Coronavirus in a patient with positive PCR test in cerebrospinal fluid led to an acute generalized tonic-clonic convulsion without brain lesion in computed tomography scan: a case report

Document Type : Case Report

Authors
D. Shalilahmadi 1
M. Sobouti 2
M. Momeni 3
K. Bavarsad 2
S. Ghafouri 2
1 Ahvaz Jundishpur University of Medical Sciences
2 Ahvaz Jundishapur University of Medical Sciences
3 Tehran University of Medical Sciences
Abstract
Background:

SARS-CoV-2 which first was observed in Wuhan region, China in December 2019 has affected many organs, such as central nervous system. We describe a case of a 57-year-old male patient, in the hospital with the loss of consciousness, in the form of lack of verbal and visual communication. He got a seizure attack for about 3 minutes in the form of generalized tonic-clonic seizure (GTS) and admitted to the neurological department and was intubated. Since, the patient was not aware, awake, did not obey, corneal reflexes test was positive and his pupils were isochoric and reactive therefore, the primary diagnosis was cerebrovascular accident (CVA). On the second day after admission, although the brain computed tomography (CT) did not show brain lesion, but the chest X-ray (CXR) revealed lung involvement. In addition, on third day the RT-PCR test for coronavirus RNA in and the cerebrospinal fluid and nasopharyngeal swap done and the result was positive for both of them. Therefore, treatment for the covid-19 was started.

Results:

Since, the treatment for the covid-19 was started with Atazanavir, Clindamycin and Ceftriaxone. Ten days after hospitalization, the lung involvement and general condition of patient got better and after two weeks he was released from the hospital.

Conclusion:

GTS should be considered as a neurological outcome of COVID-19 and medications against the coronavirus, such as Atazanavir, Clindamycin and ceftriaxone can recover the neurological deficits in these patients.

Keywords

1. Sun, M., et al., Clinical characteristics of 30 COVID-19 patients with epilepsy: A retrospective study in Wuhan. International Journal of Infectious Diseases, 2021. 103: p. 647-653.
2. Belani, P., et al., COVID-19 is an independent risk factor for acute ischemic stroke. American Journal of Neuroradiology, 2020. 41(8): p. 1361-1364.
3. Astaraki, P. and B. Hadian, Coronavirus case presentation in a patient with loss of consciousness due to dyspnea. Annals of Medicine and Surgery, 2021. 71: p. 102994.
4. Han, A.Y., et al., Anosmia in COVID-19: mechanisms and significance. Chemical senses, 2020. 45(6): p. 423-428.
5. Koralnik, I.J. and K.L. Tyler, COVID-19: A Global Threat to the Nervous System. Ann Neurol, 2020. 88(1): p. 1-11.
6. Romero-Sanchez, C.M., et al., Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology, 2020. 95(8): p. e1060-e1070.
7. Bohmwald, K., et al., Neurologic alterations due to respiratory virus infections. Frontiers in cellular neuroscience, 2018. 12: p. 386.
8. Carod-Artal, F.J., Neurological complications of coronavirus and COVID-19. Rev Neurol, 2020. 70(9): p. 311-322.
9. Pennisi, M., et al., SARS-CoV-2 and the nervous system: from clinical features to molecular mechanisms. International journal of molecular sciences, 2020. 21(15): p. 5475.
10. Ellul, M.A., et al., Neurological associations of COVID-19. Lancet Neurol, 2020. 19(9): p. 767-783.
11. Li, Y., et al., Acute cerebrovascular disease following COVID-19: a single center, retrospective, observational study. Stroke Vasc Neurol, 2020. 5(3): p. 279-284.
12. Morassi, M., et al., Stroke in patients with SARS-CoV-2 infection: case series. J Neurol, 2020. 267(8): p. 2185-2192.
13. Miller, E.H., et al., Cerebrospinal Analysis in Patients With COVID-19. Open Forum Infect Dis, 2020. 7(11): p. ofaa501.
14. Nikbakht, F., A. Mohammadkhanizadeh, and E. Mohammadi, How does the COVID-19 cause seizure and epilepsy in patients? The potential mechanisms. Multiple sclerosis and related disorders, 2020: p. 102535.
15. Kim, H.K., Y.J. Cho, and S.-Y. Lee, Neurological manifestations in patients with COVID-19: experiences from the Central Infectious Diseases Hospital in South Korea. Journal of Clinical Neurology (Seoul, Korea), 2021. 17(3): p. 435.
16. Chaves, O.A., et al., Atazanavir is a competitive inhibitor of SARS-CoV-2 Mpro, impairing variants replication in vitro and in vivo. Pharmaceuticals, 2021. 15(1): p. 21.
17. Singh, S.P., A. Qureshi, and W. Hassan, Mechanisms of action by antimicrobial agents: a review. McGill Journal of Medicine, 2021. 19(1).
18. Adebisi, Y.A., et al., The use of antibiotics in COVID-19 management: a rapid review of national treatment guidelines in 10 African countries. Tropical medicine and health, 2021. 49(1): p. 1-5.
19. Bellon, M., et al., Cerebrospinal Fluid Features in Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Reverse Transcription Polymerase Chain Reaction (RT-PCR) Positive Patients. Clinical Infectious Diseases, 2020.
Pathobiology Reserach
Volume 25, Issue 1
January 2022
Pages 57-59