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BMJ Case Rep ; 13(10)2020 Oct 15.
Article in English | MEDLINE | ID: covidwho-873485


Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.

Behavioral Symptoms , Brain Infarction , Brain Stem , Cerebellar Diseases , Cerebellum , Cognitive Dysfunction , Coronavirus Infections , Pandemics , Pneumonia, Viral , Adult , Behavioral Symptoms/diagnosis , Behavioral Symptoms/physiopathology , Behavioral Symptoms/rehabilitation , Betacoronavirus/isolation & purification , Brain Infarction/diagnosis , Brain Infarction/physiopathology , Brain Infarction/psychology , Brain Infarction/rehabilitation , Brain Stem/blood supply , Brain Stem/diagnostic imaging , COVID-19 , Cerebellar Diseases/physiopathology , Cerebellar Diseases/psychology , Cerebellar Diseases/rehabilitation , Cerebellar Diseases/virology , Cerebellum/blood supply , Cerebellum/diagnostic imaging , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/rehabilitation , Cognitive Dysfunction/virology , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Humans , Male , Neurologic Examination/methods , Neuropsychological Tests , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Psychiatric Rehabilitation/methods , SARS-CoV-2 , Treatment Outcome