Acute Hemorrhagic Encephalitis Related to COVID-19

Chalil, Alan; Baker, Carmen; Johnston, Robert; Just, Caroline; Debicki, Derek; Mayich, Michael; Bosma, Karen J.; Steven, David

doi:10.1212/cpj.0000000000000900

Cited by 18 publications

(19 citation statements)

References 15 publications

(10 reference statements)

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“…Follow-up MRI depicted rapid progression with florid parenchymal hemorrhages, which against this clinical background and CSF picture led us to make a final diagnosis of AHLE. The imaging features in our case parallel the findings demonstrated by Yong et al and Chalil et al, albeit with severe edema, mass effect, and hemorrhagic component which could explain the fatal outcome [5,6]. Intraventricular hemorrhage described by Chalil et al was not seen in our case [6].…”

Section: Discussionsupporting

confidence: 87%

“…The imaging features in our case parallel the findings demonstrated by Yong et al and Chalil et al, albeit with severe edema, mass effect, and hemorrhagic component which could explain the fatal outcome [5,6]. Intraventricular hemorrhage described by Chalil et al was not seen in our case [6]. The case described by Haqiqi et al had similar widespread involvement, but lesions were symmetric without significant edema or mass effect.…”

Section: Discussionsupporting

confidence: 86%

“…In most cases, laboratory parameters reveal elevated levels of inflammatory markers such as C-reactive protein (CRP), D-dimer, serum ferritin, and procalcitonin. CSF analysis shows elevated protein, variable cell count, and lymphocytic pleocytosis [6][7][8]. Cultures are often negative, and viral RNA is rarely demonstrated in CSF; hence, RT-PCR for CSF was not done in our patient [9,18,19].…”

Section: Discussionmentioning

confidence: 91%

“…Infective cause was not demonstrable in a few cases, and there may not be a linear relationship between the severity of neurological illness and antecedent chest symptoms [1,4]. Though neurological symptoms are common in COVID-19 patients, only a handful of COVID-19 associated AHLE have been reported to date [5][6][7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 94%

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Acute hemorrhagic leukoencephalitis in a COVID-19 patient—a case report with literature review

Varadan¹,

Shankar²,

Rajakumar³

et al. 2021

Neuroradiology

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Purpose Acute hemorrhagic leukoencephalitis (AHLE) is a rare and severe form of acute disseminated encephalomyelitis (ADEM). Only a few reports of AHLE in coronavirus disease 2019 (COVID-19) patients have been described to date. We report a case of COVID-19-related AHLE along with a literature review describing salient clinical and imaging characteristics. Methods A literature search was performed on Medline (2020-present), PubMed, Cochrane Library, CINAHL, and Google scholar on 28 January 2021 for all articles published using MeSH terms “COVID-19” or “SARS-CoV-2” with “Acute hemorrhagic leukoencephalitis” or “Acute hemorrhagic encephalitis.” Relevant case reports and case series describing clinical and imaging features of AHLE associated with SARS-CoV-2 infection were included, data compiled, and critically reviewed. Results Acute onset encephalopathy and rapidly deteriorating neurological status is the common clinical presentation in AHLE. CSF analysis reveals elevated proteins and lymphocytic pleocytosis. Typical neuroimaging features include multifocal, variable-sized, poorly defined cerebral white matter lesions with cortical sparing. Involvement of the brainstem, cerebellar peduncles, and deep grey matter can also occur, although rarely. Lesions are hyperintense on T2-weighted (T2W) and fluid-attenuated inversion recovery (FLAIR) images, hypointense on T1W images, and show microhemorrhages, variable diffusion restriction, and post-contrast enhancement. Extensive microhemorrhages, brainstem involvement, and gross hemorrhage often portend a poor prognosis. Conclusion Heightened awareness about the clinical and imaging presentation of COVID-19-related AHLE can positively alter the outcome in a select few by enabling early diagnosis and aggressive management.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 94%

See 2 more Smart Citations

Acute hemorrhagic leukoencephalitis in a COVID-19 patient—a case report with literature review

Varadan¹,

Shankar²,

Rajakumar³

et al. 2021

Neuroradiology

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“…Last but not least, there have been cases of SARS-CoV-2-associated encephalitis and encephalopathy, with various atypical clinical manifestations and imaging features, in recent publications [ 35 – 40 ]. Moriguchi et al presented a case of meningitis/encephalitis with a positive RT-PCR test for SARS-CoV-2 from the CSF, thus showing the neuro-invasive potential of the virus [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Neurological complications in COVID-19 – a diagnostic challenge

Văcăraș

Frunze²,

Cordoș³

2021

JMedLife

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With the exponential growth of COVID-19 cases, the neurological complications reported during or after the infection became more common. There is limited knowledge regarding the pathophysiological mechanisms that are responsible for these complications. Recent data provides compelling evidence for the neurotropic nature of SARS-CoV-2, based on neurological manifestations reported during the current pandemic, as well as on previous experience with other coronaviruses. We present the case of a patient who developed headaches, motor deficit and dysphasia after respiratory COVID-19. Imaging tests showed heterogeneous central nervous system lesions (multiple subarachnoid hemorrhages and two ischemic strokes). Given the plethora of atypical neurological complications of COVID-19 described in the current literature, establishing a positive diagnosis and deciding on a treatment plan proved to be particularly challenging. We set to discuss some of the possible pathologies, hypothesized to be associated with COVID-19, that could lead to concomitant neurological lesions, similar to those noticed in our patient.

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Association of CNS demyelination and COVID-19 infection: an updated systematic review

Ismail

Salama

2021

J Neurol

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Background Since the declaration of COVID-19 pandemic, several case reports of demyelination of both peripheral and central nervous systems have been published. The association between CNS demyelination and viral infection has long been documented, and this link was recently reported following SARS-CoV-2 infection as well. Objectives In this systematic review, we aim to investigate the existing literature on CNS demyelination associated with SARS-CoV-2, and the proposed pathophysiological mechanisms. Methods We conducted a systematic review of articles in PubMed, SCOPUS, EMBASE, Cochrane, Google Scholar and Ovid databases, from 1 January 2020 until June 15, 2021. The following keywords were used: "COVID-19", "SARS-CoV-2", "demyelination", "demyelinating disease", "multiple sclerosis", "neuromyelitis optica", and "transverse myelitis". Results A total of 60 articles were included in the final analysis of this systematic review and included 102 patients: 52 (51%) men and 50 (49%) women, with a median age of 46.5 years. The demyelination mimicked a variety of conditions with a picture of encephalitis/encephalomyelitis being the most common. At the same time other patterns were less frequently reported such as MS, NMOSD and even MOGAD. Longitudinally extensive transverse myelitis (LETM) was the most frequently reported pattern of spinal cord involvement. Conclusion A growing body of literature has shown an association between SARS-CoV-2 infection and the development of different types of CNS demyelination. Although causality cannot readily be inferred, this review may suggest a probable causal relationship, through a para-infectious or post-infectious immune-mediated etiology in COVID-19 patients. This relationship needs to be clarified in future research.

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Acute Hemorrhagic Encephalitis Related to COVID-19

Cited by 18 publications

References 15 publications

Acute hemorrhagic leukoencephalitis in a COVID-19 patient—a case report with literature review

Acute hemorrhagic leukoencephalitis in a COVID-19 patient—a case report with literature review

Neurological complications in COVID-19 – a diagnostic challenge

Association of CNS demyelination and COVID-19 infection: an updated systematic review

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