Neurologic Manifestations of Severe Respiratory Viral Contagions

Abstract

Endemic and pandemic viral respiratory infections have recently emerged as a critical topic of investigation given the recent severe acute respiratory syndrome coronavirus-2 outbreak. Data from such outbreaks indicate that severe systemic comorbidities including acute neurologic illness are associated with illness and lead to significant outcome differences. Herein, we will discuss the neurologic manifestations of severe viral respiratory infections including coronavirus, influenza, respiratory syncytial virus, metapneumovirus, and enterovirus.

Data sources: PubMed and EMBASE were searched by two independent investigators up to March 2020.

Study selection: Data selection included preclinical and clinical studies detailing neurologic manifestations of viral respiratory infections.

Data extraction and synthesis: Two independent investigators reviewed and extracted the data.

Conclusions: Neurologic manifestations including seizures, status epilepticus, encephalitis, critical illness neuromyopathy, acute disseminated encephalomyelitis, acute necrotizing encephalitis, Guillan-Barré syndrome, transverse myelitis, and acute flaccid myelitis have all been associated with severe viral respiratory infections. Having an understanding of the direct neurotropism of such viruses is imperative to understanding pathogenesis, clinical presentation, and potential treatment paradigms aimed at improving morbidity and mortality.

Keywords: encephalitis; meningitis; neurology; respiratory; seizure; virus.

Figure 1.

MRI of a 56-yr-old female who presented with 2 d of shortness of breath and upper respiratory congestion, followed by onset of rapidly progressive confusion culminating in seizures and then obtundation. She tested positive for influenza A antigen. Cerebrospinal fluid analysis showed a mild pleocytosis of 13 (82% neutrophils), and polymerase chain reaction testing for other viral encephalitides remained negative. She was treated with oseltamivir immediately upon confirmation of positive influenza testing. MRI at admission showed restricted diffusion and susceptibility along with Fluid-attenuated inversion recovery (FLAIR) hyperintensity, without enhancement, in bilateral thalami (A–C) and bilateral mesial temporal lobes (D–F) (A+D, FLAIR, B+E, diffusion weighted imaging, C+F, susceptibility weighted imaging sequences).