Accounts from Liberia: Reports of Neurological Manifestations During the Acute Phase of Ebola Virus Disease (P1.283)

Abstract

Objective: To describe acute neurological manifestations of Ebola Virus Disease (EVD), as witnessed by healthcare workers in Liberia during the recent Ebola outbreak in West Africa. Background: Neurologic symptoms and complications during the acute phase of EVD have never been previously described. Design/Methods: Healthcare workers at the John F. Kennedy Clinic in Monrovia, Liberia were interviewed on their experience in the Ebola Treatment Units (ETUs) regarding neurologic complications seen in EVD. A case series of noted patients with neurologic manifestations during EVD is presented here. Results: Case 1: A male patient was admitted to the ETU with typical EVD symptoms. Several days into his presentation he developed frank meningeal signs and decreased consciousness. He received a course of ceftriaxone with little improvement and subsequently died. Case 2: A pre-pubescent girl was admitted to the ETU with positive EVD viral titers. She experienced severe hallucinations, and psychotic behavior. These hallucinations continued for one month post last negative EVD PCR and she required admission to the state mental ward. She was seen in follow up with return to relative normal baseline. Case 3: A male patient was admitted to the ETU with EVD who developed hallucinations, agitation, and abnormal behaviors. He developed seizures which were poorly controlled with diazepam. He subsequently died. Patients in the acute phase of EVD presented with a number of neurologic manifestations, most notably hallucinations, coma, seizures and meningitis. Other neurologic symptoms described included marked tremors, significant generalized weakness, and acute generalized body pain. Patients with severe neurologic manifestations were noted to have higher mortality rates according to treating medical personnel. Conclusions: Patients with EVD experienced a wide range of neurologic manifestations in the acute phase of disease. In this case series, patients described with more severe neurologic manifestations tended to have poorer outcomes, including death.

Disclosure: Dr. Billioux has nothing to disclose. Dr. Bowen has received research support from the American Academy of Neurology and the University of Florida Department of Neurology. Dr. Smith has nothing to disclose. Dr. Steinbach has nothing to disclose. Dr. Azodi has nothing to disclose. Dr. Xie has nothing to disclose. Dr. Bainda has nothing to disclose. Dr. Moses has nothing to disclose. Dr. Nath has nothing to disclose.