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1.
Eur J Neurol ; 28(10): 3491-3502, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1607956

ABSTRACT

BACKGROUND AND PURPOSE: Although COVID-19 predominantly affects the respiratory system, recent studies have reported the occurrence of neurological disorders such as stroke in relation to COVID-19 infection. Encephalitis is an inflammatory condition of the brain that has been described as a severe neurological complication of COVID-19. Despite a growing number of reported cases, encephalitis related to COVID-19 infection has not been adequately characterised. To address this gap, this systematic review and meta-analysis aims to describe the incidence, clinical course, and outcomes of patients who suffer from encephalitis as a complication of COVID-19. METHODS: All studies published between 1 November 2019 and 24 October 2020 that reported on patients who developed encephalitis as a complication of COVID-19 were included. Only cases with radiological and/or biochemical evidence of encephalitis were included. RESULTS: In this study, 610 studies were screened and 23 studies reporting findings from 129,008 patients, including 138 with encephalitis, were included. The average time from diagnosis of COVID-19 to onset of encephalitis was 14.5 days (range = 10.8-18.2 days). The average incidence of encephalitis as a complication of COVID-19 was 0.215% (95% confidence interval [CI] = 0.056%-0.441%). The average mortality rate of encephalitis in COVID-19 patients was 13.4% (95% CI = 3.8%-25.9%). These patients also had deranged clinical parameters, including raised serum inflammatory markers and cerebrospinal fluid pleocytosis. CONCLUSIONS: Although encephalitis is an uncommon complication of COVID-19, when present, it results in significant morbidity and mortality. Severely ill COVID-19 patients are at higher risk of suffering from encephalitis as a complication of the infection.


Subject(s)
COVID-19 , Encephalitis , Nervous System Diseases , Encephalitis/epidemiology , Encephalitis/etiology , Humans , Incidence , SARS-CoV-2
4.
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
5.
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
6.
Eur J Neurol ; 28(10): 3491-3502, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1226671

ABSTRACT

BACKGROUND AND PURPOSE: Although COVID-19 predominantly affects the respiratory system, recent studies have reported the occurrence of neurological disorders such as stroke in relation to COVID-19 infection. Encephalitis is an inflammatory condition of the brain that has been described as a severe neurological complication of COVID-19. Despite a growing number of reported cases, encephalitis related to COVID-19 infection has not been adequately characterised. To address this gap, this systematic review and meta-analysis aims to describe the incidence, clinical course, and outcomes of patients who suffer from encephalitis as a complication of COVID-19. METHODS: All studies published between 1 November 2019 and 24 October 2020 that reported on patients who developed encephalitis as a complication of COVID-19 were included. Only cases with radiological and/or biochemical evidence of encephalitis were included. RESULTS: In this study, 610 studies were screened and 23 studies reporting findings from 129,008 patients, including 138 with encephalitis, were included. The average time from diagnosis of COVID-19 to onset of encephalitis was 14.5 days (range = 10.8-18.2 days). The average incidence of encephalitis as a complication of COVID-19 was 0.215% (95% confidence interval [CI] = 0.056%-0.441%). The average mortality rate of encephalitis in COVID-19 patients was 13.4% (95% CI = 3.8%-25.9%). These patients also had deranged clinical parameters, including raised serum inflammatory markers and cerebrospinal fluid pleocytosis. CONCLUSIONS: Although encephalitis is an uncommon complication of COVID-19, when present, it results in significant morbidity and mortality. Severely ill COVID-19 patients are at higher risk of suffering from encephalitis as a complication of the infection.


Subject(s)
COVID-19 , Encephalitis , Nervous System Diseases , Encephalitis/epidemiology , Encephalitis/etiology , Humans , Incidence , SARS-CoV-2
7.
Curr Opin Neurol ; 34(3): 410-416, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1153309

ABSTRACT

PURPOSE OF REVIEW: The COVID-19 pandemic has cast increased attention on emerging infections. Clinicians and public health experts should be aware of emerging infectious causes of encephalitis, mechanisms by which they are transmitted, and clinical manifestations of disease. RECENT FINDINGS: A number of arthropod-borne viral infections -- transmitted chiefly by mosquitoes and ticks -- have emerged in recent years to cause outbreaks of encephalitis. Examples include Powassan virus in North America, Chikungunya virus in Central and South America, and tick-borne encephalitis virus in Europe. Many of these viruses exhibit complex life cycles and can infect multiple host animals in addition to humans. Factors thought to influence emergence of these diseases, including changes in climate and land use, are also believed to underlie the emergence of the rickettsial bacterium Orientia tsutsugamushi, now recognized as a major causative agent of acute encephalitis syndrome in South Asia. In addition, the COVID-19 pandemic has highlighted the role of bats as carriers of viruses. Recent studies have begun to uncover mechanisms by which the immune systems of bats are poised to allow for viral tolerance. Several bat-borne infections, including Nipah virus and Ebola virus, have resulted in recent outbreaks of encephalitis. SUMMARY: Infectious causes of encephalitis continue to emerge worldwide, in part because of climate change and human impacts on the environment. Expansion of surveillance measures will be critical in rapid diagnosis and limiting of outbreaks in the future.


Subject(s)
COVID-19/complications , Encephalitis, Arbovirus/transmission , Encephalitis/etiology , Virus Diseases/complications , Animals , Humans , Pandemics , Public Health Surveillance , Virus Diseases/transmission
8.
J Child Neurol ; 36(10): 853-866, 2021 09.
Article in English | MEDLINE | ID: covidwho-1109882

ABSTRACT

INTRODUCTION: Although multiple neurologic manifestations associated with SARS-CoV-2 infection have been described in adults, there is little information about those presented in children. Here, we described neurologic manifestations associated with COVID-19 in the pediatric population. METHODS: Retrospective case series report. We included patients younger than 18 years, admitted with confirmed SARS-CoV-2 infection and neurologic manifestations at our hospital in Santiago, Chile. Demographics, clinical presentations, laboratory results, radiologic and neurophysiological studies, treatment, and outcome features were described. Cases were described based on whether they presented with predominantly central or peripheral neurologic involvement. RESULTS: Thirteen of 90 (14.4%) patients admitted with confirmed infection presented with new-onset neurologic symptoms and 4 patients showed epilepsy exacerbation. Neurologic manifestations ranged from mild (headache, muscle weakness, anosmia, ageusia), to severe (status epilepticus, Guillain-Barré syndrome, encephalopathy, demyelinating events). CONCLUSIONS: We found a wide range of neurologic manifestations in children with confirmed SARS-CoV-2 infection. In general, neurologic symptoms were resolved as the systemic presentation subsided. It is essential to recognize and report the main neurologic manifestations related to this new infectious disease in the pediatric population. More evidence is needed to establish the specific causality of nervous system involvement.


Subject(s)
COVID-19/complications , Dizziness/etiology , Encephalitis/etiology , Headache/etiology , Myalgia/etiology , Adolescent , Child , Child, Preschool , Female , Humans , Male , Retrospective Studies
9.
Mult Scler Relat Disord ; 50: 102857, 2021 May.
Article in English | MEDLINE | ID: covidwho-1096170

ABSTRACT

A variety of neurologic manifestations of COVID-19 infections have been reported. Here, we present a case of steroid-responsive MOG-antibody associated encephalitis, characterized by cognitive decline, headaches, fever, unilateral FLAIR-hyperintensities, and leptomeningeal enhancement, that occurred in the setting of recent COVID-19 infection.


Subject(s)
COVID-19 , Encephalitis , Encephalitis/diagnostic imaging , Encephalitis/etiology , Headache , Humans , Magnetic Resonance Imaging , SARS-CoV-2
10.
IEEE Pulse ; 12(1): 2-6, 2021.
Article in English | MEDLINE | ID: covidwho-1091099

ABSTRACT

In March 2020 -still the early days of the U.K.'s COVID-19 crisis-Rhys Thomas, a neurologist at Newcastle University, got a call at home from a concerned colleague. The colleague's cousin was hospitalized, critically ill with COVID-19, and had developed brainstem encephalitis, a severe inflammatory condition of the brain causing a suite of symptoms, from eye problems to balance problems and drowsiness. He wanted to know if Thomas knew anything about these conditions. At the time, the research coming out of Wuhan, China, only suggested a mild whiff of neurological symptoms-headache, dizziness, and the loss of taste and smell. Clearly the virus could affect the brain in some ways, but it wasn't, Thomas thought then, anything serious. But this report sounded much more concerning. Symptoms like this patient's would mean the virus was accessing more of the nervous system than scientists originally thought.


Subject(s)
Brain Diseases/etiology , COVID-19/complications , Pandemics , SARS-CoV-2 , Brain Diseases/physiopathology , Brain Diseases/psychology , COVID-19/drug therapy , COVID-19/physiopathology , COVID-19/psychology , Cytokine Release Syndrome/etiology , Cytokine Release Syndrome/physiopathology , Encephalitis/etiology , Encephalitis/physiopathology , Humans , Nervous System Diseases/etiology , Nervous System Diseases/physiopathology , Nervous System Diseases/psychology , SARS-CoV-2/pathogenicity , Stroke/etiology , Stroke/physiopathology
11.
14.
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
15.
Brain Inj ; 34(12): 1549-1568, 2020 10 14.
Article in English | MEDLINE | ID: covidwho-872817

ABSTRACT

OBJECTIVE: Following the outbreak of coronavirus 2019 (COVID-19), there is strong evidence of neurological involvement in these patients. We aimed to determine the clinical characteristics of neurological manifestations in COVID-19. METHOD: A systematic review of studies reporting neurological manifestations published between 1 December, 2019 and 11 May, 2020 was performed. Studies were grouped based on neurological manifestation. Pooled analyses of individual patient's clinical characteristics and olfactory and gustatory dysfunction prevalence were performed. RESULTS: Of 486 studies identified, 48 were included. 70 patients with 73 neurological manifestations were reported. 39 (53.4%) patients had stroke, 18 (24.7%) had Guillain-Barré syndrome and variants, 11 (15.1%) had meningitis, encephalitis, encephalopathy, or myelitis, and five (6.8%) had seizures. They had a mean age of 61.9 ± 17.7 years (60.6% male). Neurological disease occurred 8.1 ± 6.8 days from initial symptoms. Average mortality rate was 17.8%. Stroke has a mortality rate of 25.6%. Olfactory and gustatory dysfunction occurred in 59.9% and 57.5%, respectively. CONCLUSIONS: Stroke is the most frequently reported neurological manifestation in COVID-19 and has the highest mortality rate. Neurological manifestations tend to develop one to two weeks after the onset of respiratory disease. There is significant morbidity and mortality associated with COVID-19 neurological manifestations.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Cerebrovascular Disorders/etiology , Encephalitis/etiology , Guillain-Barre Syndrome/etiology , Humans
18.
Asian J Psychiatr ; 54: 102350, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-709801

ABSTRACT

Coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 has emerged as a global public health threat. Though the fear, anxiety, and stress related to COVID-19 have been studied in depth, the direct effects of SARS-CoV-2 on the central nervous system (CNS) remain elusive. Research related to the earlier coronavirus (CoV) outbreaks (like Severe Acute Respiratory Syndrome, SARS and Middle East Respiratory Syndrome, MERS) shows the neurotropic nature of CoV and the plethora of neuropsychiatric effects that it can cause. Though the current health priorities in managing COVID-19 remain restricted to containment and targeting pulmonary symptoms, the potential acute and long-term neuropsychiatric sequelae of the infection can increase morbidity and worsen the quality of life. Emerging evidence shows neural spread of the novel coronavirus. Delirium, encephalopathy, olfactory disturbances, acute behavioral changes, headache and cerebrovascular accidents are its common neuropsychiatric complications. These are directly related to increase in peripheral immunological markers, severity of infection and case fatality rate. This narrative review synthesizes available evidence related to the neuropsychiatric manifestations of COVID-19. Also, as SARS-CoV-2 shares structural and functional similarities with its earlier congeners, this article proposes possible long-term neuropsychological sequelae and pathogenic mechanisms for the same, based on research in the other coronavirus outbreaks.


Subject(s)
COVID-19/complications , Delirium/etiology , Encephalitis/etiology , Headache/etiology , Stroke/etiology , Humans
19.
J Neurol ; 268(3): 751-757, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-688846

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.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Nervous System Diseases/immunology , Adult , Aged , Aged, 80 and over , Antibodies/cerebrospinal fluid , COVID-19/cerebrospinal fluid , Delirium/etiology , Delirium/psychology , Encephalitis/etiology , Encephalitis/psychology , Female , Gangliosides/immunology , Humans , Leukocytosis/cerebrospinal fluid , Male , Membrane Proteins/cerebrospinal fluid , Middle Aged , Nerve Tissue Proteins/cerebrospinal fluid , Nervous System Diseases/cerebrospinal fluid , Neurologic Examination , Radiculopathy/etiology , Radiculopathy/psychology , Spinal Puncture
20.
Can J Neurol Sci ; 48(1): 66-76, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-646255

ABSTRACT

BACKGROUND: Growing evidence showed that coronavirus disease 2019 (COVID-19) infection may present with neurological manifestations. This review aimed to determine the neurological manifestations and complications in COVID-19. METHODS: We conducted a systematic review and meta-analysis that included cohort and case series/reports involving a population of patients confirmed with COVID-19 infection and their neurologic manifestations. We searched the following electronic databases until April 18, 2020: PubMed, Embase, Scopus, and World Health Organization database (PROSPERO registration number: CRD42020180658). RESULTS: From 403 articles identified, 49 studies involving a total of 6,335 confirmed COVID-19 cases were included. The random-effects modeling analysis for each neurological symptom showed the following proportional point estimates with 95% confidence intervals: "headache" (0.12; 0.10-0.14; I2 = 77%), "dizziness" (0.08; 0.05-0.12; I2 = 82%), "headache and dizziness" (0.09; 0.06-0.13; I2 = 0%), "nausea" (0.07; 0.04-0.11; I2 = 79%), "vomiting" (0.05; 0.03-0.08; I2 = 74%), "nausea and vomiting" (0.06; 0.03-0.11; I2 = 83%), "confusion" (0.05; 0.02-0.14; I2 = 86%), and "myalgia" (0.21; 0.18-0.25; I2 = 85%). The most common neurological complication associated with COVID-19 infection was vascular disorders (n = 23); other associated conditions were encephalopathy (n = 3), encephalitis (n = 1), oculomotor nerve palsy (n = 1), isolated sudden-onset anosmia (n = 1), Guillain-Barré syndrome (n = 1), and Miller-Fisher syndrome (n = 2). Most patients with neurological complications survived (n = 14); a considerable number of patients died (n = 7); and the rest had unclear outcomes (n = 12). CONCLUSION: This review revealed that neurologic involvement may manifest in COVID-19 infection. What has initially been thought of as a primarily respiratory illness has evolved into a wide-ranging multi-organ disease.


Subject(s)
COVID-19/physiopathology , Cerebrovascular Disorders/physiopathology , Headache/physiopathology , Myalgia/physiopathology , Anosmia/etiology , Anosmia/physiopathology , Brain Diseases/etiology , Brain Diseases/physiopathology , COVID-19/complications , Cerebral Hemorrhage/etiology , Cerebral Hemorrhage/physiopathology , Cerebral Infarction/etiology , Cerebral Infarction/physiopathology , Cerebrovascular Disorders/etiology , Confusion/etiology , Confusion/physiopathology , Dizziness/etiology , Dizziness/physiopathology , Encephalitis/etiology , Encephalitis/physiopathology , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Headache/etiology , Humans , Myalgia/etiology , Nausea/etiology , Nausea/physiopathology , Oculomotor Nerve Diseases/etiology , Oculomotor Nerve Diseases/physiopathology , SARS-CoV-2 , Sinus Thrombosis, Intracranial/etiology , Sinus Thrombosis, Intracranial/physiopathology , Vomiting/etiology , Vomiting/physiopathology
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