Case presentation
A 29-year-old female was brought to the emergency department with
frequent episodes of generalized tonic-clonic seizures. There was no
history of prior seizure, headache, behavioral change, hemiparesis, and
any other neurological symptoms. Likewise, she had no other symptoms
regarding involvement of other organs by COVID-19 at the time of
admission. The seizures were stopped with a loading dose of
levetiracetam (3000 mg per day). Initial brain and chest computed
tomography scans as well as brain magnetic resonance imaging with and
without contrast did not show any abnormality (Figure 1). Using the
real-time polymerase chain reaction (RT-PCR) test, the nasopharyngeal
swab sample was positive for SARS-CoV-2. CSF analysis indicated normal
opening pressure with normal glucose and protein levels. The CSF culture
was negative for different microorganisms. Antibodies responsible
for autoimmune encephalitis were also negative. However, the RT-PCR test
for SARS-CoV-2 in the CSF was positive. The electroencephalogram
revealed epileptiform discharges in bilateral temporal areas (figure 2).
The summary of the laboratory data is shown in Table 1.
During hospitalization, the patient received a maintenance dose of
levetiracetam (3000 mg/day) and sodium valproate (1600 mg/day). The
antiviral treatment was also started with 200 mg remdesivir on day 1,
followed by 100 mg daily for 4 days. After one week, the patient was
discharged from the hospital with no seizure. The patient remained
seizure-free during 2 months’ follow-up.