Treatment of unexplained coma and hypokinetic-rigid syndrome in a patient with COVID-19. Issue 3 (2nd March 2021)

• Record Type: Journal Article
• Authors: Roy, Devjit; Song, Justin; Awad, Nirvana; Zamudio, Paul
• Is Part Of: BMJ case reports. Volume 14:Issue 3(2021)
• Publication Date: 2021-03-02
• Subjects: neurology -- intensive care -- rehabilitation medicine -- pharmacology and therapeutics; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2020-239781
• Languages: English
• ISSNs: 1757-790X

Abstract

Abstract : The COVID-19 pandemic has dealt a devastating blow to healthcare systems globally. Approximately 3.2% of patients infected with COVID-19 require invasive ventilation during the course of the illness. Within this population, 25% of patients are affected with neurological manifestations. Among those who are affected by severe neurological manifestations, some may have acute cerebrovascular complications (5%), impaired consciousness (15%) or exhibit skeletal muscle hypokinesis (20%). The cause of the severe cognitive impairment and hypokinesis is unknown at this time. Potential causes include COVID-19 viral encephalopathy, toxic metabolic encephalopathy, post-intensive care unit syndrome and cerebrovascular pathology. We present a case of a 60 year old patient who sustained a prolonged hospitalization with COVID-19, had a cerebrovascular event and developed a persistent unexplained encephalopathy along with a hypokinetic state. He was treated successfully with modafinil and carbidopa/levodopa showing clinical improvement within 3–7 days and ultimately was able to successfully discharge home.