ABSTRACT
Objective: To determine the incidence, risk factors, clinical features, laboratory findings, management & fatality of ADEM in COVID-19 patients. Background: There has been a concerning increase in the prevalence of COVID-19 associated acute disseminated encephalomyelitis. ADEM is a rare autoimmune disorder, often post-viral, primarily attacks children and can potentially lead to long lasting neurological sequelae. As such, accurate diagnosis and timely management is of paramount clinical significance. Design/Methods: A systematic search adhering to PRISMA guidelines was performed from electronic databases (Medline, Google Scholar, OpenGray, Cochrane Library, NYAM) from inception until 12th October 2020. Renowned preprint servers like medRxiv, bioRxiv were also searched. Published case-reports/series of proven/presumed ADEM in COVID-19 patients were included. Results: Fourteen case-reports/series, with a sample size of 18 patients, were included. Mean age was 50.6±15.2 years, with a male to female ratio of 1:1. Most cases reported signs/symptoms of neurological nature prior to respiratory;the most common being: headaches, paresthesia, movement disorders, positive Babinski's sign and absent Deep tendon reflexes. Hypertension was the most common comorbidity. Eleven patients required intubation. Treatment with highdose corticosteroids and antibiotics/antivirals resulted in partial recovery of 66.6% of cases. Corticosteroids plus IVIG therapy aided in partial recovery of 27.7% of cases. Plasmapheresis was limited to 4 patients. SARS-CoV2 was reported in CSF samples of 11.1% patients. Partial recovery was seen in 88.8% and in-hospital mortality was reported in 11.1% of patients. Full clinical response was not seen. Conclusions: Neurological symptoms were the main presentation of COVID-19 which did not correlate with the severity of respiratory symptoms. High incidence of ADEM with hemorrhage (n=3) is striking. A rise in the prevalence of ADEM in adults in contrast to children is also concerning. Brain inflammation is likely caused by immune response to the disease rather than neurotropism. Clinicians need to be vigilant as early diagnosis can improve patient outcomes.