COVID-19-associated encephalitis: Difference between revisions

Jump to navigation Jump to search
Line 309: Line 309:
*[[Anti-inflammatory]] like pulse [[steroids]] ([[methylprednisolone]] 1,000 mg/day) are also helpful in this [[disease]].
*[[Anti-inflammatory]] like pulse [[steroids]] ([[methylprednisolone]] 1,000 mg/day) are also helpful in this [[disease]].
*Severe disease in these [[patients]] required [[intubation]] and [[mechanical ventilation]].
*Severe disease in these [[patients]] required [[intubation]] and [[mechanical ventilation]].
*IVIG can be administrated in severe cases.<ref name="pmid32454137">{{cite journal| author=Panariello A, Bassetti R, Radice A, Rossotti R, Puoti M, Corradin M | display-authors=etal| title=Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report. | journal=Brain Behav Immun | year= 2020 | volume= 87 | issue=  | pages= 179-181 | pmid=32454137 | doi=10.1016/j.bbi.2020.05.054 | pmc=7255176 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32454137  }}</ref><ref name="pmid32389697">{{cite journal| author=Dogan L, Kaya D, Sarikaya T, Zengin R, Dincer A, Akinci IO | display-authors=etal| title=Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: Case series. | journal=Brain Behav Immun | year= 2020 | volume= 87 | issue=  | pages= 155-158 | pmid=32389697 | doi=10.1016/j.bbi.2020.05.022 | pmc=7204750 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32389697  }}</ref>
*[[Hydroxychloroquine|Hydorxychloroquine]] and some [[antivirals]] were used in these [[patients]] but they did not resolve the [[condition]].
*[[Hydroxychloroquine|Hydorxychloroquine]] and some [[antivirals]] were used in these [[patients]] but they did not resolve the [[condition]].
*IVIG can be administrated in severe cases.<ref name="pmid32454137">{{cite journal| author=Panariello A, Bassetti R, Radice A, Rossotti R, Puoti M, Corradin M | display-authors=etal| title=Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report. | journal=Brain Behav Immun | year= 2020 | volume= 87 | issue=  | pages= 179-181 | pmid=32454137 | doi=10.1016/j.bbi.2020.05.054 | pmc=7255176 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32454137  }}</ref><ref name="pmid32389697">{{cite journal| author=Dogan L, Kaya D, Sarikaya T, Zengin R, Dincer A, Akinci IO | display-authors=etal| title=Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: Case series. | journal=Brain Behav Immun | year= 2020 | volume= 87 | issue=  | pages= 155-158 | pmid=32389697 | doi=10.1016/j.bbi.2020.05.022 | pmc=7204750 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=32389697  }}</ref>


<br />
<br />

Revision as of 01:57, 31 August 2020

For COVID-19 frequently asked outpatient questions, click here.

For COVID-19 frequently asked inpatient questions, click here.

For COVID-19 patient information, click here.


WikiDoc Resources for COVID-19-associated encephalitis

Articles

Most recent articles on COVID-19-associated encephalitis

Most cited articles on COVID-19-associated encephalitis

Review articles on COVID-19-associated encephalitis

Articles on COVID-19-associated encephalitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated encephalitis

Images of COVID-19-associated encephalitis

Photos of COVID-19-associated encephalitis

Podcasts & MP3s on COVID-19-associated encephalitis

Videos on COVID-19-associated encephalitis

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated encephalitis

Bandolier on COVID-19-associated encephalitis

TRIP on COVID-19-associated encephalitis

Clinical Trials

Ongoing Trials on COVID-19-associated encephalitis at Clinical Trials.gov

Trial results on COVID-19-associated encephalitis

Clinical Trials on COVID-19-associated encephalitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated encephalitis

NICE Guidance on COVID-19-associated encephalitis

NHS PRODIGY Guidance

FDA on COVID-19-associated encephalitis

CDC on COVID-19-associated encephalitis

Books

Books on COVID-19-associated encephalitis

News

COVID-19-associated encephalitis in the news

Be alerted to news on COVID-19-associated encephalitis

News trends on COVID-19-associated encephalitis

Commentary

Blogs on COVID-19-associated encephalitis

Definitions

Definitions of COVID-19-associated encephalitis

Patient Resources / Community

Patient resources on COVID-19-associated encephalitis

Discussion groups on COVID-19-associated encephalitis

Patient Handouts on COVID-19-associated encephalitis

Directions to Hospitals Treating COVID-19-associated encephalitis

Risk calculators and risk factors for COVID-19-associated encephalitis

Healthcare Provider Resources

Symptoms of COVID-19-associated encephalitis

Causes & Risk Factors for COVID-19-associated encephalitis

Diagnostic studies for COVID-19-associated encephalitis

Treatment of COVID-19-associated encephalitis

Continuing Medical Education (CME)

CME Programs on COVID-19-associated encephalitis

International

COVID-19-associated encephalitis en Espanol

COVID-19-associated encephalitis en Francais

Business

COVID-19-associated encephalitis in the Marketplace

Patents on COVID-19-associated encephalitis

Experimental / Informatics

List of terms related to COVID-19-associated encephalitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Wajeeha Aiman, M.D.[2], Fahimeh Shojaei, M.D.

Synonyms and keywords: Encephalitis covid-19

Overview

Encephalitis is inflammation of the brain parenchyma and it is commonly caused by viruses. COVID-19 is a virus related to the severe acute respiratory syndrome coronavirus (SARS-CoV) group and named as SARS-CoV-2. COVID-19 associated encephalitis was first discovered by Moriguchi T. et al. a Japanese critical care physician in late February 2020 during the pandemic of SARS-Coronavirus-2: SARS-CoV-2. The association between COVID-19 and encephalitis was made early in the pandemic in the Wuhan province of China. There is no established system for the classification of COVID-19 associated encephalitis. The exact pathogenesis of COVID-19 encephalitis is not fully understood. COVID-19-associated encephalitis must be differentiated from other diseases that cause fever, headache, and altered mental status with or without cough.

Historical Perspective

Classification

Pathophysiology

  • It is thought that this viral encephalitis is the result of multiple pathophysiologic pathways.


 
 
 
 
 
 
 
 
SARS-CoV-2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ACE2
 
Direct Injury due to Infection
 
Immune Injury
 
Hypoxic Injury
 
Hypercoagulability
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Viral Encephalitis
 
 
 
 
 


Causes

  • To read more about this virus, click here.
Case courtesy of Dr. Daniel J Bell, Radiopaedia.org, rID: 74536

Differentiating COVID-19-associated encephalitis from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

Risk Factors

Risk factors for COVID-19-associated encephalitis
Autoimmune disease Immunosuppression
Multiple sclerosis Interferon beta

Glatiramer

Corticosteroids

Myasthenia gravis Corticosteroids
Neuromyelitis optica Monoclonal antibody
Sarcoidosis Corticosteroids

Methotrexate

Azathioprine

Sickle cell disease (SCD) Crizanlizumab

Screening

Natural History, Complications, and Prognosis


 
 
 
 
 
 
 
 
Encephalitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Memory loss
 
Epilepsy
 
Personality changes
 
Hearing/vision loss
 
Coma/Death


Diagnosis

Diagnostic Study of Choice

History and Symptoms

Common Symptoms

Less Common Symptoms

  • Clinical manifestation of 3 cases of COVID-19 associated encephalitis are shown below:
Patient No. Early symptoms Later presentation GCS Lab. Findings Specific Tests Imaging studies
CBC CSF MRI/CT scan
24-year-old man from Japan[2] Headache,

Fever,

Fatigue

Worsening headache, Sore throat. (Day 5)

Impaired consciousness and transient generalized seizure, (Day 9)

E4V1M1 WBCs and neutrophils
lymphocytes

CRP

Clear and colorless fluid,

Pressure=320 mmH2O,

Cell count was 12/μL–10

mononuclear and 2 polymorphonuclear cells

RT-PCR of SARS-CoV-2 RNA was positive in CSF Brain MRI:

Hyperintensity in the right lateral ventricle's inferior horn along the wall,

pan-paranasal sinusitis.

In Wuhan, in a letter to editor, Ye M et.al, reported COVID-19 associated encephalitis case in a male with laboratory finding [9] Fever

SOB

Myalgia

Confusion NA WBC count (3.3 × 109/L) and lymphopenia (0.8 × 109/L) Pressure=220 mmg

WBC (0.001 × 109/L)

protein (0.27 g/L)

sugar (3.14 mmol/L)

SARS-CoV-2 was positive on nasopharyngeal swab but negative on CSF testing

All other bacterial and viral causes of encephlitis were negative

  • skull CT was normal
  • chest CT showed multiple subpleural ground glass opacities
35-year-old woman from Turkey[10][11] whose COVID-19 associated encephalitis mimicking as glial tumor of CNS Flu like symptoms Headache, nausea, dizziness, and

drug-refractory seizures.

E4V5M6 NA NA RT-PCR and antibody tests positive Brain MRI: Hyperintensity in the left temporal lobe.

MR Spectroscopy: Decrease N-acetyl aspartate peak along with a marked elevated choline peak.

31-year-old African American woman[12] SCD patient with dyspnea Paralysis and sedation (Day 13)

Comatose (Day 15) and death (Day 16)

E0V0M0 NA Pressure=30cmH2O

115 nucleated cell /ml

7374 erythrocytes

/ml

Protein> 200mg/dl

RT=PCR for SARS-CoV-2 was positive in nasopharyngeal swab Brain MRI: Nonenhancing cerebral edema and restricted diffusion in the right cerebral hemisphere with brain herniation.

Physical Examination

Neuromuscular

Laboratory Findings

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Diagnostic Studies

Treatment

Medical Therapy

The mainstays of medical therapy for viral encephalitis are:[10][13][2][14]

Symptomatic treatments:


Surgery

Primary Prevention

Secondary Prevention

References

  1. Velavan TP, Meyer CG (2020). "The COVID-19 epidemic". Trop Med Int Health. 25 (3): 278–280. doi:10.1111/tmi.13383. PMC 7169770 Check |pmc= value (help). PMID 32052514 Check |pmid= value (help).
  2. 2.0 2.1 2.2 Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J; et al. (2020). "A first case of meningitis/encephalitis associated with SARS-Coronavirus-2". Int J Infect Dis. 94: 55–58. doi:10.1016/j.ijid.2020.03.062. PMC 7195378 Check |pmc= value (help). PMID 32251791 Check |pmid= value (help).
  3. Riou J, Althaus CL (2020). "Pattern of early human-to-human transmission of Wuhan 2019 novel coronavirus (2019-nCoV), December 2019 to January 2020". Euro Surveill. 25 (4). doi:10.2807/1560-7917.ES.2020.25.4.2000058. PMC 7001239 Check |pmc= value (help). PMID 32019669 Check |pmid= value (help).
  4. Asadi-Pooya AA, Simani L (2020). "Central nervous system manifestations of COVID-19: A systematic review". J Neurol Sci. 413: 116832. doi:10.1016/j.jns.2020.116832. PMC 7151535 Check |pmc= value (help). PMID 32299017 Check |pmid= value (help).
  5. Baig AM (2020). "Neurological manifestations in COVID-19 caused by SARS-CoV-2". CNS Neurosci Ther. 26 (5): 499–501. doi:10.1111/cns.13372. PMC 7163592 Check |pmc= value (help). PMID 32266761 Check |pmid= value (help).
  6. Arabi YM, Balkhy HH, Hayden FG, Bouchama A, Luke T, Baillie JK; et al. (2017). "Middle East Respiratory Syndrome". N Engl J Med. 376 (6): 584–594. doi:10.1056/NEJMsr1408795. PMC 5362064. PMID 28177862.
  7. Tsai LK, Hsieh ST, Chang YC (2005). "Neurological manifestations in severe acute respiratory syndrome". Acta Neurol Taiwan. 14 (3): 113–9. PMID 16252612.
  8. Nath A (2020). "Neurologic complications of coronavirus infections". Neurology. 94 (19): 809–810. doi:10.1212/WNL.0000000000009455. PMID 32229625 Check |pmid= value (help).
  9. Ye M, Ren Y, Lv T (2020). "Encephalitis as a clinical manifestation of COVID-19". Brain Behav Immun. 88: 945–946. doi:10.1016/j.bbi.2020.04.017. PMC 7146652 Check |pmc= value (help). PMID 32283294 Check |pmid= value (help).
  10. 10.0 10.1 10.2 10.3
  11. Efe IE, Aydin OU, Alabulut A, Celik O, Aydin K (2020). "COVID-19-Associated Encephalitis Mimicking Glial Tumor". World Neurosurg. 140: 46–48. doi:10.1016/j.wneu.2020.05.194. PMC 7256557 Check |pmc= value (help). PMID 32479911 Check |pmid= value (help).
  12. Benameur K, Agarwal A, Auld SC, Butters MP, Webster AS, Ozturk T; et al. (2020). "Encephalopathy and Encephalitis Associated with Cerebrospinal Fluid Cytokine Alterations and Coronavirus Disease, Atlanta, Georgia, USA, 2020". Emerg Infect Dis. 26 (9). doi:10.3201/eid2609.202122. PMID 32487282 Check |pmid= value (help).
  13. Ueda R, Saito Y, Ohno K, Maruta K, Matsunami K, Saiki Y, Sokota T, Sugihara S, Nishimura Y, Tamasaki A, Narita A, Imamura A, Maegaki Y (May 2015). "Effect of levetiracetam in acute encephalitis with refractory, repetitive partial seizures during acute and chronic phase". Brain Dev. 37 (5): 471–7. doi:10.1016/j.braindev.2014.08.003. PMID 25174548.
  14. Nakano A, Yamasaki R, Miyazaki S, Horiuchi N, Kunishige M, Mitsui T (2003). "Beneficial effect of steroid pulse therapy on acute viral encephalitis". Eur. Neurol. 50 (4): 225–9. doi:10.1159/000073864. PMID 14634267.
  15. Panariello A, Bassetti R, Radice A, Rossotti R, Puoti M, Corradin M; et al. (2020). "Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report". Brain Behav Immun. 87: 179–181. doi:10.1016/j.bbi.2020.05.054. PMC 7255176 Check |pmc= value (help). PMID 32454137 Check |pmid= value (help).
  16. Dogan L, Kaya D, Sarikaya T, Zengin R, Dincer A, Akinci IO; et al. (2020). "Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis: Case series". Brain Behav Immun. 87: 155–158. doi:10.1016/j.bbi.2020.05.022. PMC 7204750 Check |pmc= value (help). PMID 32389697 Check |pmid= value (help).


Template:WikiDoc Sources