Treat the lungs and wait for the brain in COVID-19: a case report of severe COVID-19 encephalopathy

ABSTRACT

Encephalopathy is a severe and underestimated neurological complication of COVID-19 infection, with a high prevalence in COVID-19 patients in intensive care. We present a case of a 68-year-old male with severe COVID-19 encephalopathy and prolonged lowered consciousness, without showing any brain imaging abnormalities. There are multiple mechanisms of cause, such as inflammatory, hypoxic-metabolic and sepsis-related factors, and residual sedation, which were treated as described without effect on the encephalopathy. Interestingly, our patient showed no abnormalities on brain imaging and the encephalopathy only disappeared a full month after respiratory recovery. Encephalopathy considerably prolonged his ICU stay and after discharge from the medical rehabilitation clinic, he still showed mild neurological impairment. The late neurological recovery suggests that the severity of encephalopathy may not only be related to the severity of the COVID-19 pneumonia and there might be an inflammatory neurological response, without showing brain imaging abnormalities. Copyright © 2022, Netherlands Society of Intensive Care. All rights reserved.