key: cord-0252391-9vo6j9q6 authors: Malekmohammad, Majid; Hashemian, Seyed Mohammad Reza; Mansourafshar, Babak; Jamaati, Hamidreza title: Neurological Manifestations of COVID-19: A Case Report date: 2020-11-03 journal: Tanaffos DOI: nan sha: 9d8e91981afe11de1fd2f82b39f0641fcff5f167 doc_id: 252391 cord_uid: 9vo6j9q6 A novel coronavirus disease (COVID-19) was reported in Wuhan, China in December 2019 and spread rapidly around the world, causing high rates of mortality and morbidity. This disease is known for its respiratory manifestations. Also, there have been several reports of neurological involvement in patients with COVID-19. In this study, we present a 55-year-old Iranian male patient, who was referred from another medical center with a decreased level of consciousness. Upon admission, only respiratory signs of COVID-19 were observed, but later, some neurological manifestations were also observed, such as an alteration in mental status, disorientation, stupor, and finally coma. In radiological studies, a hemorrhagic encephalopathy pattern was detected. Despite improved oxygenation and alleviation of respiratory symptoms with antiviral and anti-inflammatory therapies, cerebral injuries progressed, and the patient died due to severe brain damage. Coronavirus disease 2019 (COVID-19) mostly manifests as pneumonia, involving the lower respiratory tract. This disease may also invade the nervous system. The most common symptoms of COVID-19 include fever, cough, and fatigue, while neurological manifestations, such as seizure, an altered level of consciousness, cerebral ischemia (1) (2) (3) (4) , and encephalitis may be also seen in some patients. Here, we report the case of a patient with lethal neurological complications. The patient was a 55-year-old man, referred to our center with complaints of fever, chills, cough, and fatigue over the last four days. Fever, chill, cough, and fatigue were the first manifestations of the disease, but with time, dyspnea also emerged. The patient was admitted to a center with an oxygen saturation of 75%. His medical history indicated diabetes, without any history of cardiovascular disease or hypertension. During hospitalization in the first center, deterioration of mental status and exacerbation of dyspnea were detected. Accordingly, intubation and mechanical ventilation were applied, and the patient was referred to our center. At the time of admission, the intubated patient was in a coma with no response to painful stimuli; no At the center of the largest lesion, a hemorrhagic pattern was detected. Deterioration of the patient's condition continued despite all therapies. Favipiravir was administered for the patient, but he died due to brain damage. In several studies on patients with SARS- CoV (17) . In this case report, our patient receiving appropriate antiviral and anti-inflammatory therapies died secondary to brain injuries, despite the improvement of oxygen saturation and radiological findings of the lungs. In a retrospective study in Wuhan, China on 214 patients, 36% of cases showed neurological manifestations, and this number increased to 49% in more severe cases (3) . It should be noted that the nervous system invasion may be a cause of mortality in patients. It is known that SARS-CoV-2 can invade the nervous system. Although the frequency of respiratory manifestations was higher than neurological manifestations, they may be concomitant and lethal for the patient. Therefore, proper timing of antiviral and antiinflammatory therapies for patients can improve their overall status and prevent further pulmonary complications. Also, the central nervous system injuries can lead to death and increase the mortality rate of the disease. 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