A case of area postrema variant of neuromyelitis optica spectrum disorder following SARS-CoV-2 infection

Ghosh, Ritwik; De, Kaustav; Roy, Devlina; Mandal, Arpan; Biswas, Subrata; Biswas, Subhrajyoti; Sengupta, Swagatam; Naga, Dinabandhu; Ghosh, Mrinalkanti; Benito‐León, Julián

doi:10.1016/j.jneuroim.2020.577439

Cited by 36 publications

(41 citation statements)

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“…The combination of demyelinating lesions and traces of coronavirus in brain tissue from autopsies and in CSF could explain part of the neuronal compromise of SARS-CoV-2 [ 101 ]. SARS-CoV-2 may affect white matter due to various mechanisms, including hypoxia [ 102 ], direct injury due to viral neurotropism [ 102 ], and autoimmune response combined with endothelial dysfunction [ 103 ], which can lead to clinical pictures or imaging compatible with ADEM, neuromyelitis optica spectrum disorder, or multiple sclerosis [ 66 , 71 , 104 , 105 ].…”

Section: Discussionmentioning

confidence: 99%

Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

et al. 2021

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Background SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system’s involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings. Methods We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19. Results A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10,723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system’s involvement in patients with COVID-19, ranging from 22.5 to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-CoV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. Conclusions Our evidence synthesis led to a categorical analysis of the central and peripheral neurological involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19’s central and peripheral neurological involvement and generate therapeutic decision-making strategies. Registration This review was registered in PROSPERO 2020 CRD42020193140 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193140

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Section: Discussionmentioning

confidence: 99%

Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

et al. 2021

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“…SARS-CoV-2 may affect the neurosystem by direct viral invasion and/or overactivation of inflammations and autoimmune responses. There have been three cases of NMOSD that developed during the recovery period of COVID-19 [ 1 – 3 ]. With the recent availability of COVID-19 vaccine, the rarely post-vaccination transverse myelitis and Bell’s palsy had raised concerns on vaccine safety [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

Watch out for neuromyelitis optica spectrum disorder after inactivated virus vaccination for COVID-19

Chen

Xiu

et al. 2021

Neurol Sci

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With recent availability of COVID-19 vaccine, post-vaccination neurological complications had been occasionally reported. Here, we reported for the first time a case of neuromyelitis optica spectrum disorder (NMOSD) that developed after the first dose of inactivated virus vaccine for COVID-19. The patient developed mild fever, vomiting, diarrhea, and cough after receiving the first dose of inactivated virus vaccine. Two months later, she experienced dizziness and unsteady walking. MRI scanning of the brain revealed lesions in area postrema and bilateral hypothalamus, typical for NMOSD. Serum antibodies for AQP4, ANA, SSA, SSB, Ro-52, and p-ANCA were positive. The patient was diagnosed as AQP4-positive NMOSD with coexisting systemic autoimmunity. After treatment with methylprednisolone (500 mg for 5 days), symptoms were greatly relieved. As NMOSD is seriously harmful and curative, it is important to be aware of the NMOSD symptoms after vaccination. Cautions should be given for those with preexisting systemic autoimmune abnormalities in vaccination for COVID-19.

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“…It does occur very rarely, but recent reports of neuromyelitis optica, in which the immune system attacks the spinal cord and optic nerves, paraplegia due to an epidural abscess, and cervicothoracic myelopathy, in patients with COVID-19 from that we can confirm that COVID-19 affects the spinal cord are available in the literature [141][142][143][144].…”

Section: Spinal Cord Injury In Covid-19mentioning

confidence: 79%

Biosensing surfaces and therapeutic biomaterials for the central nervous system in COVID-19

Saghazadeh

Rezaei

2021

emergent mater.

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COVID-19 can affect the central nervous system (CNS) indirectly by inflammatory mechanisms and even directly enter the CNS. Thereby, COVID-19 can evoke a range of neurosensory conditions belonging to infectious, inflammatory, demyelinating, and degenerative classes. A broad range of non-specific options, including anti-viral agents and anti-inflammatory protocols, is available with varying therapeutic. Due to the high mortality and morbidity in COVID-19–related brain damage, some changes to these general protocols, however, are necessary for ensuring the delivery of therapeutic(s) to the specific components of the CNS to meet their specific requirements. The biomaterials approach permits crossing the blood–brain barrier (BBB) and drug delivery in a more accurate and sustained manner. Beyond the BBB, drugs can protect neural cells, stimulate endogenous stem cells, and induce plasticity more effectively. Biomaterials for cell delivery exist, providing an efficient tool to improve cell retention, survival, differentiation, and integration. This paper will review the potentials of the biomaterials approach for the damaged CNS in COVID-19. It mainly includes biomaterials for promoting synaptic plasticity and modulation of inflammation in the post-stroke brain, extracellular vesicles, exosomes, and conductive biomaterials to facilitate neural regeneration, and artificial nerve conduits for treatment of neuropathies. Also, biosensing surfaces applicable to the first sensory interface between the host and the virus that encourage the generation of accelerated anti-viral immunity theoretically offer hope in solving COVID-19.

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A case of area postrema variant of neuromyelitis optica spectrum disorder following SARS-CoV-2 infection

Cited by 36 publications

References 36 publications

Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

Watch out for neuromyelitis optica spectrum disorder after inactivated virus vaccination for COVID-19

Biosensing surfaces and therapeutic biomaterials for the central nervous system in COVID-19

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