Extensive cerebellar involvement and cognitive impairment in COVID-19-associated acute necrotizing encephalopathy

Ciolac, Dumitru; Igor, Crivorucica; Eremei, Zota; Nadejda, Gorincioi; Efremova, Daniela; Diana, Manea; Crivorucica, Veaceslav; Ciocanu, Mihail; Groppa, Stanislav

doi:10.1177/1756286420985175

Cited by 22 publications

(16 citation statements)

References 14 publications

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“…An increasing body of evidence indicates that infection with SARS-CoV-2 can affect the CNS and can induce a range of neurological and neuropsychiatric syndromes, either by rare direct invasion or, more often, by secondary immune-mediated mechanisms [ 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. However, less is known about the influence of SARS-CoV-2 on neurodegenerative diseases, including CJD, and on the underlying neuropathological alterations.…”

Section: Discussionmentioning

confidence: 99%

“…Typical computed tomography findings include bilateral pulmonary ground-glass opacities, sometimes with a peripheral lung distribution [ 10 ]. Besides the respiratory manifestations, a range of neurological complications associated with a SARS-CoV-2 infection, including headache, anosmia, seizures, encephalopathy, meningitis/encephalitis, myelitis, and stroke, are being increasingly reported [ 11 , 12 , 13 ]. Reverse transcriptase polymerase chain reaction (RT-PCR)-based diagnostic tests from nasopharyngeal, nasal, or oropharyngeal specimens are considered the gold standard for the detection of the current SARS-CoV-2 infection [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and Radiological Deterioration in a Case of Creutzfeldt–Jakob Disease following SARS-CoV-2 Infection: Hints to Accelerated Age-Dependent Neurodegeneration

et al. 2021

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Systemic inflammation and the host immune responses associated with certain viral infections may accelerate the rate of neurodegeneration in patients with Creutzfeldt–Jakob disease (CJD), a rare, transmissible neurodegenerative disease. However, the effects of the newly emerged SARS-CoV-2 infection on the pathogenesis of CJD are unknown. In this study, we describe the case of an elderly female patient with sporadic CJD that exhibited clinical deterioration with the emergence of seizures and radiological neurodegenerative progression following an infection with SARS-CoV-2 and severe COVID-19. Despite efforts to control the progression of the disease, a dismal outcome ensued. This report further evidences the age-dependent neurological effects of SARS-CoV-2 infection and proposes a vulnerability to CJD and increased CJD progression following COVID-19.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Clinical and Radiological Deterioration in a Case of Creutzfeldt–Jakob Disease following SARS-CoV-2 Infection: Hints to Accelerated Age-Dependent Neurodegeneration

et al. 2021

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“…No patient showed a complete recovery. Good clinical recovery was observed in one patient (4.5%) 38 , while partial/poor recovery was reported in 13 cases (59.1%) 9,[23][24][25]27,[32][33][34]37,39 . Eight patients died (36.4%) 9,26,[29][30][31]35,36 .…”

Section: Anhlementioning

confidence: 94%

“…Three patients (13%) received low-dose steroid treatment 9,29,30 . Six patients (26.1%) were treated with IVMP pulse therapy 9,31,32,35,36,39 and six others (26.1%) with IVMP followed by IVIG 9,23,25,26,33 . One patient was treated with IVIG and PLEX 24 , another with IVIG alone 28 .…”

Section: Anhlementioning

confidence: 99%

Encephalopathy as a prognostic factor in adults with acute disseminated encephalomyelitis following COVID-19

Gelibter¹,

Bellavia²,

Arbasino³

et al. 2021

Preprint

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Numerous reports support the possible occurrence of acute disseminated encephalomyelitis (ADEM) following COVID-19. Herein, we report a case of ADEM in a 53 years-old man two weeks after SARS-CoV-2 infection. We reviewed the reports of adult cases of ADEM and its variant acute necrotizing hemorrhagic leukoencephalitis (ANHLE) to check for possible prognostic factors and clinical/epidemiological peculiarities. We performed a descriptive analysis of clinical and cerebrospinal fluid data. Ordinal logistic regressions were performed to check the effect of clinical variables and treatments on ADEM/ANHLE outcomes. We also compared ADEM and ANHLE patients. We identified a total of 20 ADEM (9 females, median age 53.5 years) and 23 ANHLE (11 females, median age 55 years). Encephalopathy was present in 80% of ADEM and 91.3% of ANHLE patients. We found that the absence of encephalopathy predicts a better clinical outcome in ADEM (OR = 0.027, 95%CI 0.001–0.611, p = 0.023), also when correcting for the other variables (OR = 0.032, 95%CI 0.001–0.995, p = 0.05). Conversely, we identified no significant prognostic factor in ANHLE patients. ANHLE patients showed a trend towards a worse clinical outcome (lower proportion of good/complete recovery, 4.5% vs 16.7%) and higher mortality (36.4% vs 11.1%) as compared to ADEM. Compared to pre-pandemic ADEM, we observed a higher median age of people with post-COVID-19 ADEM and ANHLE, a shorter interval between infection and neurological symptoms, and a worse prognosis both in terms of high morbidity and mortality. Despite being affected by the retrospective nature of the study, these observations provide new insights into ADEM/ANHLE following SARS-CoV-2 infection.

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“…Three patients (13%) received low-dose steroid treatment [ 10 , 30 , 31 ]. Six patients (26.1%) were treated with IVMP pulse therapy [ 10 , 32 , 33 , 36 , 37 , 40 ] and six others (26.1%) with IVMP followed by IVIG [ 10 , 24 , 26 , 27 , 34 ]. One patient was treated with IVIG and PLEX [ 25 ], another with IVIG alone [ 29 ].…”

Section: Anhlementioning

confidence: 99%

Encephalopathy as a prognostic factor in adults with acute disseminated encephalomyelitis following COVID-19

Gelibter¹,

Bellavia²,

Arbasino³

et al. 2022

J Neurol

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Numerous reports support the possible occurrence of acute disseminated encephalomyelitis (ADEM) following COVID-19. Herein, we report a case of ADEM in a 53-year-old man 2 weeks after SARS-CoV-2 infection. We reviewed the reports of adult cases of ADEM and its variant acute necrotizing hemorrhagic leukoencephalitis (ANHLE) to check for possible prognostic factors and clinical/epidemiological peculiarities. We performed a descriptive analysis of clinical and cerebrospinal fluid data. Ordinal logistic regressions were performed to check the effect of clinical variables and treatments on ADEM/ANHLE outcomes. We also compared ADEM and ANHLE patients. We identified a total of 20 ADEM (9 females, median age 53.5 years) and 23 ANHLE (11 females, median age 55 years). Encephalopathy was present in 80% of ADEM and 91.3% of ANHLE patients. We found that the absence of encephalopathy predicts a better clinical outcome in ADEM (OR 0.027, 95% CI 0.001–0.611, p = 0.023), also when correcting for the other variables (OR 0.032, 95% CI 0.001–0.995, p = 0.05). Conversely, we identified no significant prognostic factor in ANHLE patients. ANHLE patients showed a trend towards a worse clinical outcome (lower proportion of good/complete recovery, 4.5% vs 16.7%) and higher mortality (36.4% vs 11.1%) as compared to ADEM. Compared to pre-pandemic ADEM, we observed a higher median age of people with post-COVID-19 ADEM and ANHLE, a shorter interval between infection and neurological symptoms, and a worse prognosis both in terms of high morbidity and mortality. Despite being affected by the retrospective nature of the study, these observations provide new insights into ADEM/ANHLE following SARS-CoV-2 infection.

show abstract

Extensive cerebellar involvement and cognitive impairment in COVID-19-associated acute necrotizing encephalopathy

Cited by 22 publications

References 14 publications

Clinical and Radiological Deterioration in a Case of Creutzfeldt–Jakob Disease following SARS-CoV-2 Infection: Hints to Accelerated Age-Dependent Neurodegeneration

Clinical and Radiological Deterioration in a Case of Creutzfeldt–Jakob Disease following SARS-CoV-2 Infection: Hints to Accelerated Age-Dependent Neurodegeneration

Encephalopathy as a prognostic factor in adults with acute disseminated encephalomyelitis following COVID-19

Encephalopathy as a prognostic factor in adults with acute disseminated encephalomyelitis following COVID-19

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