A first case of meningitis/encephalitis associated with SARS-Coronavirus-2

Abstract

Neurological symptoms might be associated with a Covid-19 infection. There are frequent reports in the last weeks. The neurological symptoms range from harmless side effects of a viral infection to meningoencephalitis and acute haemorrhagic necrotizing encephalopathy. Our patient reported burning headache and paresthesia as the initial symptoms mainly without other signs of viral infection like cough or fever. Such an initial neurological presentation seems to be rare. Most cases have neurological symptoms which can be expected after severe systemic viral infections like fever associated headache. Many COVID-19 patients with mild disease are at home and the further course is unknown. Our case shows, that neurological symptoms can be the first manifestation of an COVID-19 disease. While restricted paraesthesia has been reported in SARS-CoV-2 infections, hemisymptoms have not been described as initial symptoms.

Lessons of the month 1: A case of rhombencephalitis as a rare complication of acute COVID-19 infection

“…A recent case report by Moriquchi et al from Wuhan, China reported a case of meningitis/encephalitis associated with COVID-19 presenting with symptoms of meningism and a raised CSF white cell count. 3 Hung et al reported a case of severe acute respiratory syndrome coronavirus (SARS-CoV) associated encephalitis; the CSF cell count, protein and glucose were normal, but SARS-CoV-2 RNA was detected in the CSF. 4 Another case report from China described acute myelitis as a complication of COVID-19 presenting with flaccid lower limb weakness and persistent fever; a lumbar puncture was not performed but the authors felt the likely cause of myelitis was a post-viral inflammatory process.…”

Are we facing a crashing wave of neuropsychiatric sequelae of COVID-19? Neuropsychiatric symptoms and potential immunologic mechanisms

“…One challenge to elucidating the mechanisms of COVID-19-associated neuropsychiatric complications is that SARS-CoV-2 encephalitis, or CNS inflammation as evidenced by fever, focal neurologic signs, cerebrospinal fluid (CSF) pleocytosis, neuroimaging, and electroencephalogram (EEG) findings, may be difficult to distinguish from encephalopathy arising from systemic (but not CNS) infection. At present, only one study to our knowledge has identified SARS-CoV-2 RNA in CSF of a COVID-19 patient with acute neurologic symptoms, including seizures (Moriguchi et al, 2020), although case reports of CoV detection in CSF among patients during the previous SARS-CoV-1 epidemic do exist (Lau et al, 2004). Two recent case reports of severe COVID-19 indicate meningitic and/or encephalitic pathology in the absence of viral RNA detection in CSF, Neuropsychiatric sequelae of COVID-19 11 which the authors suggest could be associated with transient or low viral load in the CNS, or due to lack of availability of testing (Duong et al, 2020;Ye et al, 2020).…”

COVID-19: Coronavirus replication, pathogenesis, and therapeutic strategies

“…Complications may also involve the central nervous system, either by direct infection or secondary damage. 27,28 Different ACE2 expression? ACE2 is expressed in various cell types of the lung, including alveolar epithelial cells, pneumocytes, and bronchial transient secretory cells, as well as enterocytes of the small intestine, heart (pericytes), and kidney.…”