Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

Zelada-Ríos, Laura; Pacheco‐Barrios, Kevin; Galecio‐Castillo, Milagros; Yamunaque-Chunga, César; Álvarez-Toledo, Kelvin; Otiniano‐Sifuentes, Ricardo

doi:10.1016/j.jneuroim.2021.577674

Cited by 24 publications

(26 citation statements)

References 64 publications

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“…The virus responsible for the current global pandemic, SARS-CoV-2 infection has been associated with ADEM as well [ 5 ]. Since the vaccination efforts to combat the pandemic began, there have also been number of published reports of possible ADEM following SARS-CoV-2 vaccination: three related to ChAdOx1 (AstraZeneca, Oxford, United Kingdom), a non-replicating viral vector vaccine; two related to Sinovac (Vero Cells, Beijing Institute of Biological Products Co., Ltd., Beijing, China), an inactivated SARS-CoV-2 vaccine, and one following Cominarty (Pfizer-BioMTech, New York, New York, USA), an mRNA vaccine [ 6 – 11 ].…”

Section: Introductionmentioning

confidence: 99%

Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination

et al. 2022

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Background Acute disseminated encephalomyelitis (ADEM) is a rare immune-mediated inflammatory demyelinating disease of the central nervous system. We report a case of ADEM presenting with bilateral optic neuritis temporally associated with the ChAdOx1 vaccine against SARS-COVID19 virus. Case presentation A 36-year-old female presented with bilateral optic neuritis following her first dose of the ChAdOx1 vaccine. Initial MRI Brain showed evidence of demyelination within the subcortical white matter, with no radiological involvement of the optic nerves. Visual evoked potentials were consistent with bilateral optic neuritis which was confirmed radiologically on follow up MRI. She was treated with intravenous steroids with improvement both in symptoms and radiological appearance. A pseudo-relapse occurred which was treated with a further course of intravenous steroids followed by an oral taper. The clinical, radiological and serological results were most consistent with diagnosis of ADEM. Conclusions ADEM is an exceedingly rare complication of ChAdOx1 vaccine despite millions of doses. While it is imperative clinicians remain aware of neurological complications of vaccines, the importance of vaccination to control a pandemic should not be undermined.

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Section: Introductionmentioning

confidence: 99%

Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination

et al. 2022

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“…A recent study included 30 ADEM cases after COVID-19 with a predominance of adult cases, possibly because adults are more likely to be infected by COVID-19 ( 38 ). For these adult cases, the average age was 50 years, which is older than those in previous reports of ADEM adults ( 39 ). More severe cases occur in older adults who often have multiple complications ( 40 ).…”

Section: Discussionmentioning

confidence: 55%

Clinical Presentation and Outcomes of Acute Disseminated Encephalomyelitis in Adults Worldwide: Systematic Review and Meta-Analysis

Wen

et al. 2022

Front. Immunol.

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BackgroundAcute disseminated encephalomyelitis (ADEM) is a rare demyelinating disorder that is often misdiagnosed. To improve early diagnosis, we performed a systematic review and meta-analysis of clinical features, outcomes for ADEM in adults.MethodsThe PubMed, Embase, Web of Science and Cochrane Library databases were searched for studies reporting the clinical features of adults with ADEM between January 1990 and May 2021. A random-effects meta-analysis model was used to pool data on clinical features and functional outcomes.ResultsTwelve studies examining 437 adults with ADEM met the inclusion criteria. Overall, the clinical features and diagnostic findings observed in more than two-thirds of the patients were white matter lesions [87.1%, 95% confidence interval (CI)=75-95.6], polyfocal onset (80.5%, 95% CI=50.5-98.9) and pyramidal signs (68.7%, 95% CI =40.0-91.9). The mortality rate was 7.8% (95% CI = 3.3–13.5), and the risk of residual deficits was 47.5% (95% CI = 31.8–63.4).ConclusionsAdults with ADEM had worse outcomes than children. Clinicians should maintain high clinical suspicion for patients presenting with certain clinical features and diagnostic findings.

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“…Previous studies have reviewed the cases of ADEM [ 9 , 41 , 42 ] and ANHLE9 following COVID-19. However, those studies did not focus on possible disease prognostic factors nor the clinical differences between ADEM and ANHLE.…”

Section: Discussionmentioning

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.

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Acute disseminated encephalomyelitis and COVID-19: A systematic synthesis of worldwide cases

Cited by 24 publications

References 64 publications

Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination

Acute disseminated encephalomyelitis with bilateral optic neuritis following ChAdOx1 COVID-19 vaccination

Clinical Presentation and Outcomes of Acute Disseminated Encephalomyelitis in Adults Worldwide: Systematic Review and Meta-Analysis

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

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