Focal status epilepticus as unique clinical feature of COVID-19: A case report

Abstract

SARS-CoV-2, a novel zoonotic coronavirus, is currently spreading all over the world, causing a pandemic disease defined coronavirus disease 2019 (COVID-19). The spectrum of COVID-19 ranges from asymptomatic or mild infection to rapidly progressive, acute respiratory distress syndrome and death [1].To the best of our knowledge, status epilepticus has never been described as initial presentation of COVID-19. We report a patient affected by COVID-19 whose primary presentation was a focal status epilepticus.

Keywords: COVID-19; Epilepsy; SARS-CoV-2; Status epilepticus; Viral infections.

Fig. 1

Electroencephalogram findings. Panel A: fifteen seconds of normal interictal EEG performed 10 days prior to the status epilepticus. Panels B and C: fifteen seconds (B) and 30 s (C) of ictal EEG. Runs of semi-rhythmic, irregular, high amplitude delta waves, predominantly lateralized over the left fronto-centro-temporal regions and mixed with rhythmic muscle jerks’ artifacts, more evident over the right fronto-temporal leads. Panel D: fifteen seconds of normal interictal EEG recorded after the resolution of status epilepticus.

Fig. 2

Radiological findings. Panels A–D: Magnetic Resonance Imaging scans. (A) Axial Diffusion-Weighted Imaging (DWI); (B) Axial Apparent Diffusion Coefficient (ADC) imaging; (C) Axial post-gadolinium T1-weighted images; (D) Coronal T2-weighted imaging. The MRI scans show extensive gliosis and atrophy involving the left temporo-parietal lobe, in the absence of new cerebral lesions. Panels E and F: Chest X-ray performed upon arrival to the Emergency Room (E) and after the diagnosis of COVID-19 (F), excluding signs of interstitial pneumonia.