Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report

Panariello, Adelaide; Bassetti, Roberta; Radice, Anna; Rossotti, Roberto; Puoti, Massimo; Corradin, Matteo; Moreno, Mauro; Percudani, Mauro

doi:10.1016/j.bbi.2020.05.054

Cited by 127 publications

(144 citation statements)

References 8 publications

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“…All the 5 studies that recorded proin ammatory cytokine analysis in CSF (interleukin-6 18,24,27,33,34 , interleukin 1β 27 , interleukin-8 18,24 , tumor necrosis factor α 18 ) showed signi cant increase (100%). Anti neuronal autoantibodies were only found in 1 case (Nmethyl-D-Aspartate receptor) 33 out of the 8 cases that were examined 2,18,27,29,31,32,33 (12.5%). SARS-CoV-2 polymerase chain reaction (PCR) examination on CSF was carried out in 28 cases, with positive results in 3 cases.…”

Section: Resultsmentioning

confidence: 99%

“…The most used pharmacological agents (Table 3) were hyroxychloroquine (48.48%), azithromycin (27.27%), and favipiravir (24.24%). Intravenous steroids were given in 8 cases (5 methylprednisolone 18,26,29,31,32 , 2 dexamethasone 28,33 , 1 unspeci ed 21 ), while immunotherapy such as, plasmapheresis and intravenous immunoglobulin (IVIG) were given to 10 patients (6 plasmapheresis 34 , 4…”

Section: Resultsmentioning

confidence: 99%

“…The use of acyclovir and ceftriaxone were generally given as the empirical therapy, and was stopped when there was no evidence of a bacterial infection or HSV. There was an increase in proin ammatory cytokines in CSF 18,24,27,33,34 , indicating the possible role of intravenous steroids and immunotherapy (IVIg and plasmapheresis) in the management of encephalitis associated with COVID-19. The methylprednisolone and IVIg therapy given in the 4 cases of COVID-19associated encephalitis 18,26,29,32 showed a positive response, with 3 patients discharged in stable conditions 18,29,32 , while 1 was still in care with signi cant improvement.…”

Section: Systemic Review Analysismentioning

confidence: 99%

“…The possibility of an autoimmune mechanism was considered based on several previous studies linking COVID-19 with GBS. There were two reported cases with autoimmune features namely, the NMDA-R 33 and limbic encephalitis (T2 hyperintense signal abnormalities in limbic lobes, bilateral medial thalamus, and frontal white matter). 32 The anti-neuronal autoantibodies were only positive in 1 case (NMDA-R) 33 of the 8 cases examined (12.5%), indicating the emergence of new antigens, mediating immune reactions to the central nervous system.…”

Section: Systemic Review Analysismentioning

confidence: 99%

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COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

Siahaan¹,

Puspitasari

Pangestu

2020

Preprint

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Background : Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system resulting to a disease called coronavirus disease 19 (COVID-19), several studies also reported the involvement of the central nervous system along the course of the disease, one of which manifest as encephalitis. This study aims to determine the clinical profile, laboratory, and imaging results of encephalitis associated with COVID-19.Methods : Three databases namely, PubMed / Medline, Embase, and Scopus were systematically used in the search for this literature, in order to gather case reports and case series related to COVID-19-associated encephalitis published from January 1, 2019 to July 20, 2020.Result: There were 24 studies with 33 cases included in this review. The most reported neurological symptoms were disorientation / confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). The laboratory examination showed an increase in the levels of C-reactive protein (48.48%), lactate dehydrogenase (30.3%), and lymphophenia (27.27%). The brain imaging examination did not show any pathological findings in half of the cases (51.51%). EEG (electroencephalography) showed a generalized decrease in 45.45% of the cases. The CSF analysis showed an increase in the levels of protein (42.42%) and lymphocytosis (24.24%). Positive cerebrospinal fluid polymerase chain reaction (PCR) was only found in 3 cases, while the most widely used pharmacological agent was hyroxychloroquine (48.48%). Intravenous steroids were given in 8 cases, while immunotherapy such as plasmapheresis and intravenous immunoglobulin were given in 10 cases. Fifteen patients were reported to be discharged from the hospital in stable conditions, while four mortality cases were recorded. Conclusion: The clinical, laboratory, and imaging findings in this review supported the hypothesis that the process of cytokine-immune mediated inflammation was the cause of cerebral damage in COVID-19-associated encephalitis, rather than direct invasion. However, due to the limited availabile facilities in this study, further research and examination are needed to confirm the hypothesis

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Systemic Review Analysismentioning

confidence: 99%

Section: Systemic Review Analysismentioning

confidence: 99%

See 2 more Smart Citations

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

Siahaan¹,

Puspitasari

Pangestu

2020

Preprint

View full text Add to dashboard Cite

show abstract

“…This currently isolated case also raises the possibility that COVID-19 may trigger auto-antibody production. 36 The available studies suggest that SARS-CoV-2 can rarely produce a true encephalitis or meningoencephalitis with associated evidence of direct viral invasion of the CNS. The failure to detect virus in CSF in the other reported cases, despite evidence of inflammation as evidenced by CSF pleocytosis and elevated protein, raises the possibility that some cases of COVID-19 encephalitis may occur in the absence of direct virus invasion, and could potentially result from immune-mediated inflammatory mechanisms (see below).…”

Section: Neuroinvasion By Sars-cov-2mentioning

confidence: 99%

COVID‐19: A Global Threat to the Nervous System

Koralnik

Tyler

2020

Annals of Neurology

427

403

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In less than 6 months, the severe acute respiratory syndrome‐coronavirus type 2 (SARS‐CoV‐2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID‐19) also involves multiple other organs, including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS‐CoV‐2 infection is rapidly accumulating. These may result from a variety of mechanisms, including virus‐induced hyperinflammatory and hypercoagulable states, direct virus infection of the central nervous system (CNS), and postinfectious immune mediated processes. Example of COVID‐19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis, and endothelialitis. In the peripheral nervous system, COVID‐19 is associated with dysfunction of smell and taste, muscle injury, the Guillain‐Barre syndrome, and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID‐19 poses a global threat to the entire nervous system. Although our understanding of SARS‐CoV‐2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID‐19. ANN NEUROL 2020;88:1–11 ANN NEUROL 2020;88:1–11

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Neurological pathophysiology of SARS‐CoV‐2 and pandemic potential RNA viruses: a comparative analysis

et al. 2021

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SARS‐CoV‐2 has infected hundreds of millions of people with over four million dead, resulting in one of the worst global pandemics in recent history. Neurological symptoms associated with COVID‐19 include anosmia, ageusia, headaches, confusion, delirium, and strokes. These may manifest due to viral entry into the central nervous system (CNS) through the blood–brain barrier (BBB) by means of ill‐defined mechanisms. Here, we summarize the abilities of SARS‐CoV‐2 and other neurotropic RNA viruses, including Zika virus and Nipah virus, to cross the BBB into the CNS, highlighting the role of magnetic resonance imaging (MRI) in assessing presence and severity of brain structural changes in COVID‐19 patients. We present new insight into key mutations in SARS‐CoV‐2 variants B.1.1.7 (P681H) and B.1.617.2 (P681R), which may impact on neuropilin 1 (NRP1) binding and CNS invasion. We postulate that SARS‐CoV‐2 may infect both peripheral cells capable of crossing the BBB and brain endothelial cells to traverse the BBB and spread into the brain. COVID‐19 patients can be followed up with MRI modalities to better understand the long‐term effects of COVID‐19 on the brain.

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Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report

Cited by 127 publications

References 8 publications

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

COVID‐19: A Global Threat to the Nervous System

Neurological pathophysiology of SARS‐CoV‐2 and pandemic potential RNA viruses: a comparative analysis

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