symptom of COVID-19
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
070
To describe a new clinical presentation of COVID-19.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has demonstrated an ability to affect a multiple organ systems beyond acute respiratory distress syndrome. Acute symptomatic seizures have been described and cortical irritation from blood-brain barrier breakdown, precipitated by the viral cytokine reaction may contribute to pathogenesis. To our knowledge, there are no previously reported cases describing refractory focal motor status epilepticus as the initial presentation to SARS-CoV-2 infection in a patient without a history of prior seizures.
We reviewed a case of focal status epilepticus secondary to coronavirus 2019 (COVID-19) treated in a tertiary referral setting.

A 45-year-old Native American man, with history of hypertension and diabetes presented to a rural emergency department for evaluation of 2-day duration of involuntary, rhythmic movements of the left hand. Computed tomography head demonstrated remote left lenticulostriate perforator infarct but no acute intracranial abnormalities. SARS-CoV-2 RdRp gene nasal swab testing was positive for COVID-19. Involuntary, rhythmic movements were unabated despite treatment of hyperglycemia and use of midazolam and levetiracetam. Patient underwent transfer for higher level care and his focal status epilepticus resolved after initiation of fosphenytoin. Electroencephalogram (EEG) showed moderate generalized slowing and rhythmic sharply contoured theta activity of 4 hertz, poorly localized but seen maximally in the paracentral head regions. After seizure control, the patient developed fever and more classic manifestions of Covid-19.
New onset focal status epilepticus is more often associated with structural changes such as stroke or history of epilepsy. EEG did not demonstrate obvious seizure focus, but in the case of small seizure foci, scalp EEG can be unremarkable as would be expected in this case. To our knowledge, this is the first known case in the United States of a patient with Covid-19 presenting with the initial symptom of focal status epilepticus.
Authors/Disclosures
Allyson Hamacher, PA
PRESENTER 		Ms. Hamacher has received personal compensation in the range of $500-$4,999 for serving as a Speaker with ThriveAP.
Sara Dawit, MD Dr. Dawit has nothing to disclose.
Matthew T. Hoerth, MD, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic Arizona) Dr. Hoerth has a non-compensated relationship as a Epilepsy.com Editorial Board member with the Epilepsy Foundation of America that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.
Maciej M. Mrugala, MD, PhD, MPH, FÂ鶹´«Ã½Ó³»­ (Mayo Clinic) Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Veevo Biomedicines Inc. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Arbor Pharmaceuticals. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra-Zeneca. Dr. Mrugala has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Servier. Dr. Mrugala has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Medscape. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck. Dr. Mrugala has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Kyiatec . The institution of Dr. Mrugala has received research support from Arbor Pharmaceuticals. Dr. Mrugala has a non-compensated relationship as a Program Director with Society for Neuro-Oncology that is relevant to Â鶹´«Ã½Ó³»­ interests or activities.