Table 1.
Characteristics of patients with COVID-19 and seizure
| Patient # 1 | Patient # 2 | Patient # 3 | Patient # 4 | Patient # 5 | |
|---|---|---|---|---|---|
| Age | 54 years | 42 years | 35 years | 2.9 years | 2 days (term) |
| Sex | Female | Male | Male | Male | Female |
| Chief complaint | Seizure (status epilepticus) | Fever, cough | Altered mental status | Fever, status epilepticus | Respiratory distress |
| Time of seizure from the onset | 1st day | 15th day | 1st day | 1st day | 1st day |
| Fever | No | Yes | Yes | Yes | No |
| Cough | Yes | Yes | Yes | No | No |
| Respiratory distress | Yes | Yes | Yes | No | Yes |
| Headache | No | No | No | - | - |
| Altered mental status | Yes | No | Yes | Yes | Yes |
| Other neurological symptoms/signs | No | No | Left pupil 2 mm non-reactive (right 3 mm reactive) | Dysarthria, bilateral upward plantar reflexes | No |
| Other signs/symptoms | No | No | Increased secretions, bilateral rales | Nausea, vomiting, abdominal pain | No |
| Comorbidity | HIV infection | No | HIV infection | Allergy to cow milk | Low birth weight |
| PaO2 | 68–90 | 22–88 | 58–100 | 52–91 | 37 |
| Admitted | ICU | ICU | ICU | ICU | ICU |
| Ventilator | Yes | No | Yes | Yes | Yes |
| Abnormal blood works | BUN 49 mg/dL, creatinine 2.8 mg/dL, platelet 55,000 per microliter | D-Dimer 6396 ng/mL, PTT 56 s, LDH 1398 U/L | CRP 91 mg/L, ESR 98 mm/h | Troponin I 154 ng/ml, CPK 482 U/L, CRP 105 mg/L, LDH1019 U/L | Total bilirubin 6 mg/dL, bicytopenia (RBC 1.93 × 106 and WBC 2000 per microliter), blood sodium level = 126 mEq/L |
| CSF | 6 PMN, 14 lymphocytes, normal protein and glucose | Not done | Not done | 1st: 1 PMN, normal protein and glucose 2nd: No cell, normal protein and glucose | Not done |
| Chest X-ray | Bilateral diffuse infiltration | Not done | Not done | Bilateral diffuse infiltration | Bilateral diffuse infiltration |
| Chest CT scan | Bilateral diffuse infiltration | Bilateral ground-glass opacity | Multiple nodule and cavity in favor of septic emboli | Not done | Not done |
| Brain imaging | Brain CT: Basal frontal hypodensity | Not done | Brain CT: right ischemic stroke | Brain CT: Right occipital mass and intracerebral hemorrhage. Brain MRI: Right occipital mass (ganglioglioma?) + intracerebral hemorrhage intracerebral hemorrhage@ | Brain sonography: Normal |
| EEG | Generalized slowing | Not done | Not done | Generalized slowing | Not done |
| Treatment (ASM) | Levetiracetam, midazolam | Midazolam | Midazolam, fentanyl, levetiracetam | Phenobarbital, levetiracetam, valproate, phenytoin, midazolam, thiopental, fentanyl | Phenobarbital |
| Other medications | Famotidine, ciprofloxacin, clindamycin, heparin, pantoprazol, propranolol, acyclovir, etomidate | Ranitidine, ondansetron, oseltamivir, levofloxacin, vancomycin, lopinavir/ritonavir, hydroxychloroquine, ribavirin, meropenem, vancomycin, ipratropium, salbutamol, salmeterol/fluticasone | Dexamethasone, vancomycin, atorvastatin, morphine, acetazolamide, dextromethorphan, acetaminophen, meropenem, N-acetylcysteine, magnesium hydroxide, amikacin, enoxaparin, clonidine, lopinavir/ritonavir | Colistin, pantoprazole, acetaminophen, meropenem, hydroxychloroquine, vancomycin, domperidone, acyclovir, dexamethasone, N-acetylcysteine, enoxaparin, vitamin B-complex, norepinephrine, furosemide, potassium chloride, packed cell | Ampicillin, amikacin, vitamin K, ceftrixone, pantoprazole |
| Outcome | Expired in ICU | Expired in ICU | Expired in ICU | Discharged | Expired in ICU |
| Duration of admission (days) | 7 | 3 | 31 | 21 | 3 |
| Follow-up | - | - | - | 4 days after being discharged: No problem, no seizures | - |
HIV human immune deficiency virus, ICU intensive care unit, BUN blood urea nitrogen, PTT partial thrombin time, LDH lactate dehydrogenase, CRP C-reactive protein, ESR erythrocyte sedimentation rate, CPK creatine phosphokinase, PRL prolactin, RBC red blood cell, WBC white blood cell, PMN polymorphonuclear leukocytes
@pathology: normal brain tissue with dilated vessels and hemorrhage