ABSTRACT
Objective: NA Background: A variety of neurologic disorders have been described in patients after receiving the COVID-19 vaccines. Acute disseminated encephalomyelitis (ADEM) have been reported especially in the younger population following any vaccination, including the Covid-19 vaccines. Reports of ADEM in the elderly patients are scarce. Design/Methods: An 83 year old male with history of hypertension, presented with suddenonset of progressive multifocal neurological deficits including blurry vision, upper extremity weakness, numbness and clumsiness with imbalance resulting in multiple falls. A few days later, he reported dysphagia, intermittent expressive aphasia and confusion. Thirteen days prior, he received his second dose of Moderna vaccine. Examination showed mild bilateral upper motor neuron and cerebellar signs. Laboratory tests were unremarkable except for elevated ESR (72), low Vitamins-B12 (311 pg/mL), and D (14.9 ng/mL) levels, and iron deficiency anemia. MRI brain with gadolinium revealed non-enhancing multifocal and confluent supra/infratentorial T2/FLAIR hyperintensity lesions. Cerebrospinal fluid (CSF) analysis showed pleocytosis (whitecell count 13 with 60% lymphocytes), elevated protein (54), and glucose (80), suggestive of underlying inflammation. CSF cytology, meningoencephalitis panel, VDRL, JC-virus PCR, India-ink, acid-fast, bacterial and fungus cultures were negative. HIV antibody was negative. Intravenous Ceftriaxone was initiated until CSF cultures returned negative. Serum anti-MOG and anti-NMO were negative. Repeat imaging within a week showed decreased confluent T2 hyperintensities, but also demonstrated new areas of patchy involvement. The patient received intravenous methylprednisolone 1000 mg daily for 5 days. In the following weeks, his symptoms improved remarkably. Results: NA Conclusions: This 83 year old patient presented with multiple neurologic symptoms, confluent T2-Flair white matter hyperintensities on imaging studies, 13 days post Covid-19 vaccination. Workup for other inflammatory and infectious etiologies was unrevealing. Symptoms improved after intravenous corticosteroids treatment. ADEM is a consideration. Theoretical and actual concerns of vaccine-related neurologic diseases exist, timely recognition and treatment can alter the course and disease progression.
ABSTRACT
Objective: NA Background: The SARS-CoV2 (COVID-19) pandemic has caused a lot of stress and fear of contracting the illness. There have been few cases describing patients presenting with psychiatric manifestations associated with COVID19 infection. Design/Methods: NA Results: We describe the case of a 26-year-old female, health care professional who was diagnosed with COVID19 infection manifested as self-resolved mild body aches, low grade fever and cough for a few days. Patient was evaluated at which time she did not require treatment;therefore, she was advised to self-isolate, which she did in a hotel for 14 days. Patient returned to work after 2 weeks of self-quarantine and resolution of her symptoms. While at work, patient had difficulty with concentration, inappropriate laughing episodes and previously recurring insomnia. She also displayed extreme anxiety towards work, dealing with COVID-19 positive patients, feeling of inadequacy, feeling guilty of spreading corona virus, crying spells, and panic attacks evidenced by palpitations, shortness of breath and restlessness. Patient was initially treated with Alprazolam, Trazodone and Escitalopram. Subsequently, patient returned with auditory hallucinations where voices were telling her that she was killing patients and that her nurse license was fake. Patient also had persecutory delusions, therefore she was afraid she may kill someone and her license will be revoked. She displayed worsening symptoms of anxiety, rapid speech, and suicidal ideations;so an inpatient admission was warranted to rule out other organic causes of acute psychosis. Workup including infectious and metabolic panel, CTH, EEG and spinal tap to rule out encephalitis or other organic causes of her symptoms were unremarkable except for persisting positive COVID 19 PCR. Consequently, she was diagnosed with acute psychosis and was successfully treated with Quetiapine, Escitalopram and Clonazepam. Conclusions: Acute psychosis is a less known complication of COVID19 infection which should be anticipated and managed appropriately to reduce morbidity.