Case and Management:
A 47 year old Caucasian male with a past history of uncontrolled hypertension presented to the emergency room in hypertensive emergency and diplopia which developed that morning. He reported four days of diarrhea, nausea, intermittent coughing, and feeling febrile. He tested positive for SARS-CoV-2 and a code stroke was initiated based on his presentation. CTA head and neck were negative for large vessel occlusion. Vitals and labs showed blood pressure at 225/123, WBC 13.2, LDH 185 and normal LFT. He was started on a Nicardipine drip. CSF analysis revealed pleocytosis with protein at 50, RBC 803, and glucose 101. MRI showed acute hemorrhagic leukorhombencephalitis with dilation of the fourth, third, and lateral ventricles. An External ventricular drain (EDV) was placed and he remained on a ventilator due to respiratory insufficiency. He underwent several rounds of plasmapheresis and high dose solumedrol for recovery.