Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

Abstract

Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in São Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.

Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

“…In adults, we observed a male predominance (73.68%, 14 cases) ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ). The mean age was 49.8 years (25 to 70 years).…”

“…Including our original case report, we identified 30 patients (pediatric = 09, adults = 21) diagnosed with ADEM related with COVID-19 from 18 documents ( Abdel-Mannan et al, 2020 ; Abdi et al, 2020 ; Assunção et al, 2020 ; De Miranda Henriques-Souza et al, 2021 ; Dominguez- Rojas et al, El Beltagi et al, 2021 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lindan et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; 2020; Umapathi et al, 2020 ; Utukuri et al, 2020 ). Only one document was reported in non-English language (Spanish).…”

“…The mean number of days since COVID-19 infection to ADEM diagnosis was 23.2 days (4 to 60 days). The comorbidity most frequently described was hypertension ( Lopes et al, 2020 ; McCuddy et al, 2020 ; Umapathi et al, 2020 ), followed by diabetes ( Lopes et al, 2020 ; McCuddy et al, 2020 ). Regarding the COVID-19 symptoms, 66.7% were severe ( N = 12/18)( Assunção et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Umapathi et al, 2020 ), 22.2% mild ( N = 4/18) ( El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ) and 11.1% asymptomatic ( N = 2/18)( Abdi et al, 2020 ; Utukuri et al, 2020 ).…”

“…The comorbidity most frequently described was hypertension ( Lopes et al, 2020 ; McCuddy et al, 2020 ; Umapathi et al, 2020 ), followed by diabetes ( Lopes et al, 2020 ; McCuddy et al, 2020 ). Regarding the COVID-19 symptoms, 66.7% were severe ( N = 12/18)( Assunção et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Umapathi et al, 2020 ), 22.2% mild ( N = 4/18) ( El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ) and 11.1% asymptomatic ( N = 2/18)( Abdi et al, 2020 ; Utukuri et al, 2020 ). The COVID-19 diagnosis was made using a PCR test in 20 cases ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ) and a serum antibody test (IgM and IgG antibody) in our case.…”

Indicadores sociodemográficos na pandemia da covid-19 por meio da distribuição espacial no Brasil: Revisão integrativa

“…A infecção ocasionada pelo SARS-Cov2 manifesta sintomatologia primeiramente no sistema respiratório, com potencial evolução para desconforto respiratório agudo e/ou dano alveolar difuso, podendo ainda, ter o envolvimento de comprometimentos a nível de sistemas cardiovascular, gastrintestinal, renal, urinário e neurológico, o que exige cuidados intensivos em sua forma grave e gera consequências negativas em relação ao quantitativo de óbitos e impactos econômico, social e demográfico nos países (Teixeira et al, 2021;Branco et al, 2020;Vázquez, Company, Felipe & Ponce, 2020).…”