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Review
. 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  1 , Fulvio A Scorza  2
Affiliations
Review

Infectious and immune-mediated central nervous system disease in 48 COVID-19 patients

Josef Finsterer et al. J Clin Neurosci. 2021 Aug.

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.

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Conflict of interest statement

Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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