COVID-19 Pregnancy and Psycho-neurological Disturbance: Single Hospital Case Report

L. Ratiani, N. Kintraia, P. Machavariani, K. GrigalaShvili, G. Tevdorashvili, T. Didbaridze, N. Metskhvarishvili, M. Rizhvadze, N. Khotivari, N. Pkhaladze, B. Japaridze, L. Barbakadze, E. Shvelashvili, M. Merkviladze, K. Chichua


31 years old pregnant woman at 38 1/7 week of gestation with fever has been admitted to the TSMU   First University Clinic Emergency, with positive COVID-19 PCR test. With characteristic complains of COVID-19 infection.  Family history not significant. Personal history reveals childhood seizure as a result of fever. Vital signs at the admission within normal ranges. All protocol based laboratory tests has been done and protocol based treatment initiated. On the seventh day of Covid-19 infection because of episodes of desaturation and termed gestation, pregnancy termination by induction has been done successfully. At the end of early puerperal period because of hypoxemia resistant to oxygen therapy and CT scan diagnosed severe viral induced pneumonia, with symptoms of encephalopathy has been documented.  Later patient transferred to the mechanical ventilation, protocol based lab tests, diagnostic procedures and treatment initiated. After 1 month with improved condition patient has been transferred to the ob/gyn department for ongoing treatment and rehabilitation at this time severely expressed symptoms of encephalopathy were documented.

The underlying mechanisms of neurologic complications in patients with COVID-19 are diverse and, in some cases, multifactorial. Neurologic complications may arise from direct effects of the virus as well as systemic response to the infection or as a result of long lasting inadequate oxygenation of all tissues. Although mechanical ventilation is highly complicated by brain damage, covid-19 induced encephalopathies are as well documented and need more scientifically proved facts of the viral role in this complication.


Severe Covid-19, Adult Respiratory Distress, Pregnancy, Psychiatric Disorder, Edinburgh Postnatal Depression Scale

Full Text:



World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. (Accessed on February 12,2020).

World Health Organization. Novel Coronavirus (2019-nCoV) technical guidance. (Accessed on February 14, 2020).

Centers for Disease Control and Prevention. 2019 Novel coronavirus, Wuhan, China. Information for Healthcare Professionals. (Accessed on February 14, 2020).

National Institutes of Health. Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. (Accessed on May 27, 2021)

Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020; 77:683.

Helms J, Kremer S, Merdji H, et al. Neurologic Features in Severe SARS-CoV-2 Infection. N Engl J Med 2020; 382:2268.

Montalvan V, Lee J, Bueso T, et al. Neurological manifestations of COVID-19 and other coronavirus infections: A systematic review. Clin Neurol Neurosurg 2020; 194:105921.

Romero-Sánchez CM, Díaz-Maroto I, Fernández-Díaz E, et al. Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry. Neurology 2020; 95:e1060.

Koralnik IJ, Tyler KL. COVID-19: A Global Threat to the Nervous System. Ann Neurol 2020; 88:1.

Xiong W, Mu J, Guo J, et al. New onset neurologic events in people with COVID-19 in 3 regions in China. Neurology 2020; 95:e1479.

Herman C, Mayer K, Sarwal A. Scoping review of prevalence of neurologic comorbidities in patients hospitalized for COVID-19. Neurology 2020; 95:77.

Liotta EM, Batra A, Clark JR, et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol 2020; 7:2221.

Pezzini A, Padovani A. Lifting the mask on neurological manifestations of COVID-19. Nat Rev Neurol 2020; 16:636.

Chou SH, Beghi E, Helbok R, et al. Global Incidence of Neurological Manifestations Among Patients Hospitalized With COVID-19-A Report for the GCS-NeuroCOVID Consortium and the ENERGY Consortium. JAMA Netw Open 2021; 4:e2112131.

Graham EL, Clark JR, Orban ZS, et al. Persistent neurologic symptoms and cognitive dysfunction in non-hospitalized Covid-19 "long haulers". Ann Clin Transl Neurol 2021; 8:1073.

Kanberg N, Ashton NJ, Andersson LM, et al. Neurochemical evidence of astrocytic and neuronal injury commonly found in COVID-19. Neurology 2020; 95:e1754.

Solomon IH, Normandin E, Bhattacharyya S, et al. Neuropathological Features of Covid-19. N Engl J Med 2020; 383:989.

Thakur KT, Miller EH, Glendinning MD, et al. COVID-19 neuropathology at Columbia University Irving Medical Center/New York Presbyterian Hospital. Brain 2021; 144:2696.

Kandemirli SG, Dogan L, Sarikaya ZT, et al. Brain MRI Findings in Patients in the Intensive Care Unit with COVID-19 Infection. Radiology 2020; 297:E232.

Radmanesh A, Derman A, Lui YW, et al. COVID-19-associated Diffuse Leukoencephalopathy and Microhemorrhages. Radiology 2020; 297:E223.

Agarwal S, Jain R, Dogra S, et al. Cerebral Microbleeds and Leukoencephalopathy in Critically Ill Patients With COVID-19. Stroke 2020; 51:2649.

Strawn WB, Ferrario CM, Tallant EA. Angiotensin-(1-7) reduces smooth muscle growth after vascular injury. Hypertension 1999; 33:207.

Ye M, Wysocki J, William J, et al. Glomerular localization and expression of Angiotensin-converting enzyme 2 and Angiotensin-converting enzyme: implications for albuminuria in diabetes. J Am Soc Nephrol 2006; 17:3067.

Lei Y, Zhang J, Schiavon CR, et al. SARS-CoV-2 Spike Protein Impairs Endothelial Function via Downregulation of ACE 2. Circ Res 2021; 128:1323.

Pilotto A, Padovani A, ENCOVID-BIO Network. Reply to the Letter "COVID-19-Associated Encephalopathy and Cytokine-Mediated Neuroinflammation". Ann Neurol 2020; 88:861.

Muccioli L, Pensato U, Cani I, et al. COVID-19-Associated Encephalopathy and Cytokine-Mediated Neuroinflammation. Ann Neurol 2020; 88:860.

Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol 2017; 39:529.

Huang KJ, Su IJ, Theron M, et al. An interferon-gamma-related cytokine storm in SARS patients. J Med Virol 2005; 75:185.

Chen G, Wu D, Guo W, et al. Clinical and immunological features of severe and moderate coronavirus disease 2019. J Clin Invest 2020; 130:2620.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395:497.

Fotuhi M, Mian A, Meysami S, Raji CA. Neurobiology of COVID-19. J Alzheimers Dis 2020; 76:3.

Pugin D, Vargas MI, Thieffry C, et al. COVID-19-related encephalopathy responsive to high-dose glucocorticoids. Neurology 2020; 95:543.

Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020; 18:1559.

Magro C, Mulvey JJ, Berlin D, et al. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res 2020; 220:1.

Al-Dalahmah O, Thakur KT, Nordvig AS, et al. Neuronophagia and microglial nodules in a SARS-CoV-2 patient with cerebellar hemorrhage. Acta Neuropathol Commun 2020; 8:147.

Zhao H, Shen D, Zhou H, et al. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Lancet Neurol 2020; 19:383.

Matschke J, Lütgehetmann M, Hagel C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurol 2020; 19:919.

Meinhardt J, Radke J, Dittmayer C, et al. Olfactory transmucosal SARS-CoV-2 invasion as a port of central nervous system entry in individuals with COVID-19. Nat Neurosci 2021; 24:168.

Song E, Zhang C, Israelow B, et al. Neuroinvasion of SARS-CoV-2 in human and mouse brain. bioRxiv 2020.

Varga Z, Flammer AJ, Steiger P, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020; 395:1417.

Ackermann M, Verleden SE, Kuehnel M, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020; 383:120.

Goldsmith CS, Miller SE, Martines RB, et al. Electron microscopy of SARS-CoV-2: a challenging task. Lancet 2020; 395:e99.

Varga Z, Flammer AJ, Steiger P, et al. Electron microscopy of SARS-CoV-2: a challenging task - Authors' reply. Lancet 2020; 395:e100.

Hanafi R, Roger PA, Perin B, et al. COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern. AJNR Am J Neuroradiol 2020; 41:1384.

Keller E, Brandi G, Winklhofer S, et al. Large and Small Cerebral Vessel Involvement in Severe COVID-19: Detailed Clinical Workup of a Case Series. Stroke 2020; 51:3719.

Allotey J, Stallings E, Bonet M, et al. Clinical manifestations, risk factors, and maternal and perinatal outcomes of coronavirus disease 2019 in pregnancy: living systematic review and meta-analysis. BMJ 2020; 370:m3320.

Martinez-Portilla RJ, Sotiriadis A, Chatzakis C, et al. Pregnant women with SARS-CoV-2 infection are at higher risk of death and pneumonia: propensity score matched analysis of a nationwide prospective cohort (COV19Mx). Ultrasound Obstet Gynecol 2021; 57:224.

Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost 2020; 18:1559.



  • There are currently no refbacks.

Copyright (c) 2022 L. Ratiani1 , N. Kintraia2, P. Machavariani2, K. GrigalaShvili2, G. Tevdorashvili2, T. Didbaridze3, N. Metskhvarishvili2. M. Rizhvadze2, N. Khotivari2, N. Pkhaladze2, B. Japaridze2, L. Barbakadze2. E. Shvelashvili2, M. Merkviladze2, K. Chichua2

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.