The Same Day on Repeat: A Unique Case of Persistent DÉjÀ Vu Phenomenon as a Long COVID Symptom in an Older Adult

INTRODUCTION: From anosmia to encephalopathy, ongoing neuropsychiatric manifestations after infection with COVID-19 are common and persistent. Déjà vu is a condition characterized by the experience of recognizing a current situation as familiar with the awareness that the recognition is inappropriate.(1) This phenomenon has been well described in temporal lobe epilepsy and is thought to be caused by abnormal synchronization in the corticolimbic network. While the etiology of neuropsychiatric symptoms in long COVID is still not well demarcated, studies have found that the virus attacks the temporal lobe and limbic system, therefore, we suggest that the ongoing symptoms of déjà vu in this case may be a manifestation of long COVID. METHODS: The patient is a 79-year-old female with a pertinent past medical history of generalized anxiety disorder, major depressive disorder, and prior hospitalization for delirium who presented with a chief complaint of being tired of living the same day over and over again. The patient was hospitalized eight months prior for a severe COVID-19 infection that now requires continuous oxygen therapy. Since leaving the hospital, the patient began to develop episodic confusion, agitation and memory impairment which has gradually improved. However, the patient developed severe distress due to a feeling of déjà vu characterized by a sense of familiarity with events in her daily life. There was no history of loss of consciousness, abnormal involuntary movements, or other semiology related to seizures. Due to the distress caused by the déjà vu symptoms, the patient also endorsed depression, anxiety, and insomnia due to deterioration of quality of life. She described the déjà vu experience as similar to being “stuck in a loop” of the same day. She also endorsed several months of hearing ringing and flowing of water in her ears. RESULTS: Patient MRI showed mild volume loss and multifocal regions, including bilateral temporal lobes, of subcortical and periventricular high T2/FLAIR signal abnormality consistent with chronic white matter microangiopathy. Her MOCA score was 24/30, and her dissociative experience scale was 15.36/100. An electroencephalogram and neuropsychological evaluation are being scheduled for further evaluation and to rule out temporal lobe pathology. The patient continues to be treated for her depression, insomnia, and severe anxiety with oral escitalopram 10mg daily and oral mirtazapine 7.5mg at night. CONCLUSIONS: Studies show that COVID-19 may be neurotropic, with an incidence of neurological symptoms in more than 80% of severe cases.(2) These symptoms frequently occur in elderly patients and individuals with multiple comorbidities. In this case, the patient's age, psychiatric history, and severity of infection likely predisposed her to her current presentation. Current MRI findings in patients with neuropsychiatric symptoms after severe COVID-19 include ischemic infarction, signal abnormalities in the medial temporal lobe, non-confluent multifocal white matter hyperintense lesions, and extensive and isolated white matter microhemorrhages.(3) While the experiences of déjà vu are rare and difficult to classify, they have been consistently shown to occur in temporal lobe epilepsy. Interestingly, déjà vu is also seen in schizophrenia and depersonalization disorders, which also affect the limbic-temporal lobe networks.(1) Given that MRI findings in COVID-19 patients have shown changes in these same networks, it may be that the déjà vu and cognitive and memory impairments in this case are occurring as a consequence of COVID-19 virus infecting the temporal lobe. Given the large and often distressing disease burden, especially in this case, of neuropsychiatric symptoms in long COVID, it is important that further studies are done to elucidate the mechanism of how COVID-19 affects the brain. (1) Bošnjak Pašić, M., Horvat Velić, E., Fotak, L., et al: Many Faces of Déjà Vu: a Narrative Review. Psychiatria Danubina, 2018, 30(1), 21–25. (2) Douaud, G., Lee, S., Alfaro-Almagro, F., et al: SARS-CoV-2 is associated with changes in brain structure in UK Biobank. Nature, 2022, 604 (7907), 697–707. (3) Han, Y., Yuan, K., Wang, Z., et al: Neuropsychiatric manifestations of COVID-19, potential neurotropic mechanisms, and therapeutic interventions. Translational psychiatry, 2021, 11(1), 499. THIS RESEARCH WAS FUNDED BY: None.