Bilateral optic neuritis as the presenting sign of post SARS-CoV-2 acute disseminated encephalomyelitis

Rossi, Tommaso; Novi, Giovanni; D’Agostino, Isabella; Cello, Luca Di; Soldati, M; Telani, Serena; Ripandelli, Guido

doi:10.1016/j.ajoc.2022.101273

Cited by 8 publications

(5 citation statements)

References 5 publications

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Section: Neuro-op Covid-19 Dinkin Sathisupporting

confidence: 67%

“…45 One case of acute disseminated encephalomyelitis after SARS-CoV-2 infection was complicated by severe bilateral vision loss with enhancement of both optic nerves. 46,47 The presence of þCOVID PCR in the cerebrospinal fluid (CSF) in this case supports the theory that delayed viral clearance from the CSF may have provoked parainfectious CNS inflammation. A case of bilateral disc edema in a 13-year-old with multisystem inflammatory syndrome (MIS) associated with COVID-19 was interpreted as ON based on the acute onset of vision loss and response to corticosteroids, 48 but the lack of pain with eye movement or enhancement on MRI is best characterized as a bilateral papillitis.…”

Section: Carriage Returnsupporting

confidence: 67%

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Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19

Dinkin

Sathi

2023

Semin Neurol

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We set out to describe in detail the afferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, new variants of COVID-19 continue to pose an international threat, and patients with rare neuro-ophthalmic complications are likely to continue to present for care.Afferent complications from COVID-19 include homonymous visual field loss, with or without higher cortical visual syndromes, resulting from stroke, intracerebral hemorrhage, or posterior reversible leukoencephalopathy. Optic neuritis has frequently been reported, sometimes along with acute disseminated encephalomyelopathy, often in association with either myelin oligodendrocyte glycoprotein antibodies (MOG-IgG) or less commonly aquaporin-4 seropositivity or in newly diagnosed multiple sclerosis. Ischemic optic neuropathy has rarely been reported. Papilledema, resulting either from venous sinus thrombosis or idiopathic intracranial hypertension in the setting of COVID-19, has also been described.Observed afferent neuro-ophthalmic associations need to be confirmed though larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.

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Section: Neuro-op Covid-19 Dinkin Sathisupporting

confidence: 67%

Section: Carriage Returnsupporting

confidence: 67%

Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19

Dinkin

Sathi

2023

Semin Neurol

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“…The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) flow chart is shown in figure 1. There were 34 studies of ON following COVID-19 infection,12–45 and an equal number of publications reported patients with ON post-COVID-19 vaccination 46–78. There were 19 case series and the remaining 49 were case reports.…”

Section: Resultsmentioning

confidence: 99%

Systematic review exploring the clinical features of optic neuritis after SARS-CoV infection and vaccination

Georganta,

Chasapi,

Smith

et al. 2023

BMJ Open Ophth

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BackgroundThis study aims to characterise the symptoms and clinical features of optic neuritis (ON) following SARS-CoV-2 infection and vaccination.MethodA literature search was conducted in four databases (PubMed, Medline, Embase and Google Scholar) to identify relevant case reports and case series. The records were screened and articles adhering to the inclusion criteria were critically appraised.ResultsSixty-eight studies were found to be eligible for inclusion, including 34 reporting ON following SARS-CoV-2 infection and an equal number reporting cases postvaccination. In total 93 patients and 125 eyes were included. The infection cohort included 42 patients and 56 eyes, 51.2% were female and 33.3% experienced bilateral ON. The mean visual acuity was 1.64 log of minimum angle of resolution (LogMAR), while pain was present in 77.8%. Oligoclonal bands were present in 3 patients, myelin oligodendrocyte glycoprotein (MOG) antibodies in 18 patients and AQP-4 antibodies in 4 patients. The vaccination cohort included 51 patients and 69 eyes. 60.8% were female and 35.3% had a bilateral ON. The mean visual acuity was 0.93 LogMAR. Oligoclonal bands were present in 46.7%, MOG antibodies in nine patients and AQP-4 antibodies in three patients.ConclusionPatients with ON post-SARS-CoV infection were more likely to experience severe visual impairment than in cases following vaccination. Further research is required to outline the clinical features of ON after COVID-19 infection and vaccination, and establish causality.

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“…Several recent systematic reviews and case reports have characterized cases of ADEM and acute hemorrhagic leukoencephalitis (AHLE) following COVID-19, though reported cases are still rare. 4,[63][64][65] Patients most commonly have neurologic symptoms beginning 2 to 4 weeks after the onset of COVID-19 respiratory symptoms. Encephalopathy, headache, seizures, and motor deficits are the most common presenting symptoms.…”

Section: Acute Disseminated Encephalomyelitis and Acute Hemorrhagic L...mentioning

confidence: 99%

Central Nervous System Neuroimmunologic Complications of COVID-19

Holroyd

Conway

2023

Semin Neurol

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Autoimmune disorders of the central nervous system following COVID-19 infection include multiple sclerosis (MS), neuromyelitis optica spectrum disorder, myelin oligodendrocyte glycoprotein antibody-associated disease, autoimmune encephalitis, acute disseminated encephalomyelitis, and other less common neuroimmunologic disorders. In general, these disorders are rare and likely represent postinfectious phenomena rather than direct consequences of the SARS-CoV-2 virus itself. The impact of COVID-19 infection on patients with preexisting neuroinflammatory disorders depends on both the disorder and disease-modifying therapy use. Patients with MS do not have an increased risk for severe COVID-19, though patients on anti-CD20 therapies may have worse clinical outcomes and attenuated humoral response to vaccination. Data are limited for other neuroinflammatory disorders, but known risk factors such as older age and medical comorbidities likely play a role. Prophylaxis and treatment for COVID-19 should be considered in patients with preexisting neuroinflammatory disorders at high risk for developing severe COVID-19.

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Bilateral optic neuritis as the presenting sign of post SARS-CoV-2 acute disseminated encephalomyelitis

Cited by 8 publications

References 5 publications

Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19

Neuro-Ophthalmic Visual Impairment in the Setting of COVID-19

Systematic review exploring the clinical features of optic neuritis after SARS-CoV infection and vaccination

Central Nervous System Neuroimmunologic Complications of COVID-19

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