Immune-mediated neurological syndromes in SARS-CoV-2-infected patients

Abstract

Background Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore investigated clinical, serological and CSF features of coronavirus disease 2019 (COVID-19) patients with neurological manifestations. Methods Consecutive COVID-19 patients with neurological manifestations other than isolated anosmia and/or non-severe headache, and with no previous neurological or psychiatric disorders were prospectively included. Neurological examination was performed in all patients and lumbar puncture with CSF examination was performed when not contraindicated. Serum anti-gangliosides antibodies were tested when clinically indicated. Results Of the 349 COVID-19 admitted to our center between March 23rd and April 24th 2020, 15 patients (4.3%) had neurological manifestations and fulfilled the study inclusion/exclusion criteria. CSF examination was available in 13 patients and showed lymphocytic pleocytosis in 2 patients: 1 with anti-contactin-associated protein 2 (anti-Caspr2) antibody encephalitis and 1 with meningo-polyradiculitis. Increased serum titer of anti-GD1b antibodies was found in three patients and was associated with variable clinical presentations, including cranial neuropathy with meningo-polyradiculitis, brainstem encephalitis and delirium. CSF PCR for SARS-CoV-2 was negative in all patients. Conclusions In SARS-Cov-2 infected patients with neurological manifestations, CSF pleocytosis is associated with para- or post-infectious encephalitis and polyradiculitis. Anti-GD1b and anti-Caspr2 autoantibodies can be identified in certain cases, raising the question of SARS-CoV-2-induced secondary autoimmunity.

Neurological manifestations associated with SARS-CoV-2 and other coronaviruses: A narrative review for clinicians

“…To date, five cohort studies provided a prevalence of neurological manifestations in a total of 2533 COVID-19 patients [2] , [3] , [4] , [5] , [6] ( Table 1 ). This prevalence ranged from 4.3 to 73.0% depending on which symptoms are considered.…”

“…Impaired consciousness was one of the most common neurological symptoms in cohort studies, reported in 1.8 to 21.3% of hospitalized COVID-19 patients [2] , [3] , [4] , [5] , [6] ( Table 1 ), up to 69% in severe patients needing intensive care management [11] . Disorder of consciousness occurred with a mean time of onset of 8 to 9 days in the evolution of COVID-19, and was associated with severe infection, older age, higher creatine kinase levels, lower lymphocyte counts and higher blood urea nitrogen [2] , [3] .…”

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

“…No studies have reported the prevalence of cognitive impairment among survivors of COVID-19, so extrapolation from other severe illnesses is necessary. Cognitive impairment comparable to mild Alzheimer's dementia has been estimated to occur in 25% of survivors of critical illness [77] and may be associated with prolonged delirium [78,79], severe hypoxaemia [78][79][80][81], early neurological manifestations [82], and duration of sedative-analgesia administration [80,83]. COVID-19 patients have risk factors for cognitive deficits [84], but there is no empirical evidence that cognitive deficits are as frequent among COVID-19 survivors or that interventions can improve cognitive outcomes [85,86].…”

Autoimmune limbic encephalitis related to SARS-CoV-2 infection: Case-report and review of the literature

“…Autoimmune panel negative on CSF and serum for anti LGI1, CASPR2, NMDAR, GABAB1R, GABAB2R, AMPAR1, AMPAR2, Hu, Yo, Ri, CV2, amphiphysin CS Slight disability, unable to perform all previous activities 4 Guilmot et al. ( Guilmot et al., 2020 ) 80, M Mild Short term memory disturbances, seizure, visual hallucinations, anxiety Not applicable Generalized slowing Normal 9 cells/mm 3 ; 46 ​mg/dl Negative CSF PCR for viral agents negative. Positive OCB.…”