COVID‐19 encephalopathy masquerading as substance withdrawal

Byrnes, Sean; Bisen, Maneesh; Syed, Baseer; Huda, Syed; Siddique, Zaid; Sampat, Parth J; Russo, Ronald; Oueida, Zaher; Johri, Geetanjali; Dargon, Ian

doi:10.1002/jmv.26065

Cited by 19 publications

(29 citation statements)

References 8 publications

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“…SARS‐COV‐2 virus, in CSF, was demonstrated only in 2 patients. In the vast majority of COVID‐19 associated encephalopathy patients, CSF was reported normal 13‐54 (Table 1).…”

Section: Analysis Of Case Report and Case Seriesmentioning

confidence: 99%

“…Acute disseminated encephalomyelitis (ADEM) is an autoimmune demyelinating disease of brain, that clinically manifests with encephalopathy and multifocal neurological signs. In ADEM, the cortical white matter brainstem, optic nerves, and spinal cord are variably affected and MRI demonstrates multifocal widespread T2/FLAIR hyperintense white matter lesions 29‐36 (Table 2).…”

Section: Neuroimagingmentioning

confidence: 99%

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Encephalopathy in patients with COVID‐19: A review

Garg

Paliwal²,

Gupta

2020

Journal of Medical Virology

197

195

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Encephalopathy and encephalitis are major and devastating severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) virus-associated central nervous system complications. Hypoxic/metabolic changes produced by intense inflammatory response against the virus triggers cytokine storm and subsequently acute respiratory distress syndrome and multiple organ failure. Hypoxic/metabolic changes result in encephalopathy. The presence of comorbidities predisposes to hypoxic/metabolic changes responsible for encephalopathy. Altered consciousness, ranging from mild confusion, delirium, to deep coma, is hallmark clinical features. Cortical and subcortical T2/FLAIR signal changes are common neuroimaging abnormalities. In a few isolated case reports of SARS-CoV-2 encephalitis, the virus has been demonstrated in cerebrospinal fluid. The presence of anosmia and ageusia can help in differentiation from other encephalopathies. We analyzed published reports on coronavirus disease 2019-associated encephalopathy. Encephalopathy is common in older patients, the majority are more than 50 years of age. The patients having encephalopathy/encephalitis are either severely or critically ill. Many patients were already on mechanical ventilation. Lung abnormalities are noted in almost all of the patients, presenting with encephalopathy. Encephalopathy is always preceded by commoner clinical features, like, fever, cough, dyspnoea, and headache. In majority, patients are already in the intensive care unit, when encephalopathy develops.

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“…SARS‐COV‐2 virus, in CSF, was demonstrated only in 2 patients. In the vast majority of COVID‐19 associated encephalopathy patients, CSF was reported normal 13‐54 (Table 1).…”

Section: Analysis Of Case Report and Case Seriesmentioning

confidence: 99%

Section: Neuroimagingmentioning

confidence: 99%

Encephalopathy in patients with COVID‐19: A review

Garg

Paliwal²,

Gupta

2020

Journal of Medical Virology

197

195

View full text Add to dashboard Cite

show abstract

“… 1,10,12,14–17,20,22–24,26–30,33,34, 36–39,42,47,48,52–55,57,61,63,64,68, 70,72–74,76,80,83,84,91,94,96 …”

Section: Resultsmentioning

confidence: 99%

“… 1,10,12,14–17,20,22–24,26,27,30,33, 34,36,38,39,42,47,48,52–54,57,63,64, 68,70,72–74,76,80,83,91,94,96,102, 103,105,111,117–119,121 …”

Section: Resultsmentioning

confidence: 99%

COVID‐19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta‐analysis of the relationship to CSF SARS‐CoV‐2

Lewis

Jain

Frontera

et al. 2021

Journal of Neuroimaging

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Background and Purpose We reviewed the literature to evaluate cerebrospinal fluid (CSF) results from patients with coronavirus disease 2019 (COVID‐19) who had neurological symptoms and had an MRI that showed (1) central nervous system (CNS) hyperintense lesions not attributed to ischemia and/or (2) leptomeningeal enhancement. We sought to determine if these findings were associated with a positive CSF severe acute respiratory syndrome associated coronavirus 2 (SARS‐CoV‐2) polymerase chain reaction (PCR). Methods We performed a systematic review of Medline and Embase from December 1, 2019 to November 18, 2020. CSF results were evaluated based on the presence/absence of (1) ≥ 1 CNS hyperintense lesion and (2) leptomeningeal enhancement. Results In 117 publications, we identified 193 patients with COVID‐19 who had an MRI of the CNS and CSF testing. There were 125 (65%) patients with CNS hyperintense lesions. Patients with CNS hyperintense lesions were significantly more likely to have a positive CSF SARS‐CoV‐2 PCR (10% [9/87] vs. 0% [0/43], p = 0.029). Of 75 patients who had a contrast MRI, there were 20 (27%) patients who had leptomeningeal enhancement. Patients with leptomeningeal enhancement were significantly more likely to have a positive CSF SARS‐CoV‐2 PCR (25% [4/16] vs. 5% [2/42], p = 0.024). Conclusion The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID‐19 is associated with increased likelihood of a positive CSF SARS‐CoV‐2 PCR. However, a positive CSF SARS‐CoV‐2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.

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“…We reviewed the relevant literature published up to April 2021 and extracted three reports of acute chorea with mild signs of encephalopathy and evidence of concurrent Covid-19 (see Table 1). [4][5][6] All the patients had mild-to-moderate leukocytosis and absence of oligoclonal bands in the CSF. Our case, the only one with CSF follow-up, suggests that the immune response, in the absence of an effective immunomodulating therapy, can persist for a long time after resolution of the triggering event.…”

Section: Discussionmentioning

confidence: 99%