Meningoencephalitis associated with COVID-19: a systematic review

Abstract

With the growing number of COVID-19 cases in recent times. significant set of patients with extra pulmonary symptoms has been reported worldwide. Here we venture out to summarize the clinical profile, investigations, and radiological findings among patients with SARS-CoV-2-associated meningoencephalitis in the form of a systemic review. This review was carried out based on the existing PRISMA (Preferred Report for Systematic Review and Meta analyses) consensus statement. The data for this review was collected from four databases: Pubmed/Medline, NIH Litcovid, Embase, and Cochrane library and Preprint servers up till 30 June 2020. Search strategy comprised of a range of keywords from relevant medical subject headings which includes “SARS-COV-2,” “COVID-19,” and “meningoencephalitis.” All peer reviewed, case–control, case report, pre print articles satisfying our inclusion criteria were involved in the study. Quantitative data was expressed in mean ± SD, while the qualitative date in percentages. Paired t test was used for analysing the data based on differences between mean and respective values with a p < 0.05 considered to be statistically significant. A total of 61 cases were included from 25 studies after screening from databases and preprint servers, out of which 54 of them had completed investigation profile and were included in the final analysis. Clinical, laboratory findings, neuroimaging abnormalities, and EEG findings were analyzed in detail. This present review summarizes the available evidences related to the occurrence of meningoencephalitis in COVID-19.

Analysis of COVID-19 Infection and Mortality Among Patients With Psychiatric Disorders, 2020

“…3,4 A growing body of evidence suggests that SARS-CoV-2 infection can affect the central nervous system (CNS), either directly or indirectly, and is associated with multiple neurological symptoms, from olfactory and gustatory dysfunction to more severe and uncommon events such as Guillain-Barré syndrome and encephalitis. [5][6][7][8][9] Great attention has also been dedicated to acute and chronic psychiatric symptoms associated with COVID-19. [10][11][12] In a prospective cohort study, anxiety, depression, and posttraumatic symptoms were observed in 23%, 18%, and 7%, respectively, of survivors of COVID-19 who had been hospitalized in an intensive care unit 4 months earlier.…”

“… 3 , 4 A growing body of evidence suggests that SARS-CoV-2 infection can affect the central nervous system (CNS), either directly or indirectly, and is associated with multiple neurological symptoms, from olfactory and gustatory dysfunction to more severe and uncommon events such as Guillain-Barré syndrome and encephalitis. 5 , 6 , 7 , 8 , 9 …”

Central nervous system outcomes of COVID-19

“…As the pandemic progressed, review articles have been useful in combining available case reports and case studies 24 , 25 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 . These reviews were key to demonstrating prevalence of neurologic manifestations 46 among COVID-19 patients and to assess the prevalence of SARS CoV-2 presence in CSF as assessed by polymerase chain reaction (PCR) or serologic testing 47 .…”

Understanding the Role of Blood Vessels in the Neurologic Manifestations of Coronavirus Disease 2019 (COVID-19)

“…The first case of encephalitis associated with SARS-CoV-2 infection was reported in May 2020 in a 24 year old man 57 and since then, many more cases have been identified. 58 Case studies have identified that the higher risk of neurological complications in patients with severe symptoms is caused primarily by a higher frequency of encephalopathy, especially in older patients. 14 , 23 Patients diagnosed with encephalitis have demonstrated signs of immune-mediated small-vessel damage, leading to altered integrity of the blood-brain barrier and brain edema.…”