Central neuroinflammation in Covid-19: a systematic review of 182 cases with encephalitis, acute disseminated encephalomyelitis, and necrotizing encephalopathies

Abstract

Growing evidence demonstrates the association of encephalitis, meningoencephalitis or encephalomyelitis, with SARS-CoV-2 infection. This study aims to determine the profile and possible mechanisms behind CNS inflammatory diseases in the context of Covid-19. We conducted a systematic review of case reports on Covid-19-related encephalitis, meningoencephalitis, acute necrotizing encephalitis, and acute disseminated encephalomyelitis in adults, published before January 2021. A total of 182 cases (encephalitis = 109, meningoencephalitis = 26, acute disseminated encephalomyelitis = 35, acute necrotizing (hemorrhagic) encephalitis = 12) were included. While cerebrospinal fluid (CSF) pleocytosis and increased protein level was present in less than 50%, magnetic resonance imaging (MRI) and electroencephalogram (EEG) were abnormal in 78 and 93.2% of all cases, respectively. Viral particles were detected in cerebrospinal fluid of only 13 patients and autoantibodies were present in seven patients. All patients presented with altered mental status, either in the form of impaired consciousness or psychological/cognitive decline. Seizure, cranial nerve signs, motor, and reflex abnormalities were among associated symptoms. Covid-19-associated encephalitis presents with a distinctive profile requiring thorough diagnosis and thereby a comprehensive knowledge of the disease. The clinical profile of brain inflammation in Covid-19 exhibits majority of abnormal imaging and electroencephalography findings with mild/moderate pleocytosis or proteinorrhachia as prevalent as normal cerebrospinal fluid (CSF). Oligoclonal bands and autoantibody assessments are useful in further evaluating neuro-covid patients, as supported by our pooled evidence. Despite the possibility that direct viral invasion cannot be easily estimated, it is still more likely that immune-mediated or autoimmune reactions play a more important role in SARS-CoV-2 neuroinflammation.

Acute Ascending Necrotizing Myelitis After COVID-19 Infection: A Clinicopathologic Report

“…Acute encephalitis, including necrotizing encephalitis, has been described with COVID-19 infection. 1,36 This is a case of COVID-19-associated ANM with histopathologic confirmation. It adds to the spectrum of encephalomyelitis in COVID-19 infection.…”

Persistent Hiccups as an Atypical Presentation of SARS-CoV-2 Infection: A Systematic Review of Case Reports

“…Although examination of the cerebrospinal fluid (CSF) was not ensued in the included patients, differential diagnosis of viral encephalitis is largely contingent on CSF virus detection ( 55 , 57 ). While SARS-CoV-2 dissemination in the CNS has been described as transient and/or limited with low CSF titres ( 55 , 57 ), reports confirm negative CSF PCR positivity with delayed neurological involvement ( 62 ). Taken together, whether persistent hiccups in SARS-CoV-2 infected patients may reflect an encephalitis lethargica-like phenotype or simply immune-mediated para-infectious encephalitis, remains unexplored.…”

A bibliometric analysis of COVID-19 publications in neurology by using the visual mapping method

“…David Garcia-Azorin focuses on post-pandemic neurological syndromes (e.g., persistent headache ( 38 , 39 ) and insomnia ( 40 )). Nima Rezaei first mainly focused on neurological complications of COVID-19 ( 41 , 42 ) and then shifted to the neurological side effects of COVID-19 vaccination ( 43 ). Henrik Zetterberg focused on exploring potential neurochemical biomarkers and underlying mechanisms of COVID-19-related neuropathy ( 44 – 46 ), Tom Solomon was the most cited author because he published two articles in Lancet Neurology ( 3 ) and Lancet Psychiatry ( 5 ) that give readers a comprehensive understanding of the neurological and neuropsychiatric complications of COVID-19.…”