Central Nervous System Neuroimmunologic Complications of COVID-19

Abstract

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.

SARS-CoV-2 brainstem encephalitis in human inherited DBR1 deficiency

“…These SARS-CoV-2–related forms of encephalitis have an estimated overall prevalence of about 2/10,000. In most cases, encephalitis occurs weeks or months after the acute respiratory viral infection and presents as post-infectious autoimmune encephalitis ( Holroyd and Conway, 2023 ). However, encephalitis may also occur in severe cases of COVID-19 pneumonia or multisystem inflammatory syndrome in children (MIS-C) with the inflammation of multiple organs, including the brain ( Olivotto et al, 2021 ).…”