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Case report
Treatment of unexplained coma and hypokinetic-rigid syndrome in a patient with COVID-19
  1. Devjit Roy1,2,
  2. Justin Song2,
  3. Nirvana Awad1 and
  4. Paul Zamudio1
  1. 1Department of Medicine, Montefiore Nyack Hospital, Nyack, NY, USA
  2. 2Department of Medicine, Albert Einstein - College of Medicine, Bronx, NY, USA
  1. Correspondence to Dr Devjit Roy; devjit.roy{at}gmail.com

Abstract

The COVID-19 pandemic has dealt a devastating blow to healthcare systems globally. Approximately 3.2% of patients infected with COVID-19 require invasive ventilation during the course of the illness. Within this population, 25% of patients are affected with neurological manifestations. Among those who are affected by severe neurological manifestations, some may have acute cerebrovascular complications (5%), impaired consciousness (15%) or exhibit skeletal muscle hypokinesis (20%). The cause of the severe cognitive impairment and hypokinesis is unknown at this time. Potential causes include COVID-19 viral encephalopathy, toxic metabolic encephalopathy, post-intensive care unit syndrome and cerebrovascular pathology. We present a case of a 60 year old patient who sustained a prolonged hospitalization with COVID-19, had a cerebrovascular event and developed a persistent unexplained encephalopathy along with a hypokinetic state. He was treated successfully with modafinil and carbidopa/levodopa showing clinical improvement within 3–7 days and ultimately was able to successfully discharge home.

  • neurology
  • intensive care
  • rehabilitation medicine
  • pharmacology and therapeutics

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

https://bmj.com/coronavirus/usage

https://doi.org/10.1136/bcr-2020-239781

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    Footnotes

    • Contributors DR: primary author, investigator and hospitalist who developed the treatment regiment of modafinil and carbidopa/levadopa and initiated the treatment on the patients. PZ: author, who is also the treating intensivist, who also used the treatment regiment on COVID-19 patients. In addition to authoring, he helped with literature review. NA: author and pharmacist helping with dosing on the case, as well as literature review. JS: author and medical student, who helped compiling the whole case, and helping during the submission process.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.