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Karami S, Khalaj F, Sotoudeh H, Tajabadi Z, Shahidi R, Habibi MA, Sattari MS, Azimi A, Forouzannia SA, Rafiei R, Reihani H, Nemati R, Teimori S, Khalaji A, Sarmadi V, Dadjou A. Acute Necrotizing Encephalopathy in Adult Patients With COVID-19: A Systematic Review of Case Reports and Case Series. J Clin Neurol 2023; 19:597-611. [PMID: 37455513 PMCID: PMC10622717 DOI: 10.3988/jcn.2022.0431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 12/22/2022] [Accepted: 02/05/2023] [Indexed: 07/18/2023] Open
Abstract
BACKGROUND AND PURPOSE Acute necrotizing encephalopathy (ANE) is a rare neurological disorder that is often associated with viral infections. Since the emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a few COVID-19-associated ANE cases have been reported. Since very little is known about ANE, the present study aimed to determine the clinical, biochemical, and radiological characteristics of affected patients. METHODS A search was conducted on PubMed, Scopus, Embase, and Web of Science databases for articles published up to August 30, 2022 using relevant keywords. Case reports and series in the English language that reported ANE in adult patients with COVID-19 confirmed by reverse transcription polymerase chain reaction were included in this study. Data on the demographic, clinical, laboratory, and radiological characteristics of patients were extracted and analyzed using the SPSS software (version 26). RESULTS The study included 30 patients (18 males) with COVID-19 and ANE who were aged 49.87±18.68 years (mean±standard deviation). Fever was the most-prevalent symptom at presentation (66.7%). Elevated C-reactive protein was observed in the laboratory assessments of 13 patients. Computed tomography and magnetic resonance imaging were the most-common radiological modalities used for brain assessments. The most commonly prescribed medications were methylprednisolone (30%) and remdesivir (26.7%). Sixteen patients died prior to discharge. CONCLUSIONS The diagnosis of COVID-19-associated ANE requires a thorough knowledge of the disease. Since the clinical presentations of ANE are neither sensitive nor specific, further laboratory and brain radiological evaluations will be needed to confirm the diagnosis. The suspicion of ANE should be raised among patients with COVID-19 who present with progressive neurological symptoms.
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Affiliation(s)
- Shaghayegh Karami
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fattaneh Khalaj
- Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Houman Sotoudeh
- Department of Radiology and Neurology, University of Alabama at Birmingham (UAB), Birmingham, AL, USA
| | - Zohreh Tajabadi
- Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Shahidi
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran.
| | - Mohammad Amin Habibi
- Clinical Research Development Center, Qom University of Medical Sciences, Qom, Iran
| | | | - Amir Azimi
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Seyed Ali Forouzannia
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Romina Rafiei
- Department of Medicine, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamid Reihani
- Student Research Committee, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Nemati
- Department of Neurology, School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Soraya Teimori
- Young Researchers and Elites Club, Faculty of Medicine, Islamic Azad University, Yazd Branch, Iran
| | | | - Vida Sarmadi
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Dadjou
- School of Medicine, Bushehr University of Medical Sciences, Bushehr, Iran
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