COVID-19-associated encephalitis successfully treated with combination therapy

Freire-Álvarez, Eric; Guillén, Lucía; Lambert, Karine; Baidez, Ana; García-Quesada, Miguel Ángel; Andréo, M; Alom, Jordi; Masiá, Mar; Gutiérrez, Félix

doi:10.1016/j.clinpr.2020.100053

Cited by 24 publications

(51 citation statements)

References 14 publications

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“…In a nationwide surveillance study to investigate the spectrum of neurological and psychiatric complications of COVID-19 across the UK, altered mental status including encephalopathy or encephalitis and primary psychiatric diagnoses was the second most common neuropsychiatric complication, often occurring in younger patients [ 40 ]. The exact pathogenic mechanism involved in neurologic injury in these cases is difficult to ascertain; however, given the constellation of pathologic findings described in the cases presented in this review and the neurologic presentation of these patients, both direct viral infection and host-specific inflammatory response might be pointed as the cause as supported also by post-mortem studies in different cases of SARS-CoV-2 infection [ 38 , 41 – 43 ].…”

Section: Discussionmentioning

confidence: 94%

Neuropathologic findings of patients with COVID-19: a systematic review

et al. 2021

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Background Despite the expanding literature that discusses insights into the clinical picture and mechanisms by which the SARS-CoV-2 virus invades the nervous system, data on the neuropathologic findings of patients who died following SARS-CoV-2 infection is limited. Methods A broad literature search was done for published articles that reported on histopathological findings of the brain in patients with COVID-19 in PubMed by MEDLINE, Embase, CENTRAL by the Cochrane Library, and SCOPUS from December 31, 2019 to October 31, 2020. Results The systematic literature search strategy used resulted in a total of 1608 articles of which 14 were included in the analysis (PROSPERO registration number: CRD42020221022). There were ten case series, two case reports, one retrospective cohort, and one prospective cohort. The age of the patients ranged between 38 and 90 years old, most of them older than 65 years old (n=66, 45.2%) and males (n=79, 54.1%). Most tested negative in SARS-CoV-2 immunohistochemistry (n=70, 47.9%). The striking pathologic changes included diffuse edema (n=25, 17.1%), gliosis with diffuse activation of microglia and astrocytes (n=52, 35.6%), infarctions involving cortical and subcortical areas of the brain (n=4, 2.7%), intracranial bleed (subarachnoid hemorrhage and punctate hemorrhages) (n=18, 12.4%), arteriosclerosis (n=43, 29.5%), hypoxic-ischemic injury (n=41, 28.1%), and signs of inflammation (n=52, 35.6%). The cause of death was attributed to the cardiorespiratory system (n=66, 45.2%). Conclusions The neuropathologic changes observed likely represent direct cytopathic effects and indirect effects secondary to host-specific inflammatory response induced by the viral infection. Further studies however are required to better elucidate the pathologic mechanism.

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Section: Discussionmentioning

confidence: 94%

Neuropathologic findings of patients with COVID-19: a systematic review

et al. 2021

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“…Although the CSF RBC count was only reported for 61/430 (14%) patients [ 22 , 28 , 29 , 31 , 35 , 39 , 40 , 44 , 73 , 74 , 77 , 78 , 81 , 89 , 92 , 102 , 110 , 118 , [120] , [121] , [122] , [123] , 128 , 133 , 134 , [138] , [139] , [140] , 156 , 165 , 166 , [172] , [173] , [174] , [175] , [176] , 180 , 184 , 188 , 191 , 192 , 198 , 202 , 204 , 208 , 215 , 220 , 225 , 227 , 233 , 241 , 242 , 246 ], the CSF white blood cell (WBC) count was provided for 409/430 (95%) patients, 270 (66%) of whom had >0 cells/μL, >1 WBC:1,000 RBC or were noted to have “pleocytosis” ( Fig. 3 ) [ [5] , [6] , [7] , [8] , 10 , 13 , [15] , [16] , [17] , [18] ...…”

Section: Resultsmentioning

confidence: 99%

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

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

141

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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“…In adults, we observed a male predominance (73.68%, 14 cases) ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ). The mean age was 49.8 years (25 to 70 years).…”

Section: Resultsmentioning

confidence: 67%

“…The comorbidity most frequently described was hypertension ( Lopes et al, 2020 ; McCuddy et al, 2020 ; Umapathi et al, 2020 ), followed by diabetes ( Lopes et al, 2020 ; McCuddy et al, 2020 ). Regarding the COVID-19 symptoms, 66.7% were severe ( N = 12/18)( Assunção et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Umapathi et al, 2020 ), 22.2% mild ( N = 4/18) ( El Beltagi et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ) and 11.1% asymptomatic ( N = 2/18)( Abdi et al, 2020 ; Utukuri et al, 2020 ). The COVID-19 diagnosis was made using a PCR test in 20 cases ( Abdi et al, 2020 ; Assunção et al, 2020 ; El Beltagi et al, 2021 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; Umapathi et al, 2020 ; Utukuri et al, 2020 ) and a serum antibody test (IgM and IgG antibody) in our case.…”

Section: Resultsmentioning

confidence: 99%

“…Including our original case report, we identified 30 patients (pediatric = 09, adults = 21) diagnosed with ADEM related with COVID-19 from 18 documents ( Abdel-Mannan et al, 2020 ; Abdi et al, 2020 ; Assunção et al, 2020 ; De Miranda Henriques-Souza et al, 2021 ; Dominguez- Rojas et al, El Beltagi et al, 2021 ; Espíndola et al, 2021 ; Freire-Álvarez et al, 2020 ; Kumar et al, 2020 ; Langley et al, 2020 ; Lindan et al, 2020 ; Lopes et al, 2020 ; McCuddy et al, 2020 ; Parsons et al, 2020 ; Paterson et al, 2020 ; Pilotto et al, 2021 ; 2020; Umapathi et al, 2020 ; Utukuri et al, 2020 ). Only one document was reported in non-English language (Spanish).…”

Section: Resultsmentioning

confidence: 99%

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Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

Zelada-Ríos

Pacheco‐Barrios

Galecio‐Castillo

et al. 2021

Journal of Neuroimmunology

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Acute disseminated encephalomyelitis (ADEM) has been reported after coronavirus disease 2019 (COVID-19). In this review, we systematically included worldwide reported cases on this association. We included 30 case reports (pediatric and adults) and explored epidemiological and clinical evidence. We described time to diagnosis, clinical, imaging, and laboratory features, response to treatment regimens, and differences regarding severity. Also, an original case report was presented. Neurologists must be alert to the occurrence of multifocal neurological symptoms with or without encephalopathy in patients recovered from COVID-19. Timely MRI studies should be performed to establish the diagnosis and to consider early corticosteroid-based treatment.

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COVID-19-associated encephalitis successfully treated with combination therapy

Cited by 24 publications

References 14 publications

Neuropathologic findings of patients with COVID-19: a systematic review

Neuropathologic findings of patients with COVID-19: a systematic review

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

Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

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