Confusion Syndrome During COVID-19: The "Herb" That Hides the Forest?

We report the case of potential Dysphania ambrosioides (Silverweed) intoxication in the context of SARS-COV-2 infection in a patient admitted for delirium with Glasgow Coma Score (GCS) of 13/15. This herb was used as an antipyretic to treat COVID-19 persistent fever. The clinical presentation of our patient raised several questions related to the viral or herbal intoxication origin of the confusion syndrome. To our knowledge, this is the first description of toxic encephalopathy after D. ambrosioides ingestionin an adult patient.

COVID-19: A Potential Cause of Non-convulsive Status Epilepticus.

Coronavirus disease 2019 (COVID-19) has been described as being primarily responsible for respiratory symptoms. Although several case reports have shown the importance of neurological manifestations, only a few have reported non-convulsive status epilepticus (NCSE) as the first manifestation of COVID-19 infection. Here, we report the case of a 30-year-old male patient with no past medical history who was admitted with altered consciousness. On examination, the patient had a Glasgow Coma Scale (GCS) of 13/15. Vital signs were within normal range. Computed tomography scan of the and magnetic resonance imaging of the brain were normal. Biochemical assessments showed a mild hyponatremia (134 mEq/L) and high levels of D-dimer and lactate dehydrogenase. Urine drug screening did not find any abnormality and a lumbar puncture showed an increased cerebrospinal fluid protein. The result of the reverse transcription polymerase chain reaction test in the nasopharyngeal swab was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Electroencephalogram (EEG) showed a generalized epileptiform activity. Upon undergoing antiepileptic treatment, patient's GCS improved to 15 gradually. A repeated EEG confirmed complete resolution of epileptic abnormalities four days later. This case report shows that SARS-CoV-2 infection can directly involve the central nervous system and can be manifested with isolated NCSE without any other neurological manifestations.

SARS-CoV2 disease seen through the prism of acutely decompensated chronic kidney disease and ischemic stroke: What lesson we have learned from using prophylaxis therapy of vascular thromboembolism?

Our case underlines the tight management of antithrombotic therapy in the context of acutely decompensated chronic kidney disease, ischemic stroke, and SARS-CoV2 infection, the development of stroke as a SARS-CoV2 complication increase the chances of adverse outcomes that may be mitigated by a rapid recognition and institution of available treatments.