244: Persistent Encephalopathy in a COVID-19-Positive Patient Following Resolution of COVID-19 Infection

INTRODUCTION: Neurologic sequelae of COVID-19 infections have been well-documented Studies have shown that neurologic complications are more common in critically ill patients and may be associated with worse outcomes One manifestation of central nervous system (CNS) dysfunction is altered mental status Possible etiologies for neurologic insults in COVID-19 infections include hypoxia, ischemia, viral encephalitis and infectious toxic encephalopathy In this case we will present a COVID-19 positive patient who exhibited persistent encephalopathy despite resolution of COVID-19 infection and the absence of abnormalities on neurologic workup METHODS: Our patient is a 59-year-old female who presented with hypoxemic respiratory failure secondary to COVID-19 pneumonia Patient required mechanical ventilation and was intubated without complications Patient was intubated for a total of 24 days after which she was successfully extubated without complications Following extubation patient opened her eyes but was unable to speak, make eye contact or follow commands Over several days patient's mental status did not improve and brain imaging was performed CT head and brain MRI both showed no acute or chronic intracranial abnormalities Electroencephalogram showed no evidence of seizure activity Patient was also retested for COVID-19 multiple times with negative results At time of discharge patient demonstrated no improvement in mental status and remained completely dependent in activities of daily living despite being extubated and testing COVID-19 negative over two months prior RESULTS: Evidence has shown that COVID-19 can infiltrate the central nervous system as the virus has been isolated in cerebrospinal fluid However, there have been no reported cases of long-term CNS dysfunction following resolution of infection Our case presents a critically ill COVID-19 infected patient who developed persistent encephalopathy with no other abnormalities found on extensive neurologic workup Further study is needed to elucidate the mechanism by which COVID-19 can cause permanent neurologic damage and the frequency of permanent neurologic injury in COVID-19 patients Our case also supports previous evidence that critically ill patients are more susceptible to neurologic sequelae of COVID-19 infections