COVID-19-associated acute disseminated encephalomyelitis: A systematic review

Abstract

Objective: The objective of this study was to provide an overview of acute disseminating encephalomyelitis, a potential and serious complication of COVID-19. Methods: Three primary databases were used, PubMed, LitCovid, and WHO. The final review articles reported acute disseminated encephalomyelitis (ADEM) in COVID-19-positive patients and were full-text, peer-reviewed articles. Articles which did not have patient data such as in vitro studies and articles with unclear inference were excluded. Results: Out of 21 cases of ADEM, the diagnosis of severe acute respiratory syndrome-coronavirus 2 was confirmed in 18 and suspected in 3. Among the neurological symptoms, altered consciousness was most common (7/21), followed by anosmia (3), paraplegia (3/21), brain stem involvement (3/21), sphincter involvement (2/21), and quadriplegia (1/21). Raised inflammatory markers were most commonly seen in 9/17. Central nervous system imaging was abnormal in 19 cases and unavailable in 2 cases. Fifteen patients were treated with corticosteroids, 11 patients received intravenous immunoglobulin, while 3 patients received convalescent plasma. Two patients needed surgical intervention. Complications included seizures (1), acute kidney injury and septicemic shock (1), raised intracranial pressure (1), and supraventricular tachycardia secondary to hydroxychloroquine (1). One patient recovered completely and one had good recovery with mild deficits. Thirteen patients had incomplete recovery with residual neurological deficit while three patients died as the consequence of the disease. Conclusion: The physicians and neurosurgeons should be diligent while treating the COVID-19 patients with neurological manifestations and include ADEM as a differential diagnosis and stress on early diagnosis and treatment to reduce mortality and achieve satisfactory clinical outcome.

Acute disseminated encephalomyelitis (ADEM) following COVID-19 vaccination: A systematic review

“…Although the exact underlying mechanism of ADEM is still a matter of discussion, it is suggested that ADEM mainly occurs after bacterial and viral infection alongside vaccination [ [12] , [13] , [14] ]. Several studies have reported ADEM occurrence after SARS-CoV-2 infection [ [15] , [16] , [17] ]. Moreover, a large number of case reports and case series have also suggested the potential association between ADEM and COVID-19 vaccination [ [18] , [19] , [20] , [21] , [22] , [23] ].…”

The Coronavirus Pandemic Effects on Children

“…Acute disseminated encephalomyelitis-like abnormalities were commonly observed in pediatric patients with severe complications, due to a SARS-CoV-2 infection [11]. This disorder causes inflammation of the brain and spinal cord, as well as damage to the white matter of the brain.…”

Young Woman With COVID-19 Unable to Walk

“…It most commonly occurs in children but has been described in postinfectious states in adults, with much lower rates seen after vaccination. 1 , 2 , 3 Classically, the clinical presentation is an abrupt onset of mental status changes ranging from lethargy to coma, with multifocal neurologic deficits, and may include seizures. 4 Magnetic resonance imaging is paramount for proper diagnosis ( Figure 2 ) and uniformly demonstrates T2-weighted image hyperintensities, which are typically widespread, asymmetric, patchy lesions involving supratentorial and infratentorial white matter but may also involve gray matter.…”