ABSTRACT
Post-infectious neurological sequelae, particularly in the pediatric population, are a rarely observed and under-explored complication of COVID-19. Few case reports exist detailing severe neurological sequelae following acute infection with COVID-19, such as encephalopathy, stroke, and coma. This case report details the diagnosis and treatment of a 16-year-old primigravida with no past medical history who presented to the emergency department with rhythmic tremors, urinary incontinence, and generalized weakness two weeks following initial COVID-19 diagnosis with admission for pneumonia and sepsis. Vital signs were remarkable for tachycardia and normotension. Shortly following admission, she experienced generalized tonic-clonic seizure activity. Neurologic evaluation was remarkable for electroencephalogram with frontally predominant generalized periodic discharges and magnetic resonance imaging of the head showing bilateral parafalcine restricted diffusion. Cerebrospinal fluid analysis and magnetic resonance imaging of the spine were unremarkable. The patient was ultimately diagnosed with reversible cerebral vasoconstriction syndrome and an anterior cerebral artery stroke. Throughout the patient's recovery, she demonstrated incoherent, delirious, and disinhibited behavior that resolved within several days. She was ultimately discharged to a skilled rehabilitation facility with follow-up in a neurology clinic.
ABSTRACT
The pandemic caused by COVID-19 is affecting populations and healthcare systems worldwide. As we gain experience managing COVID-19, more data become available on disease severity, course, and treatment in patients infected with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, data in pregnancy remain limited. This narrative review of COVID-19 during pregnancy underscores key knowledge gaps in our understanding of the impact of this viral infection on reproductive health. Current data suggest that pregnant people have similar disease course and outcomes compared to nonpregnant people, with the majority experiencing mild disease; however, pregnant people may have increased risk of hospitalization and intensive care unit (ICU) admission. Among patients who develop severe and critical disease, major maternal morbidity and mortality have been described including cardiomyopathy, mechanical ventilation, extracorporeal membrane oxygenation, and death. Many questions remain regarding maternal severity of disease in COVID-19. Further research is needed to better understand disease course in pregnancy. Additionally, the inclusion of pregnant patients in therapeutic trials will provide vital data on treatment options for patients. As we continue to treat more patients affected by SARS-CoV-2, multidisciplinary care and continued research are both needed to achieve optimal outcomes for mother and fetus.