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1.
BMC Neurol ; 22(1): 427, 2022 Nov 14.
Article in English | MEDLINE | ID: covidwho-2115832

ABSTRACT

BACKGROUND: Vaccination is an important public health strategy; however, many neurological adverse effects are associated with COVID-19 vaccination, being encephalitis a rare manifestation. CASE PRESENTATION: We present the case of a 33-year-old woman who received the first dose of the BBIBP-CorV vaccine against COVID-19 on April 4 and the second dose on April 28, 2021. Three days after receiving the second dose, she experienced a subacute episode of headache, fever, insomnia, and transient episodes of environment disconnection. We obtained negative results for infectious, systemic, and oncological causes. Brain magnetic resonance imaging showed lesions in the bilateral caudate nucleus and nonspecific demyelinating lesions at the supratentorial and infratentorial compartments. The results of the neuronal autoantibodies panel were negative. She had an adequate response to immunoglobulin and methylprednisolone; however, she experienced an early clinical relapse and received a new cycle of immunosuppressive treatment followed by a satisfactory clinical evolution. CONCLUSIONS: We report the first case of severe encephalitis associated with BBIBP-CorV (Sinopharm) vaccination in Latin America. The patient had atypical imaging patterns, with early clinical relapse and a favorable response to corticosteroid therapy.


Subject(s)
COVID-19 Vaccines , COVID-19 , Encephalitis , Adult , Female , Humans , COVID-19 Vaccines/adverse effects , Encephalitis/drug therapy , Encephalitis/etiology , Encephalitis/pathology , Recurrence , Vaccination
3.
Brain Nerve ; 74(7): 845-851, 2022 Jul.
Article in Japanese | MEDLINE | ID: covidwho-1954937

ABSTRACT

Coronavirus disease (COVID-19) causes neurological symptoms in a high percentage of patients and is associated with various types of encephalitides and encephalopathies, which are etiologically classified into (a)direct infection of the central nervous system with severe acute respiratory syndrome coronavirus 2 and resultant meningoencephalitis (this is a rare presentation), (b)COVID-19-induced cytokine storms, which trigger endothelial cell injury, blood-brain barrier disruption, and microangiopathy and consequent encephalopathy and, (c)autoimmune encephalitis secondary to para- or post-infectious mechanisms that play a key role during the acute or post-COVID-19 phase. Notably, some patients present with neurological symptoms as the first manifestation. Radiologically characteristic encephalitides and encephalopathies, such as acute necrotizing encephalopathy, acute disseminated encephalomyelitis, posterior reversible encephalopathy syndrome, and clinically mild encephalitis/encephalopathy with a reversible splenial lesion are also complicated by COVID-19. Further investigations and appropriate treatments are warranted in patients with COVID-19, who develop new neurological symptoms.


Subject(s)
Brain Diseases , COVID-19 , Encephalitis , Meningoencephalitis , Posterior Leukoencephalopathy Syndrome , Brain Diseases/etiology , COVID-19/complications , Encephalitis/diagnosis , Encephalitis/etiology , Humans , Meningoencephalitis/complications
5.
J Gen Virol ; 103(4)2022 04.
Article in English | MEDLINE | ID: covidwho-1831590

ABSTRACT

Encephalitis is most often caused by a variety of infectious agents identified through diagnostic tests utilizing cerebrospinal fluid. We investigated the clinical characteristics and potential aetiological agents of unexplained encephalitis through metagenomic sequencing of residual clinical samples from multiple tissue types and independent clinical review. Forty-three specimens were collected from 18 encephalitis cases with no cause identified by the Australian Childhood Encephalitis study. Samples were subjected to total RNA sequencing ('metatranscriptomics') to determine the presence and abundance of potential pathogens, and to describe the possible aetiologies of unexplained encephalitis. Using this protocol, we identified five RNA and two DNA viruses associated with human infection from both non-sterile and sterile sites, which were confirmed by PCR. These comprised two human rhinoviruses, two human seasonal coronaviruses, two polyomaviruses and one picobirnavirus. Human rhinovirus and seasonal coronaviruses may be responsible for five of the encephalitis cases. Immune-mediated encephalitis was considered likely in six cases and metatranscriptomics did not identify a possible pathogen in these cases. The aetiology remained unknown in nine cases. Our study emphasizes the importance of respiratory viruses in the aetiology of unexplained child encephalitis and suggests that non-central-nervous-system sampling in encephalitis clinical guidelines and protocols could improve the diagnostic yield.


Subject(s)
Encephalitis , Viruses , Australia , Child , Encephalitis/diagnosis , Encephalitis/etiology , Humans , Metagenomics , Polymerase Chain Reaction
6.
J Clin Lab Anal ; 36(5): e24426, 2022 May.
Article in English | MEDLINE | ID: covidwho-1797872

ABSTRACT

INTRODUCTION: Since COVID-19 outbreak, various studies mentioned the occurrence of neurological disorders. Of these, encephalitis is known as a critical neurological complication in COVID-19 patients. Numerous case reports and case series have found encephalitis in relation to COVID-19, which have not been systematically reviewed. This study aims to evaluate the clinical symptoms, diagnosis, treatment, and outcome of COVID-19-associated encephalitis. METHODS: We used the Pubmed/Medline, Embase, and Web of Science databases to search for reports on COVID-19-associated encephalitis from January 1, 2019, to March 7, 2021. The irrelevant studies were excluded based on screening and further evaluation. Then, the information relating diagnosis, treatment, clinical manifestations, comorbidities, and outcome was extracted and evaluated. RESULTS: From 4455 initial studies, 45 articles met our criteria and were selected for further evaluation. Included publications reported an overall number of 53 COVID-19-related encephalitis cases. MRI showed hyperintensity of brain regions including white matter (44.68%), temporal lobe (17.02%), and thalamus (12.76%). Also, brain CT scan revealed the hypodensity of the white matter (17.14%) and cerebral hemorrhages/hemorrhagic foci (11.42%) as the most frequent findings. The IV methylprednisolone/oral prednisone (36.11%), IV immunoglobulin (27.77%), and acyclovir (16.66%) were more preferred for COVID-19 patients with encephalitis. From the 46 patients, 13 (28.26%) patients were died in the hospital. CONCLUSION: In this systematic review, characteristics of COVID-19-associated encephalitis including clinical symptoms, diagnosis, treatment, and outcome were described. COVID-19-associated encephalitis can accompany with other neurological symptoms and involve different brain. Although majority of encephalitis condition are reversible, but it can lead to life-threatening status. Therefore, further investigation of COVID-19-associated encephalitis is required.


Subject(s)
COVID-19 , Encephalitis, Viral , Encephalitis , Nervous System Diseases , COVID-19/complications , COVID-19/diagnosis , Encephalitis/diagnosis , Encephalitis/epidemiology , Encephalitis/etiology , Humans , Neuroimaging/adverse effects
7.
Neurol Sci ; 43(6): 3503-3507, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1739352

ABSTRACT

INTRODUCTION: Post-ChAdOx1 vaccine (AZD1222) adverse events following immunization (AEFI) are uncommon. Recently described neurological events include thrombocytopenia with thrombosis syndrome (TTS) with cerebral venous thrombosis and Guillain-Barré syndrome. There are very few AEFI reports following COVID vaccination from India, because of underreporting or other factors. A few cases of acute transverse myelitis (ATM) and post-vaccinal encephalitis have also been reported. MATERIALS AND METHODS: Over 11 months, in 2 districts of Kerala, India, 8.19 million people were vaccinated with the ChAdOx1 vaccine. RESULTS: During this period, we encountered five cases of autoimmune central nervous system (CNS) AEFI following ChAdOX1 (Oxford/AstraZeneca, Covishield™) vaccination. These included three cases of acute disseminated encephalomyelitis (ADEM), one case of opsoclonus myoclonus ataxia syndrome (OMAS), and one case of limbic encephalitis. The calculated crude incidence of post-ChAdOX1 autoimmune CNS AEFI was approximately 0.24 cases per million for encephalitis and 0.36 per million for ADEM. This was compared to the crude annual incidence of community-acquired ADEM worldwide (3.2-4 per million) and the crude annual incidence of community-acquired encephalitis in India (8.35-10 per million). CONCLUSION: There was no increase in the incidence of post-vaccination CNS AEFI (ADEM or encephalitis) as compared to the community incidence of ADEM or encephalitis. While this emphasizes the safety of ChAdOX1 nCoV-19 vaccination for COVID-19, it is important to recognize these post-vaccination autoimmune syndromes early to initiate immunosuppressive therapy.


Subject(s)
COVID-19 , Encephalitis , Encephalomyelitis, Acute Disseminated , Opsoclonus-Myoclonus Syndrome , Vaccines , COVID-19 Vaccines/adverse effects , Central Nervous System , ChAdOx1 nCoV-19 , Encephalitis/etiology , Humans , SARS-CoV-2 , Vaccination/adverse effects
8.
Brain Behav Immun ; 87: 18-22, 2020 07.
Article in English | MEDLINE | ID: covidwho-1719333

ABSTRACT

Viral infections have detrimental impacts on neurological functions, and even to cause severe neurological damage. Very recently, coronaviruses (CoV), especially severe acute respiratory syndrome CoV 2 (SARS-CoV-2), exhibit neurotropic properties and may also cause neurological diseases. It is reported that CoV can be found in the brain or cerebrospinal fluid. The pathobiology of these neuroinvasive viruses is still incompletely known, and it is therefore important to explore the impact of CoV infections on the nervous system. Here, we review the research into neurological complications in CoV infections and the possible mechanisms of damage to the nervous system.


Subject(s)
Coronavirus Infections/physiopathology , Nervous System Diseases/physiopathology , Pneumonia, Viral/physiopathology , Betacoronavirus , COVID-19 , Consciousness Disorders/etiology , Consciousness Disorders/physiopathology , Coronavirus 229E, Human , Coronavirus Infections/complications , Coronavirus NL63, Human , Coronavirus OC43, Human , Dysgeusia/etiology , Dysgeusia/physiopathology , Encephalitis/etiology , Encephalitis/physiopathology , Encephalitis, Viral/etiology , Encephalitis, Viral/physiopathology , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Humans , Middle East Respiratory Syndrome Coronavirus , Nervous System Diseases/etiology , Neurotoxicity Syndromes/etiology , Neurotoxicity Syndromes/physiopathology , Neurotoxicity Syndromes/virology , Olfaction Disorders/etiology , Olfaction Disorders/physiopathology , Pandemics , Pneumonia, Viral/complications , Polyneuropathies/etiology , Polyneuropathies/physiopathology , SARS-CoV-2 , Seizures/etiology , Seizures/physiopathology , Severe Acute Respiratory Syndrome/complications , Severe Acute Respiratory Syndrome/physiopathology , Stroke/etiology , Stroke/physiopathology
10.
J Infect Chemother ; 28(7): 975-977, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1693268

ABSTRACT

We describe the first case of encephalitis following coronavirus disease 2019 (COVID-19) vaccination. Our patient was a 46-year-old Japanese woman who presented with acute onset diplopia. Subsequent magnetic resonance imaging revealed brain stem encephalitis that was rapidly responsive to high dosage steroid therapy and completely improved. Although the occurrence of encephalitis after vaccination could have just been a casual temporal association, her symptoms were temporally correlated with two vaccinations. Our case suggests caution and indicates treatment and prognosis, despite no evidence of a causal relationship. Nonetheless, this report emphasizes the enormous benefits of vaccination, which should not be undermined.


Subject(s)
COVID-19 , Encephalitis , COVID-19 Vaccines/adverse effects , Encephalitis/drug therapy , Encephalitis/etiology , Female , Humans , Middle Aged , SARS-CoV-2 , Vaccination
12.
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
14.
Ann Clin Transl Neurol ; 8(12): 2314-2318, 2021 12.
Article in English | MEDLINE | ID: covidwho-1536111

ABSTRACT

We report a subtype of immune-mediated encephalitis associated with COVID-19, which closely mimics acute-onset sporadic Creutzfeldt-Jakob disease. A 64-year-old man presented with confusion, aphasia, myoclonus, and a silent interstitial pneumonia. He tested positive for SARS-CoV-2. Cognition and myoclonus rapidly deteriorated, EEG evolved to generalized periodic discharges and brain MRI showed multiple cortical DWI hyperintensities. CSF analysis was normal, except for a positive 14-3-3 protein. RT-QuIC analysis was negative. High levels of pro-inflammatory cytokines were present in the CSF and serum. Treatment with steroids and intravenous immunoglobulins produced EEG and clinical improvement, with a good neurological outcome at a 6-month follow-up.


Subject(s)
COVID-19/complications , Encephalitis/etiology , Creutzfeldt-Jakob Syndrome , Encephalitis/pathology , Encephalitis/physiopathology , Humans , Male , Middle Aged , SARS-CoV-2
17.
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
18.
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
19.
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
20.
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
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