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3.
Ideggyogy Sz ; 74(7-08): 277-285, 2021 Jul 30.
Article in Hungarian | MEDLINE | ID: covidwho-1348814

ABSTRACT

Shortly after that COVID-19 appeared it became clear, that although the disease mainly characterized by respiratory symptoms, other signs frequently appeared, which showed involvation of other organs. There are several new publications which report about neurological complications. According to data developing of encephalitis could be relatively frequent among these. Its symptoms can mostly be observed concommittantly with respiratory symptoms or during critical state of the disease, and several forms were detected. In our patient symptoms of central nervous system involvement appeared a few weeks after healing of COVID-19 pneumonia. Clinical signs, imaging, electroencephalograpy and cerebrospinal fluid analysis confirmed the diagnosis of encephalitis. Considering the previous SARS-CoV-2 infection and the results of the examinations, we think this case was a postinfectious central nervous system disease. There are only a few data available regarding encephalitis after Covid-19 disease in the literature, yet.


Subject(s)
COVID-19 , Central Nervous System Diseases , Encephalitis , Nervous System Diseases , Encephalitis/diagnosis , Encephalitis/etiology , Humans , SARS-CoV-2
4.
Med Clin (Barc) ; 157(3): 141-143, 2021 08 13.
Article in English, Spanish | MEDLINE | ID: covidwho-1340761

ABSTRACT

INTRODUCTION: In the context of the global COVID-19 pandemic, the different clinical manifestations of this infection pose a challenge for healthcare professionals. Respiratory involvement, the main symptom of SARS-CoV-2 infection, means that other manifestations, such as neurological, take a back seat, with the consequent delay in diagnosis and treatment. MATERIAL AND METHODS: All COVID-19 patients admitted with neurological symptoms or diagnosed with encephalitis since March 2020 in a tertiary hospital in Zaragoza, Spain. RESULTS: Two patients with COVID-19 infection confirmed by nasopharyngeal PCR and whose clinical picture consisted of neurological alterations compatible with encephalitis. Cerebrospinal fluid (CSF) microbiology was negative for bacteria and viruses, including SARS-CoV-2 but, given the clinical suspicion of encephalitis due to the latter, antiviral treatment with immunoglobulins and plasmapheresis was started early. Despite this, the evolution was not satisfactory. CONCLUSIONS: COVID-19 encephalitis is a recently described clinical entity, whose pathophysiology is still unknown and no treatment with clinical evidence is available to date.


Subject(s)
COVID-19 , Encephalitis , Nervous System Diseases , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/virology , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , Pandemics , Spain
5.
Eur J Paediatr Neurol ; 34: 84-90, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1340639

ABSTRACT

OBJECTIVE: To characterize neurological involvement in multisystem inflammatory syndrome in children (MIS-C) related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS: Retrospective analysis of the clinical, electroencephalographic, CSF and neuroradiological parameters recorded in seven children (3 males, aged 3-10 years) affected by MIS-C with acute neurological involvement. RESULTS: All cases presented acute encephalopathy with drowsiness, irritability, mood deflection and diffuse EEG slowing with periodic posterior complexes. Focal neurological signs, normal brain MRI and CSF, were present in four patients; these patients received intravenous methylprednisolone at 30 mg/kg/day for 3 days. In all cases, the clinical picture rapidly improved in the first three days, and all neurological symptoms and EEG abnormalities disappeared within 10 and 30 days respectively. The severity and duration of the EEG abnormalities was proportional to the extent of the neurological involvement. CONCLUSIONS: Patients with MIS-C may present acute encephalitis characterized by rapid-onset encephalopathy and EEG abnormalities (slow wave activity and/or epileptic abnormalities), in some cases associated with focal neurological signs that disappear with immunomodulatory therapy. The detection through neurological evaluation of sentinel neurological signs and distinctive EEG patterns documentable at disease onset will allow timely diagnosis and treatment of these cases.


Subject(s)
COVID-19 , Encephalitis , COVID-19/complications , Child , Encephalitis/diagnosis , Humans , Male , Retrospective Studies , SARS-CoV-2 , Systemic Inflammatory Response Syndrome
6.
BMJ Case Rep ; 14(7)2021 Jul 26.
Article in English | MEDLINE | ID: covidwho-1327622

ABSTRACT

A patient presented with fever, generalised rash, confusion, orofacial movements and myoclonus after receiving the first dose of mRNA-1273 vaccine from Moderna. MRI was unremarkable while cerebrospinal fluid showed leucocytosis with lymphocyte predominance and hyperproteinorrachia. The skin evidenced red, non-scaly, oedematous papules coalescing into plaques with scattered non-follicular pustules. Skin biopsy was consistent with a neutrophilic dermatosis. The patient fulfilled the criteria for Sweet syndrome. A thorough evaluation ruled out alternative infectious, autoimmune or malignant aetiologies, and all manifestations resolved with glucocorticoids. While we cannot prove causality, there was a temporal correlation between the vaccination and the clinical findings.


Subject(s)
Encephalitis , Myoclonus , Sweet Syndrome , COVID-19 Vaccines , Encephalitis/diagnosis , Encephalitis/etiology , Humans , Myoclonus/etiology , Sweet Syndrome/diagnosis , Sweet Syndrome/drug therapy , Sweet Syndrome/etiology
7.
Indian J Pediatr ; 88(9): 948, 2021 09.
Article in English | MEDLINE | ID: covidwho-1300527
8.
Med Clin (Barc) ; 157(3): 141-143, 2021 08 13.
Article in English, Spanish | MEDLINE | ID: covidwho-1253373

ABSTRACT

INTRODUCTION: In the context of the global COVID-19 pandemic, the different clinical manifestations of this infection pose a challenge for healthcare professionals. Respiratory involvement, the main symptom of SARS-CoV-2 infection, means that other manifestations, such as neurological, take a back seat, with the consequent delay in diagnosis and treatment. MATERIAL AND METHODS: All COVID-19 patients admitted with neurological symptoms or diagnosed with encephalitis since March 2020 in a tertiary hospital in Zaragoza, Spain. RESULTS: Two patients with COVID-19 infection confirmed by nasopharyngeal PCR and whose clinical picture consisted of neurological alterations compatible with encephalitis. Cerebrospinal fluid (CSF) microbiology was negative for bacteria and viruses, including SARS-CoV-2 but, given the clinical suspicion of encephalitis due to the latter, antiviral treatment with immunoglobulins and plasmapheresis was started early. Despite this, the evolution was not satisfactory. CONCLUSIONS: COVID-19 encephalitis is a recently described clinical entity, whose pathophysiology is still unknown and no treatment with clinical evidence is available to date.


Subject(s)
COVID-19 , Encephalitis , Nervous System Diseases , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/virology , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/virology , Pandemics , Spain
9.
J Infect Dis ; 223(1): 28-37, 2021 01 04.
Article in English | MEDLINE | ID: covidwho-1066338

ABSTRACT

BACKGROUND: Several preclinical and clinical investigations have argued for nervous system involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some sparse case reports have described various forms of encephalitis in coronavirus disease 2019 (COVID-19) disease, but very few data have focused on clinical presentations, clinical course, response to treatment, and outcomes. METHODS: The SARS-CoV-2 related encephalopaties (ENCOVID) multicenter study included patients with encephalitis with full infectious screening, cerebrospinal fluid (CSF), electroencephalography (EEG), and magnetic resonance imaging (MRI) data and confirmed SARS-CoV-2 infection recruited from 13 centers in northern Italy. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment, and outcomes were recorded. RESULTS: Twenty-five cases of encephalitis positive for SARS-CoV-2 infection were included. CSF showed hyperproteinorrachia and/or pleocytosis in 68% of cases whereas SARS-CoV-2 RNA by reverse-transcription polymerase chain reaction resulted negative. Based on MRI, cases were classified as acute demyelinating encephalomyelitis (ADEM; n = 3), limbic encephalitis (LE; n = 2), encephalitis with normal imaging (n = 13), and encephalitis with MRI alterations (n = 7). ADEM and LE cases showed a delayed onset compared to the other encephalitis cases (P = .001) and were associated with previous, more severe COVID-19 respiratory involvement. Patients with MRI alterations exhibited worse response to treatment and final outcomes compared to those with other encephalitis. CONCLUSIONS: SARS-CoV-2 infection is associated with a wide spectrum of encephalitis characterized by different clinical presentation, response to treatment, and outcomes.


Subject(s)
COVID-19/complications , Encephalitis/diagnosis , Aged , Aged, 80 and over , COVID-19/therapy , Electroencephalography , Encephalitis/classification , Encephalitis/virology , Female , Humans , Italy , Longitudinal Studies , Magnetic Resonance Imaging , Male , Middle Aged
13.
CNS Neurol Disord Drug Targets ; 20(2): 101-104, 2021.
Article in English | MEDLINE | ID: covidwho-940133

ABSTRACT

COVID-19 is one of the most disastrous respiratory diseases (after the 1918 influenza outbreak) spreading in the community. So far, it has killed 7,37,417 individuals. High variability in the viral genome and its greater ability to spread in the human community are badly affecting the comorbid individuals. Although infected individuals mainly possess respiratory issues, neurological manifestations in these individuals cannot be overlooked. The literature search is based on the recent development in the concerned field. We searched databases like PubMed, Google Scholar, and ScienceDirect using the keywords "COVID-19", "neurological manifestations", "CNS", and "PNS". The major neurological complications observed in these patients are encephalitis, necrotising haemorrhagic encephalopathy, Guillain-Barré Syndrome, smell/taste impairment, epileptic seizures, and abnormal states of consciousness. COVID-19 infection is just more than a cough, fever, and respiratory illness; it can cause indirect neurological complications in infected patients. It is therefore advised to treat and have a careful observation of the COVID-19 patients for neurological manifestations.


Subject(s)
COVID-19/epidemiology , Cough/epidemiology , Disease Outbreaks , Fever/epidemiology , Nervous System Diseases/epidemiology , COVID-19/diagnosis , COVID-19/therapy , Cough/diagnosis , Cough/therapy , Disease Outbreaks/prevention & control , Encephalitis/diagnosis , Encephalitis/epidemiology , Encephalitis/therapy , Fever/diagnosis , Fever/therapy , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/therapy
15.
J Clin Neurophysiol ; 38(3): e11-e13, 2021 May 01.
Article in English | MEDLINE | ID: covidwho-910348

ABSTRACT

SUMMARY: A 78-year-old man was admitted for acute confusion. At initial investigation physical examination, blood and cerebrospinal fluid tests were unremarkable and EEG showed synchronous bifrontal periodic discharges, an evocative pattern of encephalitis. Coronavirus disease 2019 was diagnosed later after fever onset. Isolated mild confusion may thus be an initial clinical picture of Coronavirus disease 2019 infection.


Subject(s)
COVID-19/diagnosis , Confusion/diagnosis , Electroencephalography/methods , Encephalitis/diagnosis , Aged , COVID-19/physiopathology , COVID-19/psychology , Confusion/physiopathology , Confusion/psychology , Diagnosis, Differential , Encephalitis/physiopathology , Encephalitis/psychology , Humans , Male
16.
Neurol Sci ; 42(1): 35-38, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-910259

ABSTRACT

The 2019 new coronavirus (SARS-CoV-2) is a novel respiratory virus which has increasingly spread all over the world. Although the predominant clinical presentation is represented by respiratory symptoms, neurological manifestation of SARS-CoV-2 is being increasingly recognized. In the present report, we present a case of post SARS-CoV-2 autoimmune encephalitis associated with a new-onset refractory status epilepticus (NORSE).


Subject(s)
Autoimmune Diseases of the Nervous System/etiology , COVID-19/complications , Encephalitis/etiology , Status Epilepticus/etiology , Aged, 80 and over , Autoimmune Diseases of the Nervous System/diagnosis , Electroencephalography , Encephalitis/diagnosis , Humans , Male , Status Epilepticus/diagnosis
17.
BMJ Case Rep ; 13(9)2020 Sep 18.
Article in English | MEDLINE | ID: covidwho-823795

ABSTRACT

Bickerstaff's brainstem encephalitis (BBE) is a Guillain-Barré syndrome (GBS) spectrum disorder associated with predominantly central nervous system predilection. Patients exhibit a variable constellation of depressed consciousness, bilateral external ophthalmoplegia, ataxia and long tract signs. Although the pathophysiology is not fully understood, it has been associated with anti-GQ1b antibodies in two-thirds of patients. We present a patient with clinical features consistent with BBE and positive anti-GM1 and anti-GD1a antibodies. A diagnostic approach to the acutely unwell patient with brainstem encephalitis is explored in this clinical context with a literature review of the aforementioned ganglioside antibody significance. Intravenous immunoglobulin therapy is highlighted in BBE using up-to-date evidence-based extrapolation from GBS.


Subject(s)
Ataxia/immunology , Autoantibodies/blood , Brain Stem/immunology , Encephalitis/diagnosis , Ophthalmoplegia/immunology , Adult , Ataxia/blood , Autoantibodies/immunology , Diagnosis, Differential , Electroencephalography , Encephalitis/blood , Encephalitis/complications , Encephalitis/immunology , G(M1) Ganglioside/immunology , Gangliosides/immunology , Glasgow Coma Scale , Humans , Male , Ophthalmoplegia/blood
19.
Medwave ; 20(7): e7984, 2020 Aug 03.
Article in Spanish | MEDLINE | ID: covidwho-724227

ABSTRACT

There are limited reports of neurological symptoms in the pediatric population with COVID-19. We report a 13-year-old girl with three days of illness characterized by headache, non-explosive vomiting, fever, and sudden-onset sensory disorder associated with difficulty in standing and hemiparesis in limbs without evidence of meningeal signs. Brain tomography revealed diffuse brain edema, and the cerebrospinal fluid study was consistent with a viral infection. COVID-19 was diagnosed based on serology. The patient had an untoward clinical course despite treatment with hydroxychloroquine, azithromycin, and corticosteroids, dying on the third day of hospitalization. Encephalitis in a patient with COVID-19 is not frequently reported in the pediatric population. It should be considered in the differential diagnosis in patients who arrives at the emergency with a sensory disorder or neurological symptomatology in the context of the COVID-19 pandemic.


Existen limitados reportes de síntomas neurológicos en la población pediátrica con COVID-19. Reportamos el caso de una niña de 13 años con tres días de enfermedad caracterizada por cefalea, vómitos no explosivos, fiebre y trastorno del sensorio de inicio brusco asociado a dificultad para la bipedestación y hemiparesia en extremidades, sin evidencia de signos meníngeos. La tomografía cerebral reveló edema cerebral difuso y el estudio de líquido cefalorraquídeo era concordante con una infección viral. El diagnóstico de COVID-19 fue mediante pruebas serológicas. La paciente tuvo una evolución clínica desfavorable a pesar del tratamiento con hidroxicloroquina, azitromicina y corticoides, falleciendo al tercer día de hospitalización. La encefalitis en un paciente con COVID-19 es una asociación poco descrita en la población pediátrica. Esta infección debe ser considerado como diagnóstico diferencial en los pacientes que llegan a la emergencia con trastorno de sensorio o sintomatología neurológica en el contexto de la actual pandemia.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/complications , Encephalitis/diagnosis , Pneumonia, Viral/complications , Adolescent , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Diagnosis, Differential , Encephalitis/virology , Fatal Outcome , Female , Humans , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , SARS-CoV-2
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