COVID-19 Presenting as a Seizure: A Kenyan Case Report

Abstract

The new coronavirus quickly spread throughout the world in late 2019 and became a pandemic in early 2020. The most common symptoms observed are fever, dry cough, loss of taste and smell, and respiratory distress. Other rarer complications can involve the cardiovascular, gastrointestinal, or neurological systems. Of the neurological complications, epileptic seizures are a subject of particular interest due to their relatively unknown and widespread etiologies. It is understood that the entry or production of pro-inflammatory cytokines during a COVID-19 infection can result in neurotransmitter modulation and ion channel dysfunction, leading to neuronal hyperexcitability, presenting as seizures. To the best of our knowledge, we present the first case in sub-Saharan Africa of a COVID-19 positive patient presenting to our institution with a reported seizure followed by confusion. Our case highlights the need to broaden our differential diagnosis to include COVID-19 infections in patients presenting with seizures.

Cognitive impairment after long COVID-19: current evidence and perspectives

“…COVID-19 patients are often accompanied by sympathetic excitation and metabolic disorders such as hyperglycemia, hyperhomocysteinemia, and insulin resistance ( 55 , 56 ). This can damage the brain's structure and function, such as the hippocampus, by affecting the energy supply and neurotransmitter balance in the key brain areas ( 57 ). Hyperglycemia can produce excess free radicals and oxidative stress, damage hippocampal neurons, and is associated with cognitive impairment ( 58 ).…”

Hypoxic convulsions induced by adult respiratory distress syndrome in Covid-19 patient

“…1,3,8 Manifestations of hypoxic convulsions are similar to those of idiopathic epilepsy, however epileptic seizures due to acute hypoxia -hypoxemia are also often accompanied by severe pathological changes such as neuronal ischemic necrosis and developing of partial cortical softening regions due to impaired blood brain barrier permeability. 2,3,[7][8][9][10][11][12] It leads to higher neuronal excitability and lower the epileptic seizure threshold. [9][10][11][12] Similar condition is seen in chronic hypobaric hypoxia in high-altitude regions where low oxygen tension leads to various neurological diseases such as epilepsy.…”

“…2,3,[7][8][9][10][11][12] It leads to higher neuronal excitability and lower the epileptic seizure threshold. [9][10][11][12] Similar condition is seen in chronic hypobaric hypoxia in high-altitude regions where low oxygen tension leads to various neurological diseases such as epilepsy. 6 During hypoxia the cerebral blood circulation decreases due to elevation of hematocrit and blood viscosity.…”

“…1,2 8-14 Chronic hypoxia damages the physiological function of the blood-brain barrier by increasing its permeability and triggers series of neurotoxic reactions through the above-mentioned side effects of neuro-inflammation and oxidative stress. [4][5][6][7][8][10][11][12]…”