Hostname: page-component-8448b6f56d-sxzjt Total loading time: 0 Render date: 2024-04-17T15:52:43.564Z Has data issue: false hasContentIssue false
  • English
  • Français

Neuropsychiatric manifestations in a patient with prolonged COVID-19 encephalopathy: case report and literature review

Published online by Cambridge University Press:  21 September 2021

J. O’Leary ,
J. McAndrew ,
A. Shukralla  and
K.C. Murphy
J. O’Leary*
Affiliation:
Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
J. McAndrew
Affiliation:
Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
A. Shukralla
Affiliation:
Department of Neurology, Beaumont Hospital, Dublin, Ireland
K.C. Murphy
Affiliation:
Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland
*
Address for correspondence: J. O’Leary, Email: juliaoleary@mater.ie
Get access Rights & Permissions [Opens in a new window]

Abstract

While the respiratory complications of COVID-19 infection are now well known, psychiatric manifestations are an emerging issue. We report a case of prolonged encephalopathy secondary to COVID-19 which was associated with prominent neuropsychiatric features. The patient went on to develop sub-clinical seizures, a rare but recognised complication of SARS-CoV-2.

Keywords

COVID-19deliriumencephalopathy
Type
Case Report
Information
Irish Journal of Psychological Medicine , Volume 40 , Issue 3 , September 2023 , pp. 487 - 490
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of The College of Psychiatrists of Ireland

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Al Saiegh, F, Ghosh, R, Leibold, A, Avery, MB, Schmidt, RF, Theofanis, T, Mouchtouris, N, Philipp, L, Peiper, SC, Wang, ZX, Rincon, F, Tjoumakaris, SI, Jabbour, P, Rosenwasser, RH, Gooch, MR (2020). Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. Journal of Neurology, Neurosurgery, and Psychiatry 91, 846–848 DOI 10.1136/jnnp-2020-323522.CrossRefGoogle ScholarPubMed
Army Individual Test Battery (1944). Manual of Directions and Scoring. War Department, Adjunct General’s Office: Washington, DC.Google Scholar
Balloy, G, Leclair-Visonneau, L, Péréon, Y, Magot, A, Peyre, A, Mahé, PJ, Derkinderen, P (2020). Non-lesional status epilepticus in a patient with coronavirus disease 2019. Clinical Neurophysiology 131, 2059–2061 DOI 10.1016/j.clinph.2020.05.005.CrossRefGoogle Scholar
Benussi, A, Pilotto, A, Premi, E, Libri, I, Giunta, M, Agosti, C, et al. (2020). Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy. Italy Neurology 95, e910–e920 DOI 10.1212/WNL.0000000000009848.CrossRefGoogle ScholarPubMed
Bernard-Valnet, R, Pizzarotti, B, Anichini, A, Demars, Y, Russo, E, Schmidhauser, M, Cerutti-Sola, J, Rossetti, AO, Du Pasquier, R (2020). Two patients with acute meningoencephalitis concomitant with SARS-CoV-2 infection. European Journal of Neurology 27, e43–e44 DOI 10.1111/ene.14298.CrossRefGoogle ScholarPubMed
Bodro, M, Compta, Y, Sánchez-Valle, R (2020). Presentations and mechanisms of CNS disorders related to COVID-19. Neurology(R) Neuroimmunology & Neuroinflammation 8, e923 DOI 10.1212/NXI.0000000000000923.Google ScholarPubMed
Bohmwald, K, Gálvez, N, Ríos, M, Kalergis, AM (2018). Neurologic alterations due to respiratory virus infections. Frontiers in Cellular Neuroscience 12, 386 DOI 10.3389/fncel.2018.00386.CrossRefGoogle ScholarPubMed
Desforges, M, Le Coupanec, A, Brison, E, Meessen-Pinard, M, Talbot, PJ (2014). Neuroinvasive and neurotropic human respiratory coronaviruses: potential neurovirulent agents in humans. Advances in Experimental Medicine and Biology 807, 75–96 DOI 10.1007/978-81-322-1777-0_6.CrossRefGoogle ScholarPubMed
Dogan, L, Kaya, D, Sarikaya, T, Zengin, R, Dincer, A, Akinci, IO, Afsar, N (2020). Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: case series. Brain, Behavior, and Immunity 87, 155–158 DOI 10.1016/j.bbi.2020.05.022.CrossRefGoogle ScholarPubMed
Folstein, MF, Folstein, SE, McHugh, PR (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research 12, 189–198 DOI 10.1016/0022-3956(75)90026-6.CrossRefGoogle ScholarPubMed
Galanopoulou, AS, Ferastraoaru, V, Correa, DJ, Cherian, K, Duberstein, S, Gursky, J, et al. (2020). EEG findings in acutely ill patients investigated for SARS-CoV-2/COVID-19: a small case series preliminary report. Epilepsia Open 5, 314–324 DOI 10.1002/epi4.12399.CrossRefGoogle ScholarPubMed
Garg, RK, Paliwal, VK, Gupta, A (2020). Encephalopathy in patients with COVID-19: a review. Journal of Medical Virology 93, 206–222 DOI 10.1002/jmv.26207.CrossRefGoogle ScholarPubMed
Hsieh, S, Schubert, S, Hoon, C, Mioshi, E, Hodges, JR (2013). Validation of the Addenbrooke’s Cognitive Examination III in frontotemporal dementia and alzheimer’s disease. Dementia and Geriatric Cognitive Disorders 36, 242–250 DOI 10.1159/000351671.CrossRefGoogle ScholarPubMed
Huang, YH, Jiang, D, Huang, JT (2020). SARS-CoV-2 detected in cerebrospinal fluid by PCR in a case of COVID-19 encephalitis. Brain, Behavior, and Immunity 87, 149 DOI 10.1016/j.bbi.2020.05.012.CrossRefGoogle Scholar
Hui, DS, Azhar, I, Madani, E, T., A, Ntoumi, F, Kock, R, Dar, O, Ippolito, G, Mchugh, TD, Memish, ZA, Drosten, C, Zumla, A, Petersen, E (2020). The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health - the latest 2019 novel coronavirus outbreak in Wuhan, China. International Journal of Infectious Diseases 91, 264–266 DOI 10.1016/j.ijid.2020.01.009.CrossRefGoogle ScholarPubMed
Hui, DS, Wong, KT, Antonio, GE, Tong, M, Chan, DP, Sung, JJ (2009). Long-term sequelae of SARS: physical, neuropsychiatric, and quality-of-life assessment. Hong Kong Medical Journal 15 Suppl 8, 21–23.Google ScholarPubMed
Irish National Public Health Emergency Team Statement - Saturday 29 February (2020).(https://www.gov.ie/en/press-release/2f75fd-statement-from-the-national-public-health-emergency-team-sat-29-feb/). Accessed 10 July 2020.Google Scholar
Kelly, B (2020). Impact of COVID-19 on mental health in Ireland: evidence to date. Irish Medical Journal 113, P214.Google Scholar
Kim, JE, Heo, JH, Kim, HO, Song, SH, Park, SS, Park, TH, Ahn, JY, Kim, MK, Choi, JP (2017). Neurological complications during treatment of middle east respiratory syndrome. Journal of Clinical Neurology (Seoul, Korea) 13, 227–233 DOI 10.3988/jcn.2017.13.3.227.CrossRefGoogle ScholarPubMed
Krakow, K, Allen, PJ, Symms, MR, Fish, DR, Lemieux, L (1999). Imaging of interictal epileptiform discharges using spike-triggered fMRI. International Journal of Bioelectromagnetism 1, 96–101.Google Scholar
Lewis, A, Frontera, J, Placantonakis, DG, Lighter, J, Galetta, S, Balcer, L, Melmed, KR (2021). Cerebrospinal fluid in COVID-19: a systematic review of the literature. Journal of the Neurological Sciences 421, 117316 DOI 10.1016/j.jns.2021.117316.CrossRefGoogle ScholarPubMed
Lucchese, G (2020). Cerebrospinal fluid findings in COVID-19 indicate autoimmunity. The Lancet Microbe 1, e242 DOI 10.1016/S2666-5247(20)30147-6.CrossRefGoogle ScholarPubMed
Lu, H, Stratton, CW, Tang, YW (2020). Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle. Journal of Medical Virology 92, 401–402 DOI 10.1002/jmv.25678.CrossRefGoogle ScholarPubMed
Mao, L, Jin, H, Wang, M, Hu, Y, Chen, S, He, Q, Chang, J, Hong, C, Zhou, Y, Wang, D, Miao, X, Li, Y, Hu, B (2020). Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurology 77, 683–690 DOI 10.1001/jamaneurol.2020.1127.CrossRefGoogle ScholarPubMed
Nalleballe, K, Reddy Onteddu, S, Sharma, R, Dandu, V, Brown, A, Jasti, M, et al. (2020). Spectrum of neuropsychiatric manifestations in COVID-19. Brain, Behavior, and Immunity 88, 71–74 DOI 10.1016/j.bbi.2020.06.020.CrossRefGoogle ScholarPubMed
Nasreddine, ZS, Phillips, NA, Bédirian, V, Charbonneau, S, Whitehead, V, Collin, I, Cummings, JL, Chertkow, H (2005). The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment. Journal of the American Geriatrics Society 53, 695–699 DOI 10.1111/j.1532-5415.2005.53221..CrossRefGoogle Scholar
Natoli, S, Oliveira, V, Calabresi, P, Maia, LF, Pisani, A (2020). Does SARS-Cov-2 invade the brain? Translational lessons from animal models. European Journal of Neurology 27, 1764–1773 DOI 10.1111/ene.14277.CrossRefGoogle ScholarPubMed
Needham, EJ, Chou, SH, Coles, AJ, Menon, DK (2020). Neurological implications of COVID-19 infections. Neurocritical Care 32, 667–671 DOI 10.1007/s12028-020-00978-4.CrossRefGoogle ScholarPubMed
Paules, CI, Marston, HD, Fauci, AS (2020). Coronavirus infections—more than just the common cold. JAMA 323, 707–708 DOI 10.1001/jama.2020.0757.CrossRefGoogle ScholarPubMed
Patel, S, Carey, C, Cotter, D, Murphy, K (2020). A psychoeducational intervention increases use of a delirium protocol by Neurologists and Neurosurgeons in patients with brain disorders. Published online 23 November 2020. Irish Journal of Psychological Medicine, 1–9 DOI 10.1017/ipm.2020.98.Google ScholarPubMed
Petrescu, AM, Taussig, D, Bouilleret, V (2020). Electroencephalogram (EEG) in COVID-19: a systematic retrospective study. Neurophysiologie Clinique = Clinical Neurophysiology 50, 155–165 DOI 10.1016/j.neucli.2020.06.001.CrossRefGoogle ScholarPubMed
Salehi, S, Abedi, A, Balakrishnan, S, Gholamrezanezhad, A (2020). Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. American Journal of Roentgenology 215, 87–93 DOI 10.2214/AJR.20.23034.CrossRefGoogle ScholarPubMed
Scullen, T, Keen, J, Mathkour, M, Dumont, AS, Kahn, L (2020). Coronavirus 2019 (COVID-19)-associated encephalopathies and cerebrovascular disease: the New Orleans experience. World Neurosurgery 141, e437–e446 DOI 10.1016/j.wneu.2020.05.192.CrossRefGoogle ScholarPubMed
Sherman, AC, Williams, ML, Amick, BC, Hudson, TJ, Messias, EL (2020). Mental health outcomes associated with the COVID-19 pandemic: prevalence and risk factors in a southern US state. Psychiatry Research 293, 113476 DOI 10.1016/j.psychres.2020.11.CrossRefGoogle Scholar
Somani, S, Pati, S, Gaston, T, Chitlangia, A, Agnihotri, S (2020). De novo status epilepticus in patients with COVID-19. Annals of Clinical and Translational Neurology 7, 1240–1244 DOI 10.1002/acn3.51071.CrossRefGoogle ScholarPubMed
Taquet, M, Luciano, S, Geddes, JR, Harrison, PJ (2021). Bidirectional associations between COVID-19 and psychiatric disorder: retrospective cohort studies of 62 354 COVID-19 cases in the USA. The Lancet Psychiatry 8, 130–140 DOI 10.1016/S2215-0366(20)30462-4.CrossRefGoogle ScholarPubMed
Troyer, EA, Kohn, JN, Hong, S (2020). Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms. Brain, Behavior, and Immunity 87, 34–39 DOI 10.1016/j.bbi.2020.04.027.CrossRefGoogle ScholarPubMed
Varatharaj, A, Thomas, N, Ellul, MA, Davies, N, Pollak, TA, Tenorio, EL, et al. (2020). Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. The Lancet Psychiatry 7, 875–882 DOI 10.1016/S2215-0366(20)30287-X.CrossRefGoogle ScholarPubMed
Vollono, C, Rollo, E, Romozzi, M, Frisullo, G, Servidei, S, Borghetti, A, Calabresi, P (2020). Focal status epilepticus as unique clinical feature of COVID-19: a case report. Seizure 78, 109–112 DOI 10.1016/j.seizure.2020.04.009.CrossRefGoogle ScholarPubMed
Wang, W, Xu, Y, Gao, R, Lu, R, Han, K, Wu, G, Tan, W (2020). Detection of SARS-CoV-2 in different types of clinical specimens. JAMA 323, 1843–1844 DOI 10.1001/jama.2020.3786.Google ScholarPubMed
World Health Organization (WHO) (2020, March 11). WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11. Geneva. (https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020). Accessed 15 July 2020.Google Scholar
Wuhan Municipal Health Commission (2020, January 20). Report of novel coronavirus-infected pneumonia in China. (http://wjw.wuhan.gov.cn/front/web/showDetail/2020012009077). Accessed 20 November 2020.Google Scholar
Xiong, J, Lipsitz, O, Nasri, F, Lui, L, Gill, H, Phan, L, Chen-Li, D, Iacobucci, M, Ho, R, Majeed, A, McIntyre, RS (2020). Impact of COVID-19 pandemic on mental health in the general population: a systematic review. Journal of Affective Disorders 277, 55–64 DOI 10.1016/j.jad.2020.08.001.CrossRefGoogle ScholarPubMed
Zangaladze, A, Nei, M, Liporace, JD, Sperling, MR (2008). Characteristics and clinical significance of subclinical seizures. Epilepsia 49, 2016–2021 DOI 10.1111/j.1528-1167.2008.01672.x.CrossRefGoogle ScholarPubMed