Concentric demyelination pattern in COVID-19-associated acute haemorrhagic leukoencephalitis: a lurking catastrophe?

Karapanayiotides, Theodoros; Geka, E; Prassopoulos, Panayiotis; Koutroulou, Ioanna; Kollaras, Panayiotis; Kiourtzieva, Ellada; Pourzitaki, C.; Veroniki, Fotini; Sintila, Stiliani-Angeliki; Astreinidis, Athanasios; Tsivgoulis, Georgios; Grigoriadis, Nikolaos

doi:10.1093/brain/awaa375

Cited by 24 publications

(39 citation statements)

References 8 publications

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“…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 , …”

Section: Resultsmentioning

confidence: 99%

“…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 ].…”

Section: Resultsmentioning

confidence: 99%

“…As is evident by the fact that 303/430 (70%) patients we identified had CSF SARS-CoV-2 PCR testing performed, it is feasible to perform PCR testing for SARS-CoV-2 in CSF [5-10,15,17,22,24,26-38,43-59, 68-71,73,74,76-78,81,84,88,89,95,97,98,101,103,105,108,109,111, 113,116 156,157,161,164,165,169,171,177,178,[180][181][182][184][185][186][187]190,191,193,[195][196][197][198][199][200][201][203][204][205][206][207]209,[212][213][214][215][216][218][219][220][221][224][225][226][227]230,[233]…”

Section: Discussionmentioning

confidence: 99%

Section: Csf Oligoclonal Bandsmentioning

confidence: 99%

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

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

150

152

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Csf Oligoclonal Bandsmentioning

confidence: 99%

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

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

150

152

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“…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 – 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: 99%

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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