COVID-19 Related Encephalopathy

Main Article Content

José Miguel Valdés Fernando Vivanco Marianella Hernández Lorna Galleguillos

Abstract

SARS-CoV-2 infection can present with neurological symptoms due to direct or indirect invasion of the central nervous system. There are many hypotheses of why this happens, focusing on systemic inflammation, cytokines and cells, but none of them are completely understood. We present a case of a 66-year-old female that presented with a severe encephalopathy during her COVID-19 infection. We discuss physiopathology, risk factors, work up, possible treatments according to the physiopathological damage and prognosis according to the treatment response.

Article Details

How to Cite
VALDÉS, José Miguel et al. COVID-19 Related Encephalopathy. Medical Research Archives, [S.l.], v. 10, n. 12, jan. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3462>. Date accessed: 29 jan. 2023. doi: https://doi.org/10.18103/mra.v10i12.3462.
Section
Case Reports

References

1. Ariño H, Heartshorne R, Michael BD, et al. Neuroimmune disorders in COVID-19. J Neurol. 2022;269(6):2827-2839. doi:10.1007/s00415-022-11050-w
2. Michael BD, Walton D, Westenberg E, et al. Consensus Clinical Guidance for Diagnosis and Management of Adult COVID-19 Encephalopathy Patients. J Neuropsychiatry Clin Neurosci. 2022; appineuropsych22010002. doi:10.1176/appi.neuropsych.22010002
3. Siahaan YMT, Puspitasari V, Pangestu A. COVID-19-Associated Encephalopathy: Systematic Review of Case Reports. J Clin Neurol. 2022;18(2):194-206. doi:10.3988/jcn.2022.18.2.194
4. Beghi E, Michael BD, Solomon T, Westenberg E, Winkler AS; COVID-19 Neuro Research Coalition. Approaches to understanding COVID-19 and its neurological associations. Ann Neurol. 2021;89(6):1059-1067. doi:10.1002/ana.26076
5. Ousseiran ZH, Fares Y, Chamoun WT. Neurological manifestations of COVID-19: a systematic review and detailed comprehension. Int J Neurosci. 2021;1-16. doi:10.1080/00207454.2021.1973000
6. Udzik J, Jakubowski P, Niekrasz M, Barczyszyn A, Parczewski M. COVID-19-Associated Encephalopathy-Case Series and Clinical Considerations. J Clin Med. 2022;11(4):981. doi:10.3390/jcm11040981
7. Shimohata T. Neuro-COVID-19. Clin Exp Neuroimmunol. 2022;13(1):17-23. doi:10.1111/cen3.12676
8. Katzourakis A. COVID-19: endemic doesn't mean harmless. Nature. 2022;601(7894):485. doi:10.1038/d41586-022-00155-x
9. Vanderheiden A, Klein RS. Neuroinflammation and COVID-19. Curr Opin Neurobiol. 2022;76:102608. doi:10.1016/j.conb.2022.102608
10. Alexopoulos H, Magira E, Bitzogli K, et al. Anti-SARS-CoV-2 antibodies in the CSF, blood-brain barrier dysfunction, and neurological outcome: Studies in 8 stuporous and comatose patients. Neurol Neuroimmunol Neuroinflamm. 2020;7(6):e893. doi:10.1212/NXI.0000000000000893
11. Guasp M, Muñoz-Sánchez G, Martínez-Hernández E, et al. CSF Biomarkers in COVID-19 Associated Encephalopathy and Encephalitis Predict Long-Term Outcome. Front Immunol. 2022;13:866153. doi:10.3389/fimmu.2022.866153
12. Mondal R, Ganguly U, Deb S, et al. Meningoencephalitis associated with COVID-19: a systematic review. J Neurovirol. 2021;27(1):12-25. doi:10.1007/s13365-020-00923-3
13. Liotta EM, Batra A, Clark JR, et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol. 2020;7(11):2221-2230. doi:10.1002/acn3.51210
14. Kennedy M, Helfand BKI, Gou RY, et al. Delirium in Older Patients With COVID-19 Presenting to the Emergency Department. JAMA Netw Open. 2020;3(11):e2029540. doi:10.1001/jamanetworkopen.2020.29540
15. Helms J, Kremer S, Merdji H, et al. Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients. Crit Care. 2020;24(1):491. doi:10.1186/s13054-020-03200-1
16. Ladopoulos T, Zand R, Shahjouei S, et al. COVID-19: Neuroimaging Features of a Pandemic. J Neuroimaging. 2021;31(2):228-243. doi:10.1111/jon.12819
17. Gulko E, Oleksk ML, Gomes W, et al. MRI Brain Findings in 126 Patients with COVID-19: Initial Observations from a Descriptive Literature Review. AJNR Am J Neuroradiol. 2020;41(12):2199-2203. doi:10.3174/ajnr.A6805
18. Canham LJW, Staniaszek LE, Mortimer AM, Nouri LF, Kane NM. Electroencephalographic (EEG) features of encephalopathy in the setting of Covid-19: A case series. Clin Neurophysiol Pract. 2020;5:199-205. doi:10.1016/j.cnp.2020.06.001
19. Lewis A, Frontera J, Placantonakis DG, et al. Cerebrospinal fluid in COVID-19: A systematic review of the literature. J Neurol Sci. 2021;421:117316. doi:10.1016/j.jns.2021.117316
20. Wang H. COVID-19, Anti-NMDA Receptor Encephalitis and MicroRNA. Front Immunol. 2022;13:825103.. doi:10.3389/fimmu.2022.825103
21. Cao A, Rohaut B, Le Guennec L, et al. Severe COVID-19-related encephalitis can respond to immunotherapy. Brain. 2020;143(12):e102. doi:10.1093/brain/awaa337
22. Muccioli L, Pensato U, Cani I, et al. COVID-19-related encephalopathy presenting with aphasia resolving following tocilizumab treatment. J Neuroimmunol. 2020;349:577400. doi:10.1016/j.jneuroim.2020.577400
23. Franziska S. Thaler, Luise Zimmermann, Stefan Kammermeier et al. Rituximab Treatment and Long-term Outcome of Patients With Autoimmune Encephalitis. Real-world Evidence From the GENERATE Registry. Neurol Neuroimmunol Neuroinflamm. 2021;8(6):e1088. doi: 10.1212/NXI.0000000000001088
24. Simpson-Yap S, De Brouwer E, Kalincik T et al. Associations of Disease-Modifying Therapies With COVID-19 Severity in Multiple Sclerosis. Neurology. 2021;97(19):e1870-e1885. doi: 10.1212/WNL.0000000000012753.
25. Andersen KM, Bates BA, Rashidi ES et al. Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative. Lancet Rheumatol. 2022;4(1):e33-e41. doi: 10.1016/S2665-9913(21)00325-8.
26. Tavakolpour S, Rakhshandehroo T, Wei EX, Rashidian M. Lymphopenia during the COVID-19 infection: What it shows and what can be learned. Immunol Lett. 2020;225:31-32. doi: 10.1016/j.imlet.2020.06.013.
27. Marengoni A, Zucchelli A, Grande G, Fratiglioni L, Rizzuto D. The impact of delirium on outcomes for older adults hospitalised with COVID-19. Age Ageing. 2020;49(6):923-926. doi:10.1093/ageing/afaa189