Confusion and Hallucination: A Case Report of an Unusual Presentation of COVID-19

Aljumaiah, Rawabi; Alturaiki, Wael; Alosaimi, Bandar

doi:10.1155/2021/3794019

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…In some studies, with severe cases, stroke, seizure, and encephalopathy has also been reported as neurological symptoms [27]. Moreover, although confusion and hallucination has been considered as atypical and unusual presentation of COVID-19 [28], many independent studies have described these symptoms as a recurrent neurologic manifestation of COVID-19 [29,30]. In our study, 28% of the patients with neurological and mental manifestations showed confusion and 17% of patients experienced hallucination.…”

Section: Plos Onesupporting

confidence: 47%

Inventory study of an early pandemic COVID-19 cohort in South-Eastern Sweden, focusing on neurological manifestations

et al. 2023

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Background Neurological manifestations in patients with COVID-19 have been reported previously as outcomes of the infection. The purpose of current study was to investigate the occurrence of neurological signs and symptoms in COVID-19 patients, in the county of Östergötland in southeastern Sweden. Methods This is a retrospective, observational cohort study. Data were collected between March 2020 and June 2020. Information was extracted from medical records by a trained research assistant and physician and all data were validated by a senior neurologist. Results Seventy-four percent of patients developed at least one neurological symptom during the acute phase of the infection. Headache (43%) was the most common neurological symptom, followed by anosmia and/or ageusia (33%), confusion (28%), hallucinations (17%), dizziness (16%), sleep disorders in terms of insomnia and OSAS (Obstructive Sleep Apnea) (9%), myopathy and neuropathy (8%) and numbness and tingling (5%). Patients treated in the ICU had a higher male presentation (73%). Several risk factors in terms of co-morbidities, were identified. Hypertension (54.5%), depression and anxiety (51%), sleep disorders in terms of insomnia and OSAS (30%), cardiovascular morbidity (28%), autoimmune diseases (25%), chronic lung diseases (24%) and diabetes mellitus type 2 (23%) founded as possible risk factors. Conclusion Neurological symptoms were found in the vast majority (74%) of the patients. Accordingly, attention to neurological, mental and sleep disturbances is warranted with involvement of neurological expertise, in order to avoid further complications and long-term neurological effect of COVID-19. Furthermore, risk factors for more severe COVID-19, in terms of possible co-morbidities that identified in this study should get appropriate attention to optimizing treatment strategies in COVID-19 patients.

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Section: Plos Onesupporting

confidence: 47%

Inventory study of an early pandemic COVID-19 cohort in South-Eastern Sweden, focusing on neurological manifestations

et al. 2023

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Escitalopram/midazolam

2022

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A 34-year-old man exhibited lack of efficacy following treatment with escitalopram and midazolam for insomnia, restlessness, anxiety and aggressive behaviour [routes not stated; not all dosages stated].The man presented to the emergency department at King Fahad Medical City, Saudi Arabia on 23 June 2020 with hallucinations and anxiety for 5 days. He was hospitalised. Anamnesis revealed that his symptoms had started during the COVID-19 lockdown from 23 May 2020 until 27 May 2020 in Saudi Arabia. He had initially developed insomnia, restlessness and deep fears of death (anxiety). A psychiatry physician had examined him and prescribed escitalopram 10mg daily. However, despite five days of escitalopram therapy, he had developed visual and auditory hallucinations, along with anxiety and aggressive behavior, indicating lack of efficacy to escitalopram. Upon current admission, he was reported to be seeing and talking gibberish, speaking short religious phrases and hearing voices. He was conscious, alert, and oriented to the time and place but not to person. His Glasgow Coma Scale (GCS) score was 13/15 as the verbal response was inappropriate words (level 3 in GCS score). Respiratory, cardiovascular, and abdominal examination findings were unremarkable. Initially, a presumed diagnosis of acute confessional state was considered. A nasopharyngeal swab for COVID-19 was obtained due to his recent history of contact with sick patients in his family. He was admitted to isolation room with close monitoring. He was treated with midazolam, which could not control his restlessness and aggressive behaviour. He was presumed to have delirium and rhabdomyolysis and was treated with sodium chloride [normal saline]. Cultures from sputum, blood, and urine were requested. He was empirically treated with piperacillin/ tazobactam. He was also treated with haloperidol and lorazepam. Twenty-four hours later, SARS-CoV-2 RT-PCR screening test yielded positive result. Subsequently, his aggression and anxiety improved. His hallucinations, confusion, insomnia, restlessness, anxiety and aggressive behaviour were considered to be complications of COVID-19. Thereafter, his vital signs were noted to be reassuring and he was calmer but still confused with GCS score 13/15. Seventy-two hour post-admission, results from a septic blood screen and urine culture were found to be negative. However, he developed sinus tachycardia with increase in respiratory rate. He was administered sodium chloride. He became more tachypneic and tachycardic with GCS score to 10/15. He collapsed and cardiopulmonary resuscitation was conducted for 45 min with no response. Death was declared at 18:35pm.

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Understanding the state of confusion in patients with psychosis during COVID-2019 pandemic: A report of two cases

Cvjetković-Bošnjak

Bibic²,

Nedic

et al. 2022

Med pregl

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Introduction. There is a lot of evidence that coronavirus disease 2019 has various manifestations. This paper presents a report of two cases with the aim to indicate the multifactorial etiology of confusional states in patients with mental disorders at the time coronavirus disease 2019 pandemic. The severe acute respiratory syndrome coronavirus-2 affects not only the respiratory and cardiovascular systems, but also the brain, kidneys and other organ systems. One of the first manifestations of this infection can be mental confusion. Case Study. The first patient, a woman diagnosed with schizoaffective psychosis, suddenly presented with confusion, followed by hypersedation which was at first attributed to overmedication. In another patient, with the diagnosis of bipolar affective disorder, sudden confusion (delirium) was initially recognized as an element of mental disorder deterioration. A more detailed observation revealed that the confused state in both patients was caused by severe acute respiratory syndrome coronavirus-2 infection. Discussion. It is common for the manifestations of severe acute respiratory syndrome coronavirus-2 infection to include respiratory and cardiovascular syimptoms. However, symptoms related to other organs and organ systems, including changes in neurological and psychological status, should not be ignored. Conclusion. It was noticed that confusion and delirium-like states are quite common early symptoms of coronavirus disease 2019. In psychiatric patients, it is always necessary to rule out the organic etiology of the consciousness disorder and immediately proceed with the diagnostic procedures. One should certainly keep in mind that diagnostic errors are possible, not only due to various manifestations of the infection, but also due to the stigmatization of mental illness, which must be overcome in order to provide the best possible treatment effects.

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Confusion and Hallucination: A Case Report of an Unusual Presentation of COVID-19

Cited by 3 publications

References 8 publications

Inventory study of an early pandemic COVID-19 cohort in South-Eastern Sweden, focusing on neurological manifestations

Inventory study of an early pandemic COVID-19 cohort in South-Eastern Sweden, focusing on neurological manifestations

Escitalopram/midazolam

Understanding the state of confusion in patients with psychosis during COVID-2019 pandemic: A report of two cases

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