Acute disseminated encephalomyelitis after SARS-CoV-2 infection

Novi, Giovanni; Rossi, Tommaso; Pedemonte, Enrico; Saitta, Laura; Rolla, Claudia; Roccatagliata, Luca; Inglese, Matilde; Farinini, D

doi:10.1212/nxi.0000000000000797

Cited by 185 publications

(279 citation statements)

References 5 publications

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“…Alternatively, encephalitis may be caused by a CNS-specific inflammatory response 23,24 . Acute disseminated encephalomyelitis (ADEM) has been reported in SARS-CoV-2 patients, indicating a probable virally triggered immune-mediated mechanism leading to CNS inflammatory lesions 25,26 .…”

Section: Discussionmentioning

confidence: 99%

Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

Neto

Guedes

Tuma

et al. 2020

Arq. Neuro-Psiquiatr.

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Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.

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Section: Discussionmentioning

confidence: 99%

Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

Neto

Guedes

Tuma

et al. 2020

Arq. Neuro-Psiquiatr.

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“…Little is known about association between SARS-CoV-2 and acute myelitis. Up to date, 7 cases of acute myelitis, alone (4 cases) or combined with brain involvement (3 cases), have been reported in relation to COVID-19 ( AlKetbi et al, 2020 , Munz et al, 2020 , Novi et al, 2020 , Sarma and Bilello, 2020 , Valiuddin et al, 2020 , Wong, Craik, 2020a, Zanin, Saraceno, 2020). Six patients (28–64 years age range, 57.1% female) variably had symptoms of COVID-19 (fever, dyspnea, malaise, chills, and rhinorrhea) 25 to 2 days prior the onset of neurologic symptoms of myelitis ( Table 3 ).…”

Section: Neurologic Manifestationsmentioning

confidence: 99%

SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

Keyhanian

Umeton

Mohit

et al. 2021

Journal of Neuroimmunology

117

146

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Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide.

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“…Neurologic examples of a post-COVID-19 inflammatory response include Guillain-Barré syndrome and acute disseminated encephalomyelitis. 9,10 The most prominent presentation of an inflammatory response after COVID-19 has been reported in the pediatric population; children with asymptomatic SARS-CoV-2 infection have developed multisystem inflammatory syndrome in children (MIS-C), characterized by fever, elevated inflammatory markers, and single or multiorgan failure, in the absence of active infection. 11 Seizures have been observed in several children with this syndrome at our institution.…”

Section: Discussionmentioning

confidence: 99%

Post–COVID‐19 inflammatory syndrome manifesting as refractory status epilepticus

et al. 2020

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There have been multiple descriptions of seizures during the acute infectious period in patients with COVID-19. However, there have been no reports of status epilepticus after recovery from COVID-19 infection. Herein, we discuss a patient with refractory status epilepticus 6 weeks after initial infection with COVID-19. Extensive workup demonstrated elevated inflammatory markers, recurrence of a positive nasopharyngeal SARS-CoV-2 polymerase chain reaction, and hippocampal atrophy. Postinfectious inflammation may have triggered refractory status epilepticus in a manner similar to the multisystemic inflammatory syndrome observed in children after COVID-19.

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Acute disseminated encephalomyelitis after SARS-CoV-2 infection

Cited by 185 publications

References 5 publications

Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital

SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

Post–COVID‐19 inflammatory syndrome manifesting as refractory status epilepticus

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