A 68-year-old female with systemic arterial hypertension presented with a dry cough, anosmia, and ageusia for 7 days. She also had a fever in the first 7 days of symptoms. After an improvement in these symptoms, the patient began to present asthenia, nausea, and a severe headache.
This headache had a gradual onset, a severe intensity; was located in the left frontotemporal region; was described as a dull/stabbing pain; and was associated with nausea. There was no vomiting and no photophobia, phonophobia, or associated autonomic trigeminal symptoms. Her headache was continuous, with no remission periods, and lasted 8 days.
Her physical examination was normal, with a temperature of 36.7 °C, a respiratory rate of 18 incursions per minute, and 97% O2 saturation in ambient air.
On neurological examination, she presented no change in the level or content of consciousness or meningeal signs or focal signs. In the laboratory exams on admission, she presented lymphopenia (540 lymphocytes/mm3), thrombocytopenia (117,000 platelets/mm3), and 7·61 C-reactive protein (normal up to 0·03 mg/dl).
On admission, due to the persistence of a severe headache and nausea, she underwent a non-contrast cranial tomography, which was normal, and a lumbar puncture. The CSF analysis demonstrated a cell count of 21 cells/mm3 (80% lymphocytes and 20% monocytes), 34 mg/dl protein, and 79 mg/dl glucose. The CSF opening pressure was 20 cmH2O.
The result of the COVID-19 survey was positive, using the nasal swab RT-PCR technique. The CSF was not tested for the virus.
The patient remained in the hospital for 4 days and was discharged after clinical improvement.