Steroid‐Responsive Encephalitis in Coronavirus Disease 2019

Padovani, Alessandro; Odolini, Silvia; Masciocchi, Stefano; Comelli, Agnese; Volonghi, Irene; Gazzina, Stefano; Nocivelli, Sara; Pezzini, Alessandro; Focà, Emanuele; Caruso, Arnaldo; Leonardi, Matilde; Pasolini, Maria Pia; Gasparotti, Roberto; Castelli, Francesco; Ashton, Nicholas J.; Blennow, Kaj; Zetterberg, Henrik; Padovani, Alessandro

doi:10.1002/ana.25783

Cited by 258 publications

(350 citation statements)

References 23 publications

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“…All the 5 studies that recorded proin ammatory cytokine analysis in CSF (interleukin-6 18,24,27,33,34 , interleukin 1β 27 , interleukin-8 18,24 , tumor necrosis factor α 18 ) showed signi cant increase (100%). Anti neuronal autoantibodies were only found in 1 case (Nmethyl-D-Aspartate receptor) 33 out of the 8 cases that were examined 2,18,27,29,31,32,33 (12.5%). SARS-CoV-2 polymerase chain reaction (PCR) examination on CSF was carried out in 28 cases, with positive results in 3 cases.…”

Section: Resultsmentioning

confidence: 99%

“…The most used pharmacological agents (Table 3) were hyroxychloroquine (48.48%), azithromycin (27.27%), and favipiravir (24.24%). Intravenous steroids were given in 8 cases (5 methylprednisolone 18,26,29,31,32 , 2 dexamethasone 28,33 , 1 unspeci ed 21 ), while immunotherapy such as, plasmapheresis and intravenous immunoglobulin (IVIG) were given to 10 patients (6 plasmapheresis 34 , 4…”

Section: Resultsmentioning

confidence: 99%

“…IVIg 18,26,29,32 ). Fifteen patients (65.21%) were reported to be discharged from the hospital in stable conditions, while four mortality cases (17.39%) 17.23.28 were recorded.…”

Section: Resultsmentioning

confidence: 99%

“…There was an increase in proin ammatory cytokines in CSF 18,24,27,33,34 , indicating the possible role of intravenous steroids and immunotherapy (IVIg and plasmapheresis) in the management of encephalitis associated with COVID-19. The methylprednisolone and IVIg therapy given in the 4 cases of COVID-19associated encephalitis 18,26,29,32 showed a positive response, with 3 patients discharged in stable conditions 18,29,32 , while 1 was still in care with signi cant improvement. 26 A study conducted by Dogan et al stated that plasmapheresis therapy showed dramatic improvements in both clinical and laboratory ndings.…”

Section: Systemic Review Analysismentioning

confidence: 99%

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COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

Siahaan¹,

Puspitasari

Pangestu

2020

Preprint

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Background : Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system resulting to a disease called coronavirus disease 19 (COVID-19), several studies also reported the involvement of the central nervous system along the course of the disease, one of which manifest as encephalitis. This study aims to determine the clinical profile, laboratory, and imaging results of encephalitis associated with COVID-19.Methods : Three databases namely, PubMed / Medline, Embase, and Scopus were systematically used in the search for this literature, in order to gather case reports and case series related to COVID-19-associated encephalitis published from January 1, 2019 to July 20, 2020.Result: There were 24 studies with 33 cases included in this review. The most reported neurological symptoms were disorientation / confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). The laboratory examination showed an increase in the levels of C-reactive protein (48.48%), lactate dehydrogenase (30.3%), and lymphophenia (27.27%). The brain imaging examination did not show any pathological findings in half of the cases (51.51%). EEG (electroencephalography) showed a generalized decrease in 45.45% of the cases. The CSF analysis showed an increase in the levels of protein (42.42%) and lymphocytosis (24.24%). Positive cerebrospinal fluid polymerase chain reaction (PCR) was only found in 3 cases, while the most widely used pharmacological agent was hyroxychloroquine (48.48%). Intravenous steroids were given in 8 cases, while immunotherapy such as plasmapheresis and intravenous immunoglobulin were given in 10 cases. Fifteen patients were reported to be discharged from the hospital in stable conditions, while four mortality cases were recorded. Conclusion: The clinical, laboratory, and imaging findings in this review supported the hypothesis that the process of cytokine-immune mediated inflammation was the cause of cerebral damage in COVID-19-associated encephalitis, rather than direct invasion. However, due to the limited availabile facilities in this study, further research and examination are needed to confirm the hypothesis

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…IVIg 18,26,29,32 ). Fifteen patients (65.21%) were reported to be discharged from the hospital in stable conditions, while four mortality cases (17.39%) 17.23.28 were recorded.…”

Section: Resultsmentioning

confidence: 99%

Section: Systemic Review Analysismentioning

confidence: 99%

See 2 more Smart Citations

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

Siahaan¹,

Puspitasari

Pangestu

2020

Preprint

View full text Add to dashboard Cite

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“…1 provides an overview of the study selection process. Our searches identi ed 13 relevant studies published in 15 articles [6,[19][20][21][22][23][24][25][26][27][28][29][30][31]. Of these, four were cohort studies, two case series, and seven case reports.…”

Section: Resultsmentioning

confidence: 99%

The Incidence of SARS-COV-2 Manifestations in the Central Nervous System: A Rapid Review and Meta-Analysis

Mayr

Glechner

Gartlehner

et al. 2020

Preprint

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Background: Coronavirus disease 2019 (COVID-19) is caused by SARS-CoV-2 and presents itself mainly as a respiratory tract infection. However, reports of associated central nervous system (CNS) manifestations are increasing.Methods: We conducted this rapid review to determine the frequency of CNS manifestations of COVID-19 (CNS symptoms, acute cerebrovascular disease, and infectious/inflammatory CNS diseases) and to summarize the current evidence for direct invasion of the CNS by SARS-CoV-2. An information specialist searched Ovid MEDLINE, the CDC: COVID-19 Research Articles Downloadable and WHO COVID-19 Databases, CENTRAL, and Epistemonikos.org on May 13, 2020. Two reviewers screened abstracts and potentially relevant full-text publications independently. The data extraction, assessment of risk of bias,and certainty of evidence using GRADE was done by one reviewer and double-checked by another. If possible and reasonable, a meta-analysis was carried out.Results: We identified 13 relevant studies (four cohort studies, nine case studies) with a total of 866 COVID-19 patients.In a Chinese cohort, dizziness (16.8%; 36 of 214) and headache (13.1%; 28 of 214) were the most common CNS symptoms reported. A meta-analysis of four cohort studies including 851 COVID-19 patients showed an incidence of 3.3% (95% CI: 2.2–4.9) for ischemic stroke (follow-up: one to five weeks). In 13 of 15 encephalitis case studies, PCR testing of the cerebrospinal fluid did not detect any virus components.Conclusion: CNS manifestations occur frequently in patients with COVID-19. It is important to integrate neurologists into the multiprofessional COVID-19 treatment team to detect neurological complications early and to treat them correctly.

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Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children

et al. 2020

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IMPORTANCE Neurological manifestations have been reported in adults with coronavirus disease 2019 (COVID-19), which is caused by the highly pathogenic virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE To report the neurological manifestations of children with COVID-19. DESIGN, SETTING, AND PARTICIPANTS In this case-series study, patients younger than 18 years who presented with SARS-CoV-2 infection and neurological symptoms to Great Ormond Street Hospital for Children (London, UK) between March 1, 2020, and May 8, 2020, were included after infection was confirmed by either a quantitative reverse transcriptionpolymerase chain reaction assay by nasopharyngeal swab or a positive test result for IgG antibodies against SARS-CoV-2 in serum. MAIN OUTCOMES AND MEASURES Clinical and paraclinical features were retrieved from electronic patient records. RESULTS Of the 27 children with COVID-19 pediatric multisystem inflammatory syndrome, 4 patients (14.8%) who were previously healthy had new-onset neurological symptoms. Symptoms included encephalopathy, headaches, brainstem and cerebellar signs, muscle weakness, and reduced reflexes. All 4 patients required intensive care unit admission for the treatment of COVID-19 pediatric multisystem inflammatory syndrome. Splenium signal changes were seen in all 4 patients on magnetic resonance imaging of the brain. In the 2 patients whose cerebrospinal fluid was tested, samples were acellular, with no evidence of infection on polymerase chain reaction or culture (including negative SARS-CoV-2 polymerase chain reaction results) and negative oligoclonal band test results. In all 3 patients who underwent electroencephalography, a mild excess of slow activity was found. Tests for N-methyl-D-aspartate receptor, myelin oligodendrocyte glycoprotein, and aquaporin-4 autoantibodies had negative results in all patients. In all 3 patients who underwent nerve conduction studies and electromyography, mild myopathic and neuropathic changes were seen. Neurological improvement was seen in all patients, with 2 making a complete recovery by the end of the study. CONCLUSIONS AND RELEVANCE In this case-series study, children with COVID-19 presented with new neurological symptoms involving both the central and peripheral nervous systems and splenial changes on imaging, in the absence of respiratory symptoms. Additional research is needed to assess the association of neurological symptoms with immune-mediated changes among children with COVID-19.

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Steroid‐Responsive Encephalitis in Coronavirus Disease 2019

Cited by 258 publications

References 23 publications

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

The Incidence of SARS-COV-2 Manifestations in the Central Nervous System: A Rapid Review and Meta-Analysis

Neurologic and Radiographic Findings Associated With COVID-19 Infection in Children

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