COVID-19 Encephalitis with SARS-CoV-2 Detected in Cerebrospinal Fluid Presenting as a Stroke Mimic

J Stroke Cerebrovasc Dis. 2021 Sep;30(9):105915. doi: 10.1016/j.jstrokecerebrovasdis.2021.105915. Epub 2021 May 31.

Abstract

We report the case of a 35-year-old male with COVID-19 encephalitis presenting as a stroke mimic with sudden-onset expressive and receptive dysphasia, mild confusion and right arm incoordination. The patient received thrombolysis for a suspected ischaemic stroke, but later became febrile and SARS-CoV-2 was detected in cerebrospinal fluid. Electroencephalography demonstrated excess in slow waves, but neuroimaging was reported as normal. Respiratory symptoms were absent throughout and nasopharyngeal swab was negative for SARS-CoV-2. At the most recent follow-up, the patient had made a full neurological recovery. Clinicians should therefore consider testing for SARS-CoV-2 in CSF in patients who present with acute focal neurology, confusion and fever during the pandemic, even when there is no evidence of respiratory infection.

Keywords: COVID-19; Encephalitis; SARS-Cov-2; Stroke mimic.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • COVID-19 / cerebrospinal fluid
  • COVID-19 / diagnosis*
  • COVID-19 / virology
  • COVID-19 Nucleic Acid Testing*
  • Diagnosis, Differential
  • Electroencephalography
  • Encephalitis, Viral / cerebrospinal fluid
  • Encephalitis, Viral / diagnosis*
  • Encephalitis, Viral / virology
  • Humans
  • Ischemic Stroke / diagnosis*
  • Magnetic Resonance Imaging
  • Male
  • Predictive Value of Tests
  • RNA, Viral / cerebrospinal fluid*
  • SARS-CoV-2 / genetics*
  • Tomography, X-Ray Computed

Substances

  • RNA, Viral