tetano
Editor, Senior Moderator
J Clin Neurosci
. 2021 Aug;90:140-143.
doi: 10.1016/j.jocn.2021.05.065. Epub 2021 Jun 1.
Infectious and immune-mediated central nervous system disease in 48 COVID-19 patients
Josef Finsterer[SUP] 1 [/SUP], Fulvio A Scorza[SUP] 2 [/SUP]
Affiliations
Abstract
Objectives: To summarise and discuss current knowledge about SARS-CoV-2-associated infectious/immune-mediatedcentral nervous system (CNS)-disease.
Method: Literature review.
Results: Altogether 28 articles were found, which reported 48 patients with SARS-CoV-2-associated infectious/immune-mediatedCNS-disease. Age ranged from 22 to 79y. There was male preponderance. There were 14 patients with infectious CNS-disease (meningitis (n = 1), encephalitis (n = 5), meningo-encephalitis (n = 5), myelitis (n = 3)), and 34 patients with parainfectious CNS-disease (encephalopathy (n = 18), autoimmune encephalitis (n = 11), acute, disseminated, encephalo-myelitis (n = 3), acute, haemorrhagic, necrotizing encephalopathy (n = 2)). The cerebrospinal fluid (CSF) was tested for SARS-CoV-2 in 40 patients and was positive for the virus in 4 patients with infectious CNS-disease but was negative for the virus in all patients with parainfectious CNS-disease. Immune-modulating treatment may be more effective than virostatics/antibiotics for SARS-CoV-2-associated infectious/parainfectious, non-vascular, non-hypoxic CNS-disease. In patients with autoimmune encephalitis plasmapheresis may be beneficial. Twenty-two patients recovered, 2 did not, and 6 patients died.
Conclusions: SARS-CoV-2 can cause infectious/immune-mediatedCNS-disease. The CSF is positive for virus-RNA in only few patients with infectious CNS-disease but negative for virus-RNA in immune-mediatedCNS-disease, suggesting an immune-mediated pathophysiological mechanism. The outcome of SARS-CoV-2-associated infectious/immune-mediatedCNS-disease is favourable in the majority of cases but can be fatal in single cases.
Keywords: Central nervous system; Coronavirus; Encephalitis; Immune-mediated; Immune-mediated1; Meningitis.
. 2021 Aug;90:140-143.
doi: 10.1016/j.jocn.2021.05.065. Epub 2021 Jun 1.
Infectious and immune-mediated central nervous system disease in 48 COVID-19 patients
Josef Finsterer[SUP] 1 [/SUP], Fulvio A Scorza[SUP] 2 [/SUP]
Affiliations
- PMID: 34275539
- DOI: 10.1016/j.jocn.2021.05.065
Abstract
Objectives: To summarise and discuss current knowledge about SARS-CoV-2-associated infectious/immune-mediatedcentral nervous system (CNS)-disease.
Method: Literature review.
Results: Altogether 28 articles were found, which reported 48 patients with SARS-CoV-2-associated infectious/immune-mediatedCNS-disease. Age ranged from 22 to 79y. There was male preponderance. There were 14 patients with infectious CNS-disease (meningitis (n = 1), encephalitis (n = 5), meningo-encephalitis (n = 5), myelitis (n = 3)), and 34 patients with parainfectious CNS-disease (encephalopathy (n = 18), autoimmune encephalitis (n = 11), acute, disseminated, encephalo-myelitis (n = 3), acute, haemorrhagic, necrotizing encephalopathy (n = 2)). The cerebrospinal fluid (CSF) was tested for SARS-CoV-2 in 40 patients and was positive for the virus in 4 patients with infectious CNS-disease but was negative for the virus in all patients with parainfectious CNS-disease. Immune-modulating treatment may be more effective than virostatics/antibiotics for SARS-CoV-2-associated infectious/parainfectious, non-vascular, non-hypoxic CNS-disease. In patients with autoimmune encephalitis plasmapheresis may be beneficial. Twenty-two patients recovered, 2 did not, and 6 patients died.
Conclusions: SARS-CoV-2 can cause infectious/immune-mediatedCNS-disease. The CSF is positive for virus-RNA in only few patients with infectious CNS-disease but negative for virus-RNA in immune-mediatedCNS-disease, suggesting an immune-mediated pathophysiological mechanism. The outcome of SARS-CoV-2-associated infectious/immune-mediatedCNS-disease is favourable in the majority of cases but can be fatal in single cases.
Keywords: Central nervous system; Coronavirus; Encephalitis; Immune-mediated; Immune-mediated1; Meningitis.