Two patients with acute meningoencephalitis concomitant with SARS‐CoV‐2 infection

Bernard‐Valnet, Raphaël; Pizzarotti, Beatrice; Anichini, Angelica; Demars, Yoris; Russo, Enrico; Schmidhauser, Marie; Cerutti‐Sola, Jonathan; Rossetti, Andrea O.; Pasquier, Renaud Du

doi:10.1111/ene.14298

Cited by 158 publications

(165 citation statements)

References 6 publications

(6 reference statements)

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“…Bernard-Valnet et al reported on two patients with "meningoencephalitis concomitant to SARS-CoV2." 33 These patients had nuchal rigidity, altered mental status, mild CSF lymphocytic pleocytosis (17-21 cells/μl 3 on initial lumbar puncture [LP]), and mildly elevated CSF protein (46-47 mg/dl). However, in both patients, the MRI was normal and neither patient had a positive CSF RT-PCR for SARS-CoV-2.…”

Section: Neuroinvasion By Sars-cov-2mentioning

confidence: 99%

COVID‐19: A Global Threat to the Nervous System

Koralnik

Tyler

2020

Annals of Neurology

422

403

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In less than 6 months, the severe acute respiratory syndrome‐coronavirus type 2 (SARS‐CoV‐2) has spread worldwide infecting nearly 6 million people and killing over 350,000. Initially thought to be restricted to the respiratory system, we now understand that coronavirus disease 2019 (COVID‐19) also involves multiple other organs, including the central and peripheral nervous system. The number of recognized neurologic manifestations of SARS‐CoV‐2 infection is rapidly accumulating. These may result from a variety of mechanisms, including virus‐induced hyperinflammatory and hypercoagulable states, direct virus infection of the central nervous system (CNS), and postinfectious immune mediated processes. Example of COVID‐19 CNS disease include encephalopathy, encephalitis, acute disseminated encephalomyelitis, meningitis, ischemic and hemorrhagic stroke, venous sinus thrombosis, and endothelialitis. In the peripheral nervous system, COVID‐19 is associated with dysfunction of smell and taste, muscle injury, the Guillain‐Barre syndrome, and its variants. Due to its worldwide distribution and multifactorial pathogenic mechanisms, COVID‐19 poses a global threat to the entire nervous system. Although our understanding of SARS‐CoV‐2 neuropathogenesis is still incomplete and our knowledge is evolving rapidly, we hope that this review will provide a useful framework and help neurologists in understanding the many neurologic facets of COVID‐19. ANN NEUROL 2020;88:1–11 ANN NEUROL 2020;88:1–11

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Section: Neuroinvasion By Sars-cov-2mentioning

confidence: 99%

COVID‐19: A Global Threat to the Nervous System

Koralnik

Tyler

2020

Annals of Neurology

422

403

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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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“…However, among these recognized human respiratory pathogens, at least HCoV-OC43, HCoV-229E, and SARS-CoV could be associated with the triggering or the exacerbation of neurological diseases as viral RNA or infectious virus can be detected in human brains [9][10][11]. Preliminary reports showed some COVID-19 patients showed CNS manifestations, such as dizziness, headache, nausea, vomiting, impaired consciousness, acute cerebrovascular disease, ataxia, and seizure, which warned that SARS-CoV-2 could have neuroinvasive potential [4][5][6][7][8][9][10][11][12][13]. Similar to SARS-CoV, SARS-CoV-2 also bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells [14].…”

Section: Resultsmentioning

confidence: 99%

“…Recently, a study reported that SARS-CoV-2 can productively infect human neural progenitor cells and brain organoids, highlighting the potential of direct viral involvement in neurological symptoms in COVID-19 patients [5]. However, proof of a direct involvement of SARS-CoV-2 is missing in the most cases of COVID-19 with central nervous system (CNS) symptoms have been reported until now, because the virus or nucleic acid was not detected in cerebrospinal uid (CSF) [6][7][8]. Here, we report a case of involvement of the CNS by the SARS-CoV-2, which was con rmed by ultrahigh depth metagenomic next generation sequencing (mNGS).…”

Section: Introductionmentioning

confidence: 99%

Detection of SARS-CoV-2 nucleic acid in CSF by ultrahigh depth sequencing in a patient with COVID-19 and neurological dysfunction: a case report

Pan

Lü

et al. 2020

Preprint

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Background: SARS-Coronavirus-2 (SARS-CoV-2), the pathogen of coronavirus disease 2019 (COVID-19), not only infects the respiratory tract, but also other organs. About a third of the inpatients of COVID-19 have neurological symptoms and in vitro experiments revealed that SARS-CoV-2 could infect human neural progenitor cells and brain organoids. However, the traditional test often reports negative owing to the low number of virus in the cerebrospinal fluid. To date, timely diagnosis of central nervous system infection of SARS-CoV-2 remains a challenge.Case presentation: On day 14 of COVID-19, seizures, maxillofacial convulsions, intractable hiccups and significant increase in intracranial pressure developed in a 56-year-old man. The RT-PCR of SARS-CoV-2 was negative. SARS-CoV-2 nucleic acid were detected in cerebrospinal fluid (CSF) by ultrahigh depth sequencing. The patient was successfully treated after 14 days of mechanical ventilation and treatment of pneumonia and neurological dysfunction.Conclusions: This case suggests SARS-CoV-2 can invade the central nervous system and relevant examinations with CSF including ultrahigh depth sequencing of SARS-CoV-2 are needed among COVID-19 patients with neurological dysfunction.

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Two patients with acute meningoencephalitis concomitant with SARS‐CoV‐2 infection

Cited by 158 publications

References 6 publications

COVID‐19: A Global Threat to the Nervous System

COVID‐19: A Global Threat to the Nervous System

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

Detection of SARS-CoV-2 nucleic acid in CSF by ultrahigh depth sequencing in a patient with COVID-19 and neurological dysfunction: a case report

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