Bickerstaff encephalitis after COVID-19

Abstract

A 72-year-old woman with a history of hypertension, hyperlipidemia, smoking, and depression presented on early April 2020 with delirium and fever. A cranial CT scan was normal. A chest X-ray showed bilateral interstitial pneumonia, and nasopharyngeal exudate polymerase chain reaction (PCR) testing was positive to SARS-CoV-2. Cerebrospinal fluid (CSF) was normal. She was admitted and started on hydroxychloroquine, azithromycin, ceftriaxone, and IV methylprednisolone. A few days later she was transferred to the intensive care unit due to a cardiogenic shock caused by a myocardial infarction. Further hemodynamic and respiratory evolution was good, and she was discharged without delirium or cognitive impairment on day 22 after admission. She was readmitted eight days later due to a 48-h history of dizziness, oscillopsia, and unsteadiness. Her vital signs were normal, and she was afebrile. Systemic examination was unremarkable. She was conscious, and her language and speech were normal, but slight inattention and disorientation were present. A downbeat nystagmus in all gaze positions and impairment of smooth pursuit eye movements were present. Horizontal and vertical eye movements showed no limitation. Motor and sensory examinations were normal, and deep tendon reflexes were all present and symmetrical. The left plantar response was extensor. There was no limb dysmetria, but severe truncal ataxia was present. Reflex

Cerebrospinal fluid in COVID-19: A systematic review of the literature

“…CSF oligoclonal bands were tested in 114 patients who did not have a positive CSF SARS-CoV-2 PCR or positive CSF antibodies to SARS-CoV-2 (103 (90%) who had symptoms that localized to the CNS and 11 (10%) who had symptoms that localized to the PNS) [ 9 , 10 , 19 , 20 , 35 , 36 , 42 , 44 , 45 , 58 , 69 , 74 , 79 , 81 , 101 , 112 , 113 , 116 , 117 , 126 , 127 , 130 , 135 , 136 , 147 , 149 , 152 , 154 , 160 , [168] , [169] , [170] , [171] , 177 , 181 , 182 , [185] , [186] , [187] , [188] , 191 , 194 , 203 , 205 , 207 , 209 , 212 , 213 , 215 , 216 , 218 , 233 , 242 , 245 ]. Of these, 35 (31%) had matched CSF and serum bands [ 9 , 35 , 79 , 112 , 113 , 127 , 147 , 170 , 171 , …”

“…Of the patients who did not have a positive CSF SARS-CoV-2 PCR, CSF SARS-CoV-2 antibodies or CSF-specific oligoclonal bands, 45 had CSF immunoglobulins measured [ 9 , 10 , 42 , 45 , 49 , 57 , 58 , 62 , 69 , 74 , 81 , 113 , 117 , 148 , 181 , 182 , 187 , 194 , 205 , 215 , 220 , 242 , 246 ]. Of these, 29 (64%) patients had normal immunoassays [ 42 , 45 , 49 , 57 , 58 , 62 , 69 , 74 , 81 , 113 , 181 , 182 , 187 , 194 , 215 , 242 , 246 ].…”

“…Autoimmune antibodies were tested in the CSF of 72/430 (17%) patients (60 (83%) of whom were encephalopathic or comatose, 4 (6%) of whom were paraparetic, 3 (4%) of whom had seizures, 3 (4%) of whom had cerebellar symptoms, 1 (1%) of whom had parkinsonism and 1 (1%) of whom was locked-in) [ 10 , 25 , 30 , 34 , 44 , 45 , 74 , 122 , 135 , 136 , 141 , 148 , 154 , 164 , 169 , 171 , 177 , 182 , 185 , 186 , 191 , 193 , 194 , [205] , [206] , [207] , 209 , 213 , 215 , 216 , 220 , 233 , 234 , 242 , 245 , 246 ]. Of the 72 patients who had autoimmune antibodies tested in the CSF, 4 (6%) had positive autoimmune antibodies [ 30 , 169 , 171 , 205 ].…”

Neurological update: COVID-19

“…The most common of these conditions is Guillain-Barré syndrome (GBS), a post-infectious neuropathy which is thought to occur as a result of molecular mimicry between epitopes on the pathogen and peripheral nerve structures. There have now been numerous reports and case-series of GBS and related disorders such as Miller-Fisher Syndrome occurring following COVID-19 [46][47][48][49][50][51], but unlike in the Zika virus pandemic, there does not seem to be a disproportionately high risk of developing GBS following COVID-19 compared with other viruses. Indeed, in a large United Kingdom paired epidemiological and cohort study, the incidence of GBS in the UK was lower during the pandemic than in previous years, presumably because of reduced transmission of higher risk pathogens such as campylobacter jejuni [52].…”

The Significance of COVID-19 Immunological Status in Severe Neurological Complications and Multiple Sclerosis—A Literature Review

“…An interesting case was presented in a study describing a patient who returned to the hospital after COVID-19 with neurological symptoms, including dizziness, eye movement disorders and disorientation. Anti-GD-1 antibodies were found in the serum, and Bickerstaff encephalitis was diagnosed [ 69 , 70 ].…”