Atypical neurologic sequelae post COVID-19 infection

Introduction: Though neurologic sequelae are well known complications of viral infections, specific syndromes related to COVID-19 are still being discovered. This case report seeks to highlight an atypical presentation of acute disseminated encephalomyelitis. Case Description: 42 year old female with no past medical history presented with bilateral lower extremity weakness with associated numbness and urinary retention onset 2 days prior. Patient reported ascending lower extremity weakness and numbness, starting from toes that spread to thigh level. Patient tested positive for COVID-19 2 weeks before presentation. Patient described her illness as anosmia, dysgeusia and mild diarrhea. Foley was placed after bladder scan showed greater than 600mL of urine. MRI brain showed subtle T2/FLAIR hyperintensity involving: bilateral thalami, periventricular white matter of the parietal lobes, left middle cerebellar peduncle and left lateral pons suspicious for post-viral inflammatory process known as acute disseminated encephalomyelitis. Lumbar puncture was significant for elevated myelin basic protein. Patient was treated with high-dose intravenous steroids and symptoms resolved within 5 days. Discussion: This case highlights an atypical presentation of acute disseminated encephalomyelitis in the setting of prior COVID-19 infection. The patient’s history of recent infection, clinical exam, location of MRI brain lesions and CSF findings are consistent with an acute demyelinating process in the context of prior COVID-19 infection. As more COVID-19 complications are discovered, it is important to consider acute disseminated encephalomyelitis in the workup of post-viral neurologic complications as early recognition and treatment are essential.