Infectious encephalitis: mimics and chameleons

Toledano, Michel; Davies, Nicholas W S

doi:10.1136/practneurol-2018-002114

Cited by 10 publications

(9 citation statements)

References 43 publications

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“…This pattern was related to an unfavorable prognosis (score 4 qualitative classification of EEG alteration: Amodio et al, 1999) [40][41][42] or irreversible character as at ischemic encephalopathy 39,[42][43][44][45] with the exception of hypothyroid encephalopathy, which is reversible except for cretinism. 39,42,43,[45][46][47] , but in our series we found a good evolution in 60% of the patients. It has also been described in diffuse neuronal dysfunction like hypothermia, intoxication by central nervous system depressant drugs or anesthesia, 39,43,44 but we have ruled out all these causes in our patients.…”

Section: Discussioncontrasting

confidence: 55%

Retrospective Analysis of EEG in Patients With COVID-19: EEG Recording in Acute and Follow-up Phases

et al. 2021

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Background. Interest in electroencephalographic (EEG) coronavirus disease 2019 (COVID-19) findings has been growing, especially in the search for a specific-features EEG of encephalopathy. Methods. We made a retrospective analysis of 29 EEGs recorded in 15 patients with COVID-19 and neurological symptoms. We classified the EEGs as “Acute EEG” and “follow-up EEG.” We did a statistical analysis between voltage and respiratory status of the patient, stay or not in the intensive care unit (ICU), days of stay in the ICU, sedative drugs, pharmacological treatment, type of symptoms predominating, and outcome. Results. We found EEG abnormalities in all patients studied. We observed the amplitude of background <20 µV at 93% of “acute EEG,” versus only 21.4% of “follow-up EEG.” The average voltage went from 12.33 ± 5.09 µV in the acute EEGs to 32.8 ± 20.13 µV in the follow-up EEGs. A total of 60% of acute EEGs showed an intermittent focal rhythmic. We have not found a statistically significant association between voltage of acute EEG and nonneurological clinical status (including respiratory) that may interfere with the EEG findings. Conclusions. Nonspecific diffuse slowing EEG pattern in COVID-19 is the most common finding reported, but we found in addition to that, as a distinctive finding, low voltage EEG, that could explain the low prevalence of epileptic activity published in these patients. A metabolic/hypoxic mechanism seems unlikely on the basis of our EEG findings. This pattern in other etiologies is reminiscent of severe encephalopathy states associated with poor prognosis. However, an unreactive low voltage pattern in COVID-19 patients is not necessarily related to poor prognosis.

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Section: Discussioncontrasting

confidence: 55%

Retrospective Analysis of EEG in Patients With COVID-19: EEG Recording in Acute and Follow-up Phases

et al. 2021

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“…In the case of viral encephalitis, CSF analysis usually demonstrates lymphocytic pleocytosis. 26 In addition, the CSF protein level is typically elevated in viral encephalitis. CSF viral RT-PCR is usually positive but can be negative if done too early.…”

Section: Discussionmentioning

confidence: 99%

“…An alternative hypothesis appears more relevant: the neurovirulence of hCoVs, especially MERS-CoV, seems to be a consequence of immune-mediated processes. 19,[27][28][29] Indeed, ADEM and Bickerstaff brainstem encephalitis, which were described with MERS-CoV, [18][19][20][21][22][23][24][25][26][27] are 2 examples of autoimmune demyelinating diseases resulting from a postinfectious or parainfectious process. A recent case report 9 has described a case of acute hemorrhagic necrotizing encephalopathy (which is the most severe form of ADEM) associated with COVID-19, which strengthens the hypothesis of a predominant immunologic mechanism.…”

Section: Discussionmentioning

confidence: 99%

Neurologic and neuroimaging findings in patients with COVID-19

Kremer

Lersy²,

Anheim³

et al. 2020

Neurology

193

187

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ObjectiveTo describe neuroimaging findings and to report the epidemiological and clinical characteristics of COVID-19 patients with neurological manifestations.MethodsIn this retrospective multicenter study (10 Hospitals), we included 64 confirmed COVID-19 patients with neurologic manifestations who underwent a brain MRI.ResultsThe cohort included 43 men (67%), 21 women (33%), and the median age was 66 years (range: 20-92). 36 (56%) brain MRIs were considered abnormal, possibly related to SARS-CoV-2. Ischemic strokes (27%), leptomeningeal enhancement (17%), and encephalitis (13%) were the most frequent neuroimaging findings. Confusion (53%) was the most common neurological manifestation, following by impaired consciousness (39%), presence of clinical signs of corticospinal tract involvement (31%), agitation (31%), and headache (16%). The profile of patients experiencing ischemic stroke was different from the other patients with abnormal brain imaging since the former had less frequently acute respiratory distress syndrome (p=0·006) and more frequently corticospinal tract signs (p=0·02). Patients with encephalitis were younger (p=0·007), whereas agitation was more frequent for patients with leptomeningeal enhancement (p=0·009).ConclusionsCOVID-19 patients may develop a wide range of neurological symptoms, which can be associated with severe and fatal complications, such as ischemic stroke or encephalitis. Concerning the meningoencephalitis involvement, even if a direct effect of the virus cannot be excluded, the pathophysiology rather seems to involve an immune and/or inflammatory process given the presence of signs of inflammation in both cerebrospinal fluid and neuroimaging but the lack of virus in cerebrospinal fluid.

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“…Other causes include autoimmune diseases and certain medications (3). In many cases, the etiology remains unknown (4). Diagnosis is typically based on symptoms and supported by blood tests, medical imaging, and analysis of cerebrospinal fluid (5).…”

Section: Introductionmentioning

confidence: 99%

Dysbiosis of Gut Microbiota and Short-Chain Fatty Acids in Encephalitis: A Chinese Pilot Study

Tan

et al. 2020

Front. Immunol.

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Background: Encephalitis, the inflammation of the brain, may be caused by an infection or an autoimmune reaction. However, few researches were focused on the gut microbiome characteristics in encephalitis patients. Methods: A prospective observational study was conducted in an academic hospital in Guangzhou from February 2017 to February 2018. Patients with encephalitis were recruited. Fecal and serum samples were collected at admission. Healthy volunteers were enrolled from a community. Disease severity scores were recorded by specialized physicians, including Glasgow Coma Scale (GCS), Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation-II (APACHE-II). 16S rRNA sequence was performed to analyze the gut microbiome, then the α-diversities and β-diversities were estimated. Short-chain fatty acids (SCFAs) were extracted from fecal samples and determined by gas chromatography-mass spectrometry. Serum D-lactate (D-LA), intestinal fatty acid-binding protein (iFABP), lipopolysaccharide (LPS), and lipopolysaccharide-binding protein (LBP) were measured by enzyme-linked immunosorbent assay (ELISA). The associations among microbial indexes and clinical parameters were evaluated by Spearman correlation analysis. Results: In total, twenty-eight patients were recruited for analysis (median age 46 years; 82.1% male; median GCS 6.5; median SOFA 6.5; median APACHE-II 14.5). Twenty-eight age-and sex-matched healthy subjects were selected as controls. The β-diversities between patients and healthy subjects were significantly different. The α-diversities did not show significant differences between these two groups. In the patient group, the abundances of Bacteroidetes, Proteobacteria, and Bacilli were significantly enriched. Accordingly, fecal SCFA levels were decreased in the patient group, whereas serum D-LA, iFABP, LPS, and LBP levels were increased compared with those in healthy subjects. Correlation analyses showed that disease severity had positive correlations with Proteobacteria and Akkermansia but negative correlations with Firmicutes, Clostridia, and Ruminococcaceae abundances. The cerebrospinal fluid

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Infectious encephalitis: mimics and chameleons

Cited by 10 publications

References 43 publications

Retrospective Analysis of EEG in Patients With COVID-19: EEG Recording in Acute and Follow-up Phases

Retrospective Analysis of EEG in Patients With COVID-19: EEG Recording in Acute and Follow-up Phases

Neurologic and neuroimaging findings in patients with COVID-19

Dysbiosis of Gut Microbiota and Short-Chain Fatty Acids in Encephalitis: A Chinese Pilot Study

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