Abstract Details

Title COVID-19 associated Posterior Reversible Encephalopathy Syndrome

Topic Infectious Disease

Presentation(s) Infectious Disease Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 009

Objective To report a unique case of posterior reversible encephalopathy syndrome (PRES) secondary to COVID-19 infection.

Background PRES was first described in 1996, it usually manifests with rapid onset of symptoms including headache, seizures, altered sensorium, visual disturbance and reversible vasogenic edema in MRI, most commonly in association with severe hypertension, kidney disease, and with immunosuppressive therapy. It is also known to occur with severe systemic infections. This is a case report of PRES secondary to COVID-19.

Design/Methods We report a case of a 77 year old female with no prior history of seizures who presented to our hospital with new-onset recurrent generalized tonic-clonic seizures. She was recently symptomatic with loss of taste, cough, shortness of breath and tested positive for COVID-19. She has no history of hypertension, malignancy or renal disease, and not on immunosuppressant.
Her blood pressure was normal and she was non-focal on examination, she received lorazepam and loaded with levetiracetam and seizures stopped. Labs showed leukocytosis and high inflammatory markers including D-Dimer and ferritin levels, in addition to evidence of subsegmental pulmonary embolism on CTA chest indicating the severe underlying inflammatory and hypercoagulable state.

Results MRI brain showed multiple bilateral frontal, parietal and occipital T2 FLAIR hyperintensities which is more pronounced posteriorly in addition to bilateral cerebellar hemispheres involvement compatible with PRES diagnosis. EEG showed left-hemispheric LPDs but no ongoing seizures. COVID-19 PCR was found to be positive from the CSF sample.

Conclusions COVID-19 is a novel coronavirus that affects mainly the respiratory system but is a multi-systemic disease with reported neurological complications including stroke and demyelinating lesions. Our case suggests that PRES is another neurological complication that can be caused by COVID-19 infection. PRES occurs due to blood-brain barrier disruption and endothelial dysfunction which may be one of the COVID-19 pathophysiological mechanisms that can affect the nervous system.

Authors/Disclosures
Ammar Tarabichi, MD PRESENTER	Dr. Tarabichi has nothing to disclose.
Faisal A. Ibrahim, MD (Cleveland Clinic Foundation)	Dr. Ibrahim has nothing to disclose.
Ahmed Abbas, MD	Dr. Abbas has nothing to disclose.
Hesham A. Allam, MD (Saint Louis University Hospital)	Dr. Allam has nothing to disclose.

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Abstract Details