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Xue H, Zeng L, He H, Xu D, Ren K. Autoimmune encephalitis in COVID-19 patients: a systematic review of case reports and case series. Front Neurol 2023; 14:1207883. [PMID: 37771454 PMCID: PMC10525333 DOI: 10.3389/fneur.2023.1207883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 08/22/2023] [Indexed: 09/30/2023] Open
Abstract
Background There is mounting evidence suggesting that autoimmune encephalitis (AE) can be observed as a neurological complication in patients with COVID-19. This review aimed to summarize the clinical manifestations, types, and outcomes of COVID-19-associated AE. Methods A systematic search was conducted in the PubMed, Embase, and Web of Science databases to identify case reports and case series related to COVID-19-associated AE from 1 January 2020 to 31 March 2023. After a thorough screening and evaluation, irrelevant articles were excluded. Relevant information concerning types, clinical manifestations, and outcomes was extracted and synthesized. Results A total of 37 studies, comprising 34 case reports and 3 case series, were included in this review. Among the 42 COVID-19-associated AE patients, 21 (50%) cases were classified as an unknown antibodies (Ab) type of COVID-19-associated AE, 10 (23.80%) cases as anti-N-methyl-D-aspartate (NMDA) encephalitis, 4 (9.5%) cases as limbic encephalitis, and 3 (7.1%) cases as anti-myelin-oligodendrocyte-glycoprotein encephalitis, along with other rare types of AE. Disturbance of consciousness, seizures, and psychiatric symptoms were identified as the main clinical manifestations of COVID-19-associated AE. While the symptoms of AE displayed variation, most patients achieved full recovery although a few experienced residual symptoms of neurological damage. Conclusion This systematic review comprehensively describes the characteristics of COVID-19-associated AE. The main type of COVID-19-associated AE identified in this study is an unknown Ab type of COVID-19-associated AE. Despite the potentially life-threatening risks of COVID-19-associated AE, the majority of patients survived, with some patients reporting residual neurological symptoms.
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Affiliation(s)
- Hua Xue
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Li Zeng
- Department of Respiratory, Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, Guangxi, China
| | - Hongxian He
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Dongxun Xu
- Department of Neurology, Sichuan Taikang Hospital, Chengdu, Sichuan, China
| | - Kaixin Ren
- Department of Rehabilitation, Affiliated Hospital of Yunnan University, Kunming, Yunnan, China
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Faro SH, Manmatharayan A, Leiby B, Jain N, Mohamed FB, Talekar KS, Doshi A, Jambor I, Chang S, Finkelstein M, Kremer S, Lersy F, Lindgren B, Figueiredo NM, Gerevini S, Napolitano A, Jain R, Dogra S, Pillai JJ, Ryan D, Jager R, Carletti F, Mian A, Kaliev A, Anand P, Takahashi C, Murat A, Colen R, Mansueto G, Pizzini F. Neuroimaging findings in 4342 hospitalized COVID-19 subjects: A multicenter report from the United States and Europe. J Neuroimaging 2023; 33:752-763. [PMID: 37381160 DOI: 10.1111/jon.13140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/12/2023] [Accepted: 06/13/2023] [Indexed: 06/30/2023] Open
Abstract
BACKGROUND AND PURPOSE To determine the incidence of acute neuroimaging (NI) findings and comorbidities in the coronavirus disease of 2019 (COVID-19)-infected subjects in seven U.S. and four European hospitals. METHODS This is a retrospective study of COVID-19-positive subjects with the following inclusion criteria: age >18, lab-confirmed COVID-19 infection, and acute NI findings (NI+) attributed to COVID-19 on CT or MRI brain. NI+ and comorbidities in total hospitalized COVID-19-positive (TN) subjects were assessed. RESULTS A total of 37,950 COVID-19-positive subjects were reviewed and 4342 underwent NI. NI+ incidence in subjects with NI was 10.1% (442/4342) including 7.9% (294/3701) in the United States and 22.8% (148/647) in Europe. NI+ incidence in TN was 1.16% (442/37,950). In NI (4342), incidence of ischemic stroke was 6.4% followed by intracranial hemorrhage (ICH) (3.8%), encephalitis (0.5%), sinus venous thrombosis (0.2%), and acute disseminated encephalomyelitis (ADEM) (0.2%). White matter involvement was seen in 57% of NI+. Hypertension was the most common comorbidity (54%) before cardiac disease (28.8%) and diabetes mellitus (27.7%). Cardiac disease (p < .025), diabetes (p < .014), and chronic kidney disease (p < .012) were more common in the United States. CONCLUSION This multicenter, multinational study investigated the incidence and spectrum of NI+ in 37,950 hospitalized adult COVID-19 subjects including regional differences in incidences of NI+, associated comorbidities, and other demographics. NI+ incidence in TN was 1.16% including 0.95% in the United States and 2.09% in Europe. ICH, encephalitis, and ADEM were common in Europe, while ischemic strokes were more common in the United States. In this cohort, incidence and distribution of NI+ helped characterize the neurological complications of COVID-19.
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Affiliation(s)
- Scott H Faro
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Arichena Manmatharayan
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Benjamin Leiby
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Neelu Jain
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Feroze B Mohamed
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Kiran S Talekar
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Amish Doshi
- Department of Radiology, Mt. Sinai Hospital, New York, New York, USA
| | - Ivan Jambor
- Department of Radiology, Mt. Sinai Hospital, New York, New York, USA
| | - Sanders Chang
- Department of Radiology, Mt. Sinai Hospital, New York, New York, USA
| | - Mark Finkelstein
- Department of Radiology, Mt. Sinai Hospital, New York, New York, USA
| | - Stephane Kremer
- Department of Radiology, University of Strasbourg, Strasbourg, France
| | - Francois Lersy
- Department of Radiology, University of Strasbourg, Strasbourg, France
| | - Brenden Lindgren
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | - Nathalia M Figueiredo
- Department of Radiology, Temple University Hospital, Philadelphia, Pennsylvania, USA
| | | | | | - Rajan Jain
- Department of Radiology, New York University, New York, New York, USA
| | - Siddhanth Dogra
- Department of Radiology, New York University, New York, New York, USA
| | - Jay J Pillai
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
- Division of Neuroradiology, Mayo Clinic, Rochester, Minnesota
| | - Dan Ryan
- Department of Radiology, Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Rolf Jager
- Department of Radiology, University College Hospital, London, UK
| | | | - Asim Mian
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Artem Kaliev
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Pria Anand
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Courtney Takahashi
- Department of Radiology, Boston Medical Center, Boston, Massachusetts, USA
| | - Ak Murat
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rivka Colen
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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Koupaei M, Shadab Mehr N, Mohamadi MH, Asadi A, Abbasimoghaddam S, Shekartabar A, Heidary M, Shokri F. Clinical symptoms, diagnosis, treatment, and outcome of COVID-19-associated encephalitis: A systematic review of case reports and case series. J Clin Lab Anal 2022; 36:e24426. [PMID: 35435264 PMCID: PMC9102669 DOI: 10.1002/jcla.24426] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/14/2022] [Accepted: 04/01/2022] [Indexed: 12/17/2022] Open
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.
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Affiliation(s)
- Maryam Koupaei
- Department of Microbiology, School of Medicine, Kashan University of Medical Sciences, Tehran, Iran
| | - Negar Shadab Mehr
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Arezoo Asadi
- Microbial Biotechnology Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | | | | | - Mohsen Heidary
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Fazlollah Shokri
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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Payus AO, Jeffree MS, Ohn MH, Tan HJ, Ibrahim A, Chia YK, Raymond AA. Immune-mediated neurological syndrome in SARS-CoV-2 infection: a review of literature on autoimmune encephalitis in COVID-19. Neurol Sci 2021; 43:1533-1547. [PMID: 34853897 PMCID: PMC8635316 DOI: 10.1007/s10072-021-05785-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 11/23/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION The novel Coronavirus Disease 2019 (COVID-19) is an infection caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which has been spreading rapidly amongst humans and causing a global pandemic. The notorious infection has shown to cause a wide spectrum of neurological syndrome, including autoimmune encephalitis. OBJECTIVE Here, we systematically review the literature on autoimmune encephalitis that developed in the background of SARS-CoV-2 infections and also the possible pathophysiological mechanisms of auto-immune mediated damage to the nervous system. METHODOLOGY An exhaustive search was made in Medline/PubMed, Embase, Scopus and other medical databases, and 28 relevant published articles were selected according to the strict inclusion criteria. RESULTS Autoimmune encephalitis can occur via three possible proposed pathophysiological mechanism and can manifest during or after the acute infection period. It is more common in adult but can also occur in the paediatric patients. There were various spectra of autoantibody panels reported including antineuronal antibody, anti-gangliosides antibody and onconeural antibody. Majority of the patients responded well to the immunomodulating therapy and achieved good recovery. CONCLUSION In conclusion, SARSCoV-2 infection can induce various spectrum of autoimmune encephalitis. It is a major concern since there is very limited long-term study on the topic. Hence, this review aims to elucidate on the potential long-term complication of SARS-CoV-2 infection and hopefully to improve the management and prognosis of COVID-19.
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Affiliation(s)
- Alvin Oliver Payus
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.
| | - Mohammad Saffree Jeffree
- Faculty of Medicine and Health Science, Universiti Malaysia Sabah (UMS), Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - May Honey Ohn
- Cardiology Department, University Lewisham Hospital, High Street, London, SE13 6LH, UK
| | - Hui Jan Tan
- Department of Internal Medicine, Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Jalan Yaacob Latif, 56000, Cheras, Kuala Lumpur, Malaysia
| | - Azliza Ibrahim
- Department of Neurology, Hospital Pengajar Universiti Putra Malaysia, Persiaran Mardi - UPM, 43400, Serdang, Selangor, Malaysia
| | - Yuen Kang Chia
- Neurology Unit, Department of Medicine, Queen Elizabeth Hospital, 13a Jalan Penampang, 88200, Kota Kinabalu, Sabah, Malaysia
| | - Azman Ali Raymond
- Department of Medicine, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, 47000, Sungai Buloh, Selangor, Malaysia
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