Prolonged Encephalopathy in COVID 19

Coronavirus 2 (SARS CoV2 or CoV2) infection which is responsible for the COVID 19 pandemic has been noted to cause multi-organ involvement including lungs, heart, kidney, and the brain. Neurologic effects of this disease vary on a spectrum ranging from anosmia, delirium or confusion, strokes, seizures, encephalopathy and or encephalitis, and Guillain Barre-like syndrome. However, rarely prolonged encephalopathy has been observed. There is not a good amount of evidence behind all the factors contributing to the occurrence of this prolonged encephalopathy or delayed awakening. In this manuscript, we have reviewed the existing literature and highlighted various postulated etiological theories and the impact of factors including the patient, disease as well as physician-related, contributing to the delayed awakening. We have discussed the available management modalities for these group of patients as well based on the limited literature available thus far.