COVID-19 associated meningoencephalitis complicated with intracranial hemorrhage. A case report.

Alolama, Mohammad; Rashid, Anas; Garozzo, Debora

doi:10.21203/rs.3.rs-28203/v1

Cited by 28 publications

(40 citation statements)

References 3 publications

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“…Whereas headaches, anosmia, dysgeusia, and neuralgia occur even in mild courses of the disease, epilepsy, acute cerebrovascular disease, and disturbed consciousness have been described in severe cases of COVID‐19 13 . Reports of COVID‐19 encephalitis are rare 14,15 . To the best of our knowledge, the present case constitutes the first description of meningoencephalitis in a solid organ recipient.…”

Section: Discussionmentioning

confidence: 69%

Allograft infiltration and meningoencephalitis by SARS-CoV-2 in a pancreas-kidney transplant recipient

Westhoff

Seibert

Bauer

et al. 2020

American Journal of Transplantation

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Severe acute respiratory syndrome corona virus 2 (SARS‐CoV‐2) preferentially affects epithelia of the upper and lower respiratory tract. Thus, impairment of kidney function has been primarily attributed until now to secondary effects such as cytokine release or fluid balance disturbances. We provide evidence that SARS‐CoV‐2 can directly infiltrate a kidney allograft. A 69‐year‐old male, who underwent pancreas‐kidney transplantation 13 years previously, presented to our hospital with coronavirus disease 2019 (COVID‐19) pneumonia and impaired pancreas and kidney allograft function. Kidney biopsy was performed showing tubular damage and an interstitial mononuclear cell infiltrate. Reverse transcriptase polymerase chain reaction from the biopsy specimen was positive for SARS‐CoV‐2. In‐situ hybridization revealed SARS‐CoV‐2 RNA in tubular cells and the interstitium. Subsequently, he had 2 convulsive seizures. Magnetic resonance tomography suggested meningoencephalitis, which was confirmed by SARS‐CoV‐2 RNA transcripts in the cerebrospinal fluid. The patient had COVID‐19 pneumonia, meningoencephalitis, and nephritis. SARS‐CoV‐2 binds to its target cells through angiotensin‐converting enzyme 2, which is expressed in a broad variety of tissues including the lung, brain, and kidney. SARS‐CoV‐2 thereby shares features with other human coronaviruses including SARS‐CoV that were identified as pathogens beyond the respiratory tract as well. The present case should provide awareness that extrapulmonary symptoms in COVID‐19 may be attributable to viral infiltration of diverse organs.

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Section: Discussionmentioning

confidence: 69%

Allograft infiltration and meningoencephalitis by SARS-CoV-2 in a pancreas-kidney transplant recipient

Westhoff

Seibert

Bauer

et al. 2020

American Journal of Transplantation

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“…SARS-CoV-2 polymerase chain reaction (PCR) examination on CSF was carried out in 28 cases, with positive results in 3 cases. 19,20,30 CSF and PCR examination of other viruses such as, herpes simplex virus (HSV), human herpes virus 6 (HHV 6), cytomegalovirus (CMV), varicella-zooster virus (VZV) produced negative results.…”

Section: Resultsmentioning

confidence: 99%

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

Siahaan¹,

Puspitasari

Pangestu

2020

Preprint

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Background : Although severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system resulting to a disease called coronavirus disease 19 (COVID-19), several studies also reported the involvement of the central nervous system along the course of the disease, one of which manifest as encephalitis. This study aims to determine the clinical profile, laboratory, and imaging results of encephalitis associated with COVID-19.Methods : Three databases namely, PubMed / Medline, Embase, and Scopus were systematically used in the search for this literature, in order to gather case reports and case series related to COVID-19-associated encephalitis published from January 1, 2019 to July 20, 2020.Result: There were 24 studies with 33 cases included in this review. The most reported neurological symptoms were disorientation / confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). The laboratory examination showed an increase in the levels of C-reactive protein (48.48%), lactate dehydrogenase (30.3%), and lymphophenia (27.27%). The brain imaging examination did not show any pathological findings in half of the cases (51.51%). EEG (electroencephalography) showed a generalized decrease in 45.45% of the cases. The CSF analysis showed an increase in the levels of protein (42.42%) and lymphocytosis (24.24%). Positive cerebrospinal fluid polymerase chain reaction (PCR) was only found in 3 cases, while the most widely used pharmacological agent was hyroxychloroquine (48.48%). Intravenous steroids were given in 8 cases, while immunotherapy such as plasmapheresis and intravenous immunoglobulin were given in 10 cases. Fifteen patients were reported to be discharged from the hospital in stable conditions, while four mortality cases were recorded. Conclusion: The clinical, laboratory, and imaging findings in this review supported the hypothesis that the process of cytokine-immune mediated inflammation was the cause of cerebral damage in COVID-19-associated encephalitis, rather than direct invasion. However, due to the limited availabile facilities in this study, further research and examination are needed to confirm the hypothesis

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“…In our review, 23 patients (in 17 studies) had con rmed CNS in ammatory lesions, including encephalitis, meningoencephalitis, and encephalomyelitis, with variable prevalence [5,25,35,36]. In a cohort of 2660 hospitalized COVID-19 patients, six patients presented with encephalitis as the rst and only disorder, two with fatal outcomes [5].…”

Section: Neuroin Ammatory Disordersmentioning

confidence: 98%

“…Anosmia and dysgeusia/parageusia indicate early involvement of the PNS by SARS-CoV-2, allowing for early screening and isolation of suspected cases before the onset of respiratory symptoms. The neurotrophic properties of SARS-CoV-2 may facilitate access to the CNS through the olfactory nerve and explain why many patients have reported anosmia as a preceding symptom [36]. In COVID-19, the sudden olfactory loss is typically unrelated to nasal swelling or rhinitis [7,37].…”

Section: Cranial Nerve Impairmentmentioning

confidence: 99%

Central and peripheral nervous system involvement by COVID-19: A systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

Guerrero

Barragán

Martinez

et al. 2020

Preprint

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Background: SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system's involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings.Methods: We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19.Results: A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system's involvement in patients with COVID-19, ranging from 22.5% to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-COV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. Conclusions: Our evidence synthesis led to a categorical analysis of the central and peripheral involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19's CNS and PNS involvement and generate strategies for therapeutic decision-making.Registration: This review is registered in PROSPERO (CRD42020193140), July 24, 2020.

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COVID-19 associated meningoencephalitis complicated with intracranial hemorrhage. A case report.

Cited by 28 publications

References 3 publications

Allograft infiltration and meningoencephalitis by SARS-CoV-2 in a pancreas-kidney transplant recipient

Allograft infiltration and meningoencephalitis by SARS-CoV-2 in a pancreas-kidney transplant recipient

COVID-19-Associated Encephalitis: Systematic Review of Case ReportsFindings on Cytokine-Immune-Mediated Inflammation as an Underlying Mechanism

Central and peripheral nervous system involvement by COVID-19: A systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings

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