MUMBAI, 19 OCTOBER, 2020 (GPN): A teamheaded by Dr Pavan Pai, a Neurologist at Wockhardt Hospital Mira Road, successfully treated a critically ill 47-year-old woman with altered sensorium like impaired consciousness, central nervous system (CNS) related symptoms, delirium, brain inflammation, viral meningitis is a rare manifestation of COVID‐19 associated encephalitis. COVID‐19 not only affects respiratory health. Lately, severe neurological complications, like encephalitis, Guillain‐Barré syndrome, and stroke has also been reported in some patients.

Shaista Pathan, a resident of Palghar, a housewife, suddenly became confused, complained of abdominal pain and headache. The patient was taken to a local hospital that administered pain killers to her on 13 August. Still, the pain persisted and her condition deteriorated further. However, the patient was referred to Wockhardt Hospital, Mira Road, wherein her life was saved.

Dr Pavan Pai, a Neurologist at Wockhardt Hospital Mira Road, explained, “On admission,the patient presented with altered sensorium, delirium, confusion, fluctuating consciousness, agitated behavior, fever and abdominal pain on August 14. There was no medical, infectious, or behavioral prodrome in past but had a contact history with her cousin who also had similar symptoms and was tested COVID positive at another hospital. A CT scan of the abdomen, chest, and brain was performed before admitting her to the COVID suspect ICU as her antigen test was negative. Her blood reports were normal. On August 15, an MRI brain was done that showed no bleeding or blood clot in brain. She had neck stiffness and it was suggesting towards CNS infection but she was not allowing to perform CSF analysis to confirm it due to her agitated behaviour. She was given medications to manage meningitis and calm down.  A COVID swab test was done and she was positive. The patient was presumed to have COVID‐19 associated encephalitis and shifted in the COVID ICU.”

The common clinical features of COVID‐19 are cough, shortness of breath, and fever. Lately, COVID‐19 related severe neurological complications, like encephalitis, Guillain‐Barré syndrome, skeletal muscle involvement, and stroke have also been reported. Encephalitis is an acute inflammatory condition of the brain characterized by fever, delirium, and altered consciousness is seen in critically ill patients.

“The patient was treated with antivirals, antiepileptic drug, antibiotics, steroids, and brain edema reduction drugs, to treat the brain infection and help her gain her senses. On 17^th August evening patient recovered, recollected everything, spoke to her relatives, and even ate food on her own. On August 19, her CSF confirmed viral meningitis. She recovered completely, was discharged on August 22, and was sent for a week mandatory quarantine at home,” said Dr Pai.

“I am fortunate to have received prompt and timely treatment at Wockhardt Hospital, Mira Road as I didn’t recollect things after I got infected as it took a toll on my functioning of the brain. But now I have gained my senses back. I thank doctors for giving me a new lease of life,”concluded patient Shaista Pathan.