Acute Demyelinating Encephalomyelitis (ADEM) in COVID-19 infection: A Case Series

Abstract

Objective: To report three patients infected with COVID-19 with severe respiratory syndrome requiring intubation, who developed acute demyelinating encephalomyelitis (ADEM). Method: Patient data were obtained from medical records from the North Memorial Health Hospital, Robbinsdale, MN, USA Results: Three patients (two men and one woman, aged 38 - 63) presented with fatigue, cough and fever leading to development of acute respiratory distress syndrome secondary to COVID-19 infection requiring intubation and ventilatory support. Two patients were unresponsive, one with strong eye deviation to the left and the third patient had severe diffuse weakness. MRI in all patients showed findings consistent with ADEM. CSF showed elevated protein in all patients with normal cell count and no evidence of infection, including negative COVID-19 PCR. All three of the patients received Convalescent plasma therapy for COVID-19. All patients were treated with intravenous corticosteroids and improved, although two responded minimally. Two patients treated with IVIG showed no further improvement. Conclusion: Neurological complications from COVID-19 are being rapidly recognized. Our three cases highlight the occurrence of ADEM as a postinfectious/immune mediated complication of COVID-19 infection, which may be responsive to corticosteroid treatment. Early recognition of this complication and treatment is important to avoid long term complications.

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

“…CSF showed only mild protein elevation, and CSF PCR for SARS-CoV-2 was negative in all cases. COVID-19 infection severity in this case series is similar to that found in our cases, with prolonged mechanical ventilation and ICU stay 23 .…”

“…In a case series 23 , ADEM was related to severe COVID-19 infection requiring long ICU stay in three patients. Two of these presented with post-extubation encephalopathy characterized by unresponsiveness.…”

Neurological Manifestations as the Predictors of Severity and Mortality in Hospitalized Individuals with COVID-19: A Multicenter Prospective Clinical Study

“…To date, few cases with post-infectious demyelinating conditions of the central nervous system (CNS) after the COVID-19 disease were diagnosed (13,48). The structure and replication of SARS-CoV-2 was reported to be similar with mouse hepatitis virus (MHV) (49).…”

“…Each item can be scored from 0 to 4 and the total possible scores ranged from 0 to 42. Neurological impairments can be divided into four categories using NIHSS: a. mild (0-4), b. moderate (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15), c. Moderate to severe (16)(17)(18)(19)(20), and d. severe . The intracerebral hemorrhage (ICH) score was also calculated in participants with ICH.…”

Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222)

“…Lesions revealed by spinal cord MRI included LEATM from medulla oblongata and cervico-thoracic cord (Th 6 ) in Patient 3 ( 8 ); cervicothoracic spinal cord lesions down to the conus medullaris in Patient 18 ( 24 ); C 1-7 -Th 2 in Patient 35 ( 40 ); and, Th 5-6 and Th 10-11 down to the conus medullaris in Patient 37 ( 40 ). ATM at Th 8 level occurred in Patient 8 ( 13 ); at C 2-3 level in Patient 16 ( 22 ); pons and medulla-cord junction in Patient 19 ( 25 ); and, intramedullary lesion of the conus medullaris in Patient 36 ( 40 ). Brain MRI lesions consistent with ADEM included among others, multiple T1 post-Gd enhancing white matter lesions plus bilateral edema of the optic nerves; hyperintense FLAIR lesions in the medial temporal lobe; bilateral lesions involving cerebral white matter, corpus callosum and brainstem including pons and medulla-cord junction.…”