Steroid-responsive encephalitis in Covid-19 disease

Abstract

SARS-CoV-2 infection has the potential for targeting central nervous system and several neurological symptoms have been described in patients with severe respiratory distress. Here we described the case of an otherwise healthy 60-year old subject with SARS-CoV-2 infection but only mild respiratory abnormalities who developed severe progressive encephalopathy associated with mild pleocytosis and hyperproteinorrachia. MRI was negative whereas EEG showed theta waves on the anterior brain regions. Serum and CSF analyses excluded other known infectious or autoimmune disorders. The patient dramatically improved after high-doses steroid treatment suggesting an inflammatory-mediated brain involvement related to SARS-CoV-2 infection.

Assessment of neurological manifestations in hospitalized patients with COVID‐19

“…Furthermore, a direct invasion of virus on the CNS seems extremely rare, being reported in only a few cases [9][10][11]. In our cohort, just one patient was diagnosed as affected by encephalitis.…”

Neurological complications of COVID-19: a preliminary review

“…However, in one case hyperintense signal in the right mesial temporal lobe and hippocampus was noted [30] whilst hemorrhagic rim enhancing lesions within the bilateral thalami, medial temporal lobes and subinsular regions was reported in the case of acute necrotizing encephalopathy [28]. EEG was performed in two of the cases presenting with seizures as well as one other with encephalopathy [29]; all showed generalized slowing.…”

“…Of the 8 reports published up to May 1st 2020, 7 were single case reports [26][27][28][29][30][31][32] and one a case series (n = 2) [33] in the context of oropharyngeal swabs or CSF positive for SARS-Cov-2 using RT-qPCR. Of the 9 cases, 5 were females and 3 were males; one did not specify gender; average age 55.5; male 42.0, female 60.8.…”

SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation

“…Improvements of the clinical status were observed in 5/6 patients, and MRI findings were reversible in all 3 patients with positive MRI. Another case from Italy ( Pilotto et al, 2020 ) described a 60-year old man with mild respiratory symptoms that developed akinetic mutism and nuchal rigidity. MRI and EEG were negative for any abnormalities.…”

“…Although the exact pathogenetic mechanism of autoimmune encephalitis in the setting of COVID-19 is unclear, it may be related to cytokine storm with direct damage to the BBB and increased leukocyte migration to the brain ( Sohal and Mossammat, 2020 ), as well as dysregulation of viral immunity mediated by molecular mimicry ( Pilotto et al, 2020 ). A trial with immunomodulatory therapies can be crucial to diagnose autoimmune encephalitis.…”