University of Wisconsin–Madison Medical College of Wisconsin

Encephalopathy With Akinetic Mutism in a Child With COVID-19 Infection: A Case Report

Tess Jewell, BA; David Arendt, MD, PhD; Kayla Haffley, MD; Alexa Beversdorf, APNP; Nicole E. St. Clair, MD; David Hsu, MD, PhD

WMJ. 2022;121(3):e42-e45

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Introduction: COVID-19 has been associated with neurological complications, including encephalopathy and akinetic mutism.

Case Presentation: A 7-year-old unvaccinated boy presented with visual hallucinations, urinary incontinence, and akinetic mutism 13 days after he was exposed to COVID-19. He had minimal respiratory symptoms, including just 1 day of fever and cough. Evaluations showed slowing on electroencephalogram, normal cerebrospinal fluid, normal brain magnetic resonance imaging, and mild sinus bradycardia. He recovered rapidly to baseline after 5 days of intravenous methylprednisolone.

Discussion: COVID-19-related encephalopathy including akinetic mutism is usually found in older adult patients with more severe COVID-19 illness. Our case demonstrates that akinetic mutism can present in children with mild COVID-19 illness and that it can respond rapidly and completely to intravenous methylprednisolone.

Conclusions: COVID-19-related encephalopathy may be immune mediated. A heightened awareness of its association with COVID-19 illness should lead to earlier diagnosis and consideration of immunomodulatory therapy.

Author Affiliations: University of Wisconsin School of Medicine and Public Health (UWSMPH), Madison, Wisconsin (Jewell); Department of Neurology, UWSMPH, Madison, Wisconsin (Haffley, Beversdorf, Hsu); Department of Pediatrics, UWSMPH, Madison, Wisconsin (Arendt, St. Clair).
Corresponding Author: David Hsu, MD, PhD, 1685 Highland Ave, Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA 53705; phone 608.265.7951; email; ORCID ID 0000-0002-8343-0406
Funding/Support: None declared.
Financial Disclosures: None declared.
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