ABSTRACT
We have read with interest the article by Watroba and Bryda on a new-born male with SARS-CoV-2 associated meningo-encephalitis, post-inflammatory hydrocephalus and seizures [1]. Neuro-COVID in this patient was treated with a polypragmatic approach, including phenobarbital, acetazolamide, fluconazole, acyclovir, cefotaxime, and vancomycin [1]. The study is appealing but has limitations that raise concerns and should be discussed.
Subject(s)
COVID-19 , Meningoencephalitis , Humans , Male , SARS-CoV-2 , Meningoencephalitis/drug therapy , Seizures , AcetazolamideABSTRACT
The topic of SARS-CoV-2 coronavirus infections in children is still complex and not fully understood. Acute meningoencephalitis (ME) was not considered a common presentation of COVID-19 in paediatrics, however, over time, several paediatric patients with ME associated with SARS-CoV-2 coronavirus infection have been described. The case report describes the clinical case of a newborn admitted to the Neonatal Intensive Care Unit (NICU) on 11th day of life due to severe SARS-CoV-2 coronavirus infection, who experienced multiple seizure episodes. The patient was diagnosed with ME and hydrocephalus. In the absence of clinical improvement, despite the use of standard treatment, acetazolamide (ACZ) was used, achieving complete relief of seizures and gradual regression of hydrocephalus. This means that ACZ can be considered as an add-on therapy to standard treatment in cases of ME and postinflammatory hydrocephalus in the course of COVID-19 disease.
Subject(s)
COVID-19 , Hydrocephalus , Meningoencephalitis , Infant, Newborn , Humans , Child , COVID-19/complications , Acetazolamide/therapeutic use , SARS-CoV-2 , Hydrocephalus/drug therapy , Hydrocephalus/etiology , Meningoencephalitis/drug therapy , Meningoencephalitis/etiologyABSTRACT
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.
Subject(s)
COVID-19/physiopathology , Cough/physiopathology , Fatigue/physiopathology , Fever/physiopathology , Meningoencephalitis/physiopathology , SARS-CoV-2/pathogenicity , Adult , Aged , Antiviral Agents/therapeutic use , Azithromycin/therapeutic use , COVID-19/diagnostic imaging , COVID-19/virology , Confusion/diagnostic imaging , Confusion/drug therapy , Confusion/physiopathology , Confusion/virology , Cough/diagnostic imaging , Cough/drug therapy , Cough/virology , Dyspnea/diagnostic imaging , Dyspnea/drug therapy , Dyspnea/physiopathology , Dyspnea/virology , Electroencephalography , Fatigue/diagnostic imaging , Fatigue/drug therapy , Fatigue/virology , Female , Fever/diagnostic imaging , Fever/drug therapy , Fever/virology , Humans , Hydroxychloroquine/therapeutic use , Male , Meningoencephalitis/diagnostic imaging , Meningoencephalitis/drug therapy , Meningoencephalitis/virology , Middle Aged , Neuroimaging , SARS-CoV-2/drug effects , COVID-19 Drug TreatmentABSTRACT
A 40-year-old man presented with altered mental status after a recenthospitalisation for COVID-19 pneumonia. Cerebrospinal fluid (CSF) analysis showed lymphocytosis concerning for viral infection. The CSF PCR for SARS-CoV-2 was negative, yet this could not exclude COVID-19 meningoencephalitis. During hospitalisation, the patient's mentation deteriorated further requiring admission to the intensive care unit (ICU). Brain imaging and electroencephalogram (EEG) were unremarkable. He was, thus, treated with intravenous immunoglobulin (IVIg) for 5 days with clinical improvement back to baseline. This case illustrates the importance of considering COVID-19's impact on the central nervous system (CNS). Haematogenous, retrograde axonal transport, and the effects of cytokine storm are the main implicated mechanisms of CNS entry of SARS-CoV-2. While guidelines remain unclear, IVIg may be of potential benefit in the treatment of COVID-19-associated meningoencephalitis.