Table 1.

Clinical features, investigations, treatment, and outcome of 14 positive SARS-CoV-2 cases.

S. No.	Patient demographic	Neurological presentation	Associated COVID-19 symptoms	Positive SARS-CoV-2 test type	Relevant blood investigations and radiologic findings	Neurological investigations (CSF findings, neuroimaging)	Treatment and outcome
		Cerebrovascular accidents
1	55 yr F	Patient presented with left hemiparesis with global aphasia.	Two weeks after the stroke developed fever with dyspnoea.	Upper Respiratory swab PCR	Increased total cell count with neutrophilic leucocytosis. Mildly deranged transaminases with deranged INR (2.54). CRP was raised. D-dimer was raised. Chest X ray showed an opaque left hemi thorax suggestive of a collapse/consolidation.	CT brain showed right malignant MCA infarct. MRA showed MCA main stem occlusion	Treated conservatively for stroke. After development of COVID-19 symptoms required intubation and mechanical ventilator. Died within 2 days of diagnosis of COVID-19.
2	70 yr F	Patient presented with sudden onset left hemiparesis (lower limb more than upper limb), NIHSS 6 at the time of admission with a window period of 3.5 h.	Cough and sore throat at the time of admission.	Upper Respiratory swab PCR	Normal blood counts and other parameters. CRP was raised. Ferritin Normal.	Infarct in right centrum semiovale. Left CCA showing 30% stenosis.	Was thrombolysed with alteplase. Post-thrombolysis her NIHSS improved from 6 to 4. She was treated with azithromycin, hydroxychloroquine, and was discharged on day 15 post-admission.
		Meningoencephalitis
3	15 yr M	Patient presented with fever and headache from 5 days prior to admission.	Sore throat, diarrhea, and fever 5 days prior to admission.	Upper Respiratory swab PCR positivity, negative CSF PCR	Routine investigations were normal.	CSF study revealed an opening pressure of 30 cm of water, 12 cells (60% lymphocytes, and 40% neutrophils) with normal sugar, protein levels. Negative culture and Virology results with a negative TB PCR. MRI brain was normal.	Empirically started on acyclovir but had disabling headache. Put on dexamethasone, topiramate, acetazolamide. Required a repeat lumbar puncture for therapeutic purpose. Discharged on tapering dose of dexamethasone, acetazolamide, and topiramate. One month into follow up patient is symptom free and not on any medication.
4	35 yr F	Presented with new onset focal seizures with impaired awareness, acute onset memory impairment.	Fever 7 days prior to presentation.	Upper Respiratory swab PCR positivity, negative CSF PCR	Routine investigations normal.	CSF study 100 cells with 90% lymphocytes and mildly raised protein (56mg/dl). Negative cultures and virology panel. MRI showed T2/Flair hyperintensity in left temporo-occipital lobe, hippocampus with diffusion restriction, and right frontal periventricular white matter T2 flair hyperintensity (Figure 1). EEG showed generalized slowing.	Empirically started on acyclovir and levetiracetam. Then put on dexamethasone. Discharged after 14 days of inpatient stay with a diagnosis of probable COVID-19 encephalitis.
5	38 yr M	Presented with fever, headache, altered behavior.	Fever 5 days prior to admission.	Upper Respiratory swab PCR positivity, negative CSF PCR	Routine investigations normal.	Lumbar puncture showed 200 cells with 90% lymphocytes with increased protein. Negative cultures and virology pattern. Negative TB PCR. MRI brain with contrast normal.	Treated empirically with acyclovir but gradual improvement in symptoms, no other treatment given.
6	23 yr M	Presented with headache, fever, altered sensorium.	Fever, myalgia, vomiting, abdominal pain five days prior to admission.	Upper Respiratory swab PCR positivity, negative CSF PCR	Normal counts. Deranged liver function Tests, hyponatremia. CXR showed opacities (Figure 2).	CSF showed 94 cells 80% neutrophils and normal sugar and protein. MRI brain normal/CT Normal. Negative culture and viral serology. TB PCR negative.	Treated with anti tubercular drugs, acyclovir and dexamethasone.
		Other neurological diseases with COVID-19
7	70 yr F	Patient diagnosed case of tubercular meningitis presented with altered sensorium.	Fever Shortness of breath	Upper Respiratory swab PCR. Initial test was Negative	Normal counts with hyponatremia. Rest investigations within normal limit. CT chest showed consolidation in bilateral upper zone and right lower zone.	CSF study showed 140 cells with 90% lymphocytes with normal sugar and increased protein (112 mg/dl). Neuroimaging consistent with TBM with hydrocephalus.	Treated with dexamethasone, anti-tubercular drugs, mannitol, and acetazolamide. She was referred for neurosurgical intervention.
8	25 yr F	Diagnosed case of Tubercular Meningitis with CNS Tuberculoma on treatment presented with status epilepticus.	Fever, Myalgia, Dyspnea 4 days prior to admission.	Upper Respiratory swab PCR	Neutrophilic leucocytosis with hypokalemia, CXR showing right lower zone opacities.	MRI brain with contrast suggestive of Tuberculoma. EEG suggestive of generalized epileptiform discharges. CSF normal study.	Treated for status epilepticus, Anti tubercular drugs, recovered and discharged.
9	15 yr F	Seizures and myoclonus	Asymptomatic	Upper Respiratory swab PCR	Normal investigations.	CSF showed 2 cells with normal sugar and protein. EEG showed slow periodic 2-3Hz discharges. CSF IgG positive for measles antibody	Diagnosed as SSPE - Treated with valproate, levetiracetam. She was asymptomatic. Discharged after monitoring.
10	53 yr M	Presented with status epilepticus and altered mental status.	Asymptomatic	Upper Respiratory swab PCR	Increased counts. Deranged Liver function test. CXR showed Bilateral middle zone opacities.	Gliosis in left fronto parietal lobes. CSF normal study.	Treated for status epilepticus with IV antibiotics and hydroxychloroquine, recovered well and discharged.
11	45 yr M	Diabetic patient presented with right eye ptosis, complete ophthalmoplegia, anosmia, ageusia with headache.	Fever and running nose 10 days prior to admission.	Upper Respiratory swab PCR positivity, negative CSF PCR	Leucocytosis with other normal blood parameters.	Neuroimaging revealed right side cavernous sinus thrombosis with pansinusitis. CSF study showed 35 cells with 90% lymphocytes and normal sugar and protein. Negative for culture and virology. TB-PCR negative.	Treated with IV antibiotics and IV amphoterecin B on suspicion of fungal cavernous sinus thrombosis.
12	48 yr F	Diabetic patient presented with altered sensorium and non-convulsive status.	Asymptomatic	Upper Respiratory swab PCR	Leucocytosis with raised blood sugar and serum osmolality. CXR was normal.	Neuroimaging showed bilateral caudate hyperdensities with hypodensity in left basal ganglia. EEG showing generalized epileptiform discharges. CSF study was normal.	On treatment with IV anti epileptics, insulin infusion.
13	65 yr M	Peripheral nervous system manifestationPresented with paraparesis with progressing weakness to upper limb and dysphagia.	Fever, ageusia five days prior to presentation. Cough present at the time of admission.	Upper Respiratory swab PCR	Neutrophilic Leucocytosis with Thrombocytosis. Hyponatremia. CXR Normal.	Demyelination with secondary axonal changes in nerve conduction studies.	On Intravenous immunoglobulin.
14	30 yr M	Loss of smell and taste.	Asymptomatic	Upper Respiratory swab PCR	Normal	Normal	Isolation and hydroxychloroquine for 5 days.