To describe a rare presentation of adult onset Acute disseminated encephalomyelitis (ADEM) following a COVID-19 infection.

ADEM is rare disease of central nervous system with myriads of presentation. More commonly affecting children in age group of 6-8 years following an antigenic challenge.

64-year-old right-handed Hispanic Male with history of hypertension, hyperlipidemia, diabetes and chronic kidney disease presented with complain of shortness of air, congestion and was being treated for pneumonia with COVID-19. On hospital day 9th patient had acute mental status change; non-contrast head was concerning for embolic stroke. On exam patient was obtunded, sluggish pupil, right facial droop, 2/5 strength in all extremities. Magnetic resonance imaging (MRI) brain reported wide-spread diffusion restriction in white matter and cerebellum with corresponding T2 Flair hyper-intensities signal not following a vascular pattern. Further Cerebrospinal fluid (CSF) testing revealed lymphocytic pleocytosis, normal protein, glucose. Further infectious work up including serum and CSF autoimmune panel, meningoencephalitis panel, fungal, bacterial culture and COVID was negative. Given the MRI pattern, no history of any drug use and further unremarkable infectious work up diagnosis was most consistent with ADEM secondary to novel coronavirus infection.

As more patients reach the weeks after initial infection with COVID-19, ADEM should be considered a potentially treatable cause of profound encephalopathy or multifocal neurological deficits.The lesions described in this case provides an insight into the potential para-infectious processes affecting in COVID-19 patients, which may direct clinical management and ongoing research into the disease.