Infectious and immune-mediated central nervous system disease in 48 COVID-19 patients

COVID-19 Presenting as Encephalitis and Myopericarditis: A Report of a Rare Case

COVID-19 might present with a wide range of clinical manifestations, from mild respiratory distress to severe multi-organ dysfunction. We present a unique case of complex COVID-19 presentation in a 45-year-old female who initially developed general symptoms such as fever, cough, headache, and weakness, which escalated to coma, requiring intubation and ICU admission. A brain MRI revealed lesions compatible with encephalitis, the cause of which remained unexplained after an in-depth clinical, laboratory, and imaging investigation. While in the ICU, the patient also developed cardiac tamponade, requiring pericardiocentesis, and atypical electrocardiographic changes. After treatment with steroids, her condition improved, and the patient was extubated and transferred to the ward. Upon checkup, cardiac MRI revealed fibrous tissue in the inferior cardiac wall and the adjacent intraventricular septum. In the absence of an alternative diagnosis, it might be important to consider the central nervous system and cardiac involvement in patients with COVID-19.

Parainfectious Brown-Séquard syndrome associated with COVID-19

Acute myelitis encompasses syndromes associated with inflammation of the spinal cord. In cases of inflammatory lesions that only involve a unilateral portion of the axial plane of the cord, Brown-Séquard syndrome may occur, resulting in potential ipsilateral corticospinal, dorsal spinocerebellar, or dorsal column dysfunction or contralateral spinothalamic dysfunction below the level of the lesion. We report a case of an adult male who presented with Brown-Séquard syndrome and with a positive SARS-CoV-2 nasopharyngeal swab PCR test. Neurological symptoms rapidly resolved after initiation of high-dose methylprednisolone. The findings reported not only contribute to documenting a new presentation of neurological complications associated with SARS-CoV-2 infection but also non-exclusively supports the body of literature suggesting the immune-mediated response to this infection as a mechanism of neuropathogenesis. In this case, COVID-19-related acute myelitis responded to treatment with a short regimen of high-dose glucocorticoids.

COVID-19 infection: a possible induction factor for development of autoimmune diseases?

Following the global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the importance of investigation of the pathogenesis and immunological characteristics of COVID-19 became quite clear. Currently, there are reports indicating that COVID-19 is able to induce autoimmune responses. Abnormal immune reactions are a cornerstone in the pathogenicity of both conditions. Detection of autoantibodies in COVID-19 patients may suggest a link between COVID-19 and autoimmunity. In this study, we focused on the similarities and possible differences between COVID-19 and autoimmune disorders to explore the relationship between them. Comparing the pathogenicity of SARS-CoV-2 infection with autoimmune conditions revealed significant immunological properties of COVID-19 including the presence of several autoantibodies, autoimmunity-related cytokines, and cellular activities that could be useful in future clinical studies aiming at managing this pandemic.

Encephalopathy in a Young Female With COVID-19: A Case Report

Cases of severe central nervous system (CNS) complications have been reported in relation to coronavirus-19 (COVID-19). Cases of encephalitis have been reported primarily in older patients with multiple comorbidities. We present a case of encephalitis in a young female patient with a history of chronic marijuana use that presented with nausea, vomiting, and acute altered mental status. Extensive testing for infectious and autoimmune causes of encephalitis were negative, except for a positive COVID-19 test. She was treated with steroids and intravenous immune globulin (IVIG) and improved with residual mutism.

Autoimmune meningoencephalitis associated with anti‐glutamic acid decarboxylase antibody following COVID‐19 infection: A case report

Anti‐glutamic acid decarboxylase (Anti‐GAD) are associated with various neurologic condition; but no meningitis has been reported with it, so far. Evidence demonstrates the associated of autoimmune meningoencephalitis with COVID‐19 infection. Here, we report a 44‐year‐old female with progressive loss of consciousness with anti‐GAD65 meningoencephalitis 1 month after COVID‐19 infection.

Exploring the relationship between novel Coronavirus pneumonia and Parkinson's disease

The hypothesis is that there is 0a relationship between Parkinson's disease and coronavirus disease 2019 (COVID-19). By summarizing the pathogenesis of Parkinson's disease and COVID-19 and the impact of COVID-19 on the central nervous system, the relationship between Parkinson's disease and COVID-19 was analyzed, including whether Parkinson's disease is a predisposition factor for COVID-19 and whether COVID-19 causes the occurrence of Parkinson's disease. Discuss the impact of COVID-19 on patients with Parkinson's disease, including symptoms and life impact. To summarize the principles, goals and methods of home rehabilitation for Parkinson's disease patients during COVID-19. Through the analysis of this paper, it is believed that COVID-19 may cause Parkinson's disease. Parkinson's disease has the condition of susceptibility to COVID-19, but this conclusion is still controversial.

Case of Acute Necrotizing Encephalitis Following Coronavirus Disease 2019 Infection—A Rare Presentation

Coronavirus disease 2019 (COVID-19) results from infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Typical presentations include fever, shortness of breath, and cough though neurological manifestations have been rarely reported. Acute necrotizing encephalitis is a rare manifestation of COVID-19 and can be associated with devastating neurological outcomes. Difficulty in timely acquisition of neuroimaging and high rates of early mortality in these patients hinder timely diagnosis. In this clinicoradiological syndrome, patients suffer from rapidly worsening encephalopathy in first 2 weeks of illness and necrotizing parenchymal changes on neuroimaging. The pathophysiology is hypothesized to occur due to cytokine storm, blood–brain-barrier dysfunction, and viral-mediated immune dysregulation leading to endotheliopathy. Early immunomodulatory treatment with intravenous immunoglobulin and steroids is associated with a favorable outcome. Here, we report a one-and-half-year-old boy who presented with fever, seizures, and decreased activity since 3 days. He was noted to have hypertonia in all four limbs with exaggerated deep tendon reflexes. Nasopharyngeal reverse transcriptase polymerase chain reaction test for SARS-CoV-2 was positive. Magnetic resonance imaging brain was suggestive of acute necrotizing encephalopathy. Patient was treated with steroids.

COVID-19-Associated Encephalitis: Two Case Reports

The infection with SARS-CoV-2 is primarily associated with respiratory symptoms. Since its appearance, several neurological symptoms have been reported, most commonly headache and anosmia, as well as less frequent complications such as COVID-19-associated encephalitis and meningitis. In this case report, we describe two patients, who were 49- and 50-year-old infected with SARS-CoV-2, who presented to the emergency department with altered mental status and behavioral changes. A diagnosis of acute meningoencephalitis associated with COVID-19 was considered, and both patients had a good response to corticosteroid treatment.

The case of fatal acute hemorrhagic necrotizing encephalitis in a two-month-old boy with Covid-19

SARS-CoV-2 infection in healthy children is usually benign. However, severe, life-threatening cases have previously been reported, notably in infants. We must be aware that data on the natural history of COVID-19 are still full of gaps, especially as far as the pediatric population is concerned. Therefore, it is important to describe rare manifestations of SARS-CoV-2 acute infection in children. Here we present the case of acute hemorrhagic necrotizing encephalitis (AHNE) in a previously healthy, 2-month-old male infant with SARS-CoV-2 infection. After 2 days of fever with signs of respiratory tract infection, neurological manifestations appeared: irritability, nystagmus, agitation then apathy. As a consequence of apnea, he required emergent intubation and was transferred to our PICU. Brain MRI revealed diffuse areas of oedema associated with numerous symmetrical changes with punctate hemorrhages in basal ganglia, thalami, brainstem, and cerebral gray matter. CSF was clear with pleocytosis 484 cells/µl, elevated lactic acid and protein. Despite broad microbiological testing, only SARS-CoV2 was detected in PCR nasal swab. Therefore, acute hemorrhagic necrotizing encephalitis (AHNE) as a result of COVID-19 was the most probable diagnosis. The outcome was unfavorable - brain death was confirmed, life support was withdrawn.

Molecular imaging findings on acute and long-term effects of COVID-19 on the brain: A systematic review

Molecular imaging techniques such as PET and SPECT have been used to shed light on how coronavirus disease 2019 (COVID-19) affects the human brain. We provide a systematic review that summarizes the current literature according to 5 predominant topics. First, a few case reports have suggested reversible cortical and subcortical metabolic alterations in rare cases with concomitant para- or postinfectious encephalitis. Second, imaging findings in single patients with the first manifestations of parkinsonism in the context of COVID-19 resemble those in neurodegenerative parkinsonism (loss of nigrostriatal integrity), but scarceness of data and a lack of follow-up preclude further etiologic conclusions (e.g., unmasking/hastening of neurodegeneration vs. infectious or parainfectious parkinsonism). Third, several case reports and a few systematic studies have addressed focal symptoms and lesions, most notably hyposmia. The results have been variable, although some studies found regional hypometabolism of regions related to olfaction (e.g., orbitofrontal and mesiotemporal). Fourth, a case series and systematic studies in inpatients with COVID-19–related encephalopathy (acute to subacute stage) consistently found a frontoparietal-dominant neocortical dysfunction (on imaging and clinically) that proved to be grossly reversible in most cases until 6 mo. Fifth, studies on post–COVID-19 syndrome have provided controversial results. In patients with a high level of self-reported complaints (e.g., fatigue, memory impairment, hyposmia, and dyspnea), some authors found extensive areas of limbic and subcortical hypometabolism, whereas others found no metabolic alterations on PET and only minor cognitive impairments (if any) on neuropsychologic assessment. Furthermore, we provide a critical appraisal of studies with regard to frequent methodologic issues and current pathophysiologic concepts. Finally, we devised possible applications of PET and SPECT in the clinical work-up of diagnostic questions related to COVID-19.