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The authors explain that, based on experimental data and findings of anosmia early in the disease course, there is evidence that COVID-19 enters the central nervous system through olfactory neurons. Additionally, a recent case report has shown hypometabolism on PET imaging within the orbitofrontal cortex, and a significant number of EEG studies that were performed in COVID-19 patients for suspected encephalopathy and/or seizure-like events revealed epileptiform discharges within the frontal lobes. In support of SARS-CoV-2 involving the frontal lobes, the authors present a case report of status epilepticus as a manifestation of COVID-19 showing right frontal lobe involvement, as demonstrated by both MRI (with DWI images showing right orbitofrontal cortex and caudate nucleus–restricted diffusion) and EEG abnormalities (rhythmic epileptiform activity in the right frontal lobe, suggestive of a nonconvulsive status epilepticus).
This is an interesting case report of SARS-CoV-2 infection and the potential connection with mesial frontal areas presenting as status epilepticus, which apparently was treated with intravenous immunoglobulin therapy.
– Omar Iqbal Khan, MD
This abstract is available on the publisher's site.
Neurological manifestations of coronavirus disease 19 (COVID-19) such as encephalitis and seizures have been reported increasingly, but our understanding of COVID-19-related brain injury is still limited. Herein we describe prefrontal involvement in a patient with COVID-19 who presented prior anosmia, raising the question of a potential trans-olfactory bulb brain invasion.