A patient (65-year-old female) who has a history of cognitive decline and Alzheimer’s disease presented with widespread involuntary movements, difficulty speaking, disorientation, confusion, visual hallucinations, and deteriorating vision, 6 days after the onset of COVID-19 symptoms. On admission, she had the following behavioural and cognitive abnormalities:

• Widespread stimulus sensitive myoclonus involving the tongue and all four limbs with marked hyperekplexia
• Episodic opsoclonus and prominent convergence spasm on visual fixation
• Non-fluent aphasia with oral apraxia (difficulty repeating sentences and was only able to follow single stage commands)

Her myoclonus was treated with levetiracetam and clonazepam, and her presumed post-infectious autoimmune encephalitis affecting cortex and brainstem was treated with a course of steroids. At the time of writing, her cognition and visual symptoms were still ongoing, but they had improved.