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Review
. 2022 Aug;93(8):769-778.
doi: 10.1007/s00115-022-01294-2. Epub 2022 May 12.

[Manifestations of the central nervous system after COVID-19]

[Article in German]
Ameli Gerhard  1 , Harald Prüß  1   2 , Christiana Franke  3
Affiliations
Review

[Manifestations of the central nervous system after COVID-19]

[Article in German]
Ameli Gerhard et al. Nervenarzt. 2022 Aug.

Abstract
in English, German

Numerous diseases of the central nervous system (CNS), especially in the postacute phase after an infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been described. These include neuroimmunologically mediated diseases, such as encephalopathy, encephalitis, myelitis, acute disseminated encephalomyelitis (ADEM), acute necrotizing hemorrhagic leukoencephalitis (ANHLE) and neuromyelitis optica spectrum disorder (NMOSD) as well as others, such as posterior reversible encephalopathy syndrome (PRES), opsoclonus myoclonus ataxia (OMA) and cerebrovascular diseases. A parainfectious or postinfectious association is discussed but the pathophysiological mechanisms are so far unknown. Underlying mechanisms could be a virus-triggered overactivation of the immune system with hyperinflammation and cytokine storm but possibly also the development of specific autoantibodies against CNS tissue. Direct damage due to the invasion of SARS-CoV‑2 into the brain or spinal cord does not seem to play a relevant role. An exact clinical phenotyping and initiation of additional diagnostics are recommended, also to rule out other causes. To date no medicinal treatment options for CNS manifestations of long COVID exist; however, first results regarding inflammation and autoimmunity are promising and could lead to new treatment approaches.

Zahlreiche Erkrankungen des Zentralnervensystems sind insbesondere in der Postakutphase nach einer Infektion mit SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“) beschrieben. Diese umfassen neuroimmunologisch vermittelte Erkrankungen wie Enzephalopathien, Enzephalitiden, Myelitiden, ADEM (akute disseminierte Enzephalomyelitis), ANHLE (akute nekrotisierende hämorrhagische Leukoenzephalitis) und NMOSD (Neuromyelitis-optica-Spektrum-Erkrankungen), aber auch andere wie PRES (posteriores reversibles Enzephalopathiesyndrom), OMAS (Opsoklonus-Myoklonus-Ataxie-Syndrom) sowie zerebrovaskuläre Erkrankungen. Ein para- oder postinfektiöser Zusammenhang wird diskutiert, jedoch sind pathophysiologische Mechanismen bislang unbekannt. Ursächlich könnte eine virusgetriggerte Überaktivierung des Immunsystems mit Hyperinflammation und Zytokinsturm, aber möglicherweise auch die Bildung spezifischer Autoantikörper gegen Gewebe des Zentralnervensystems sein. Eine direkte Schädigung durch die Invasion von SARS-CoV‑2 in das Gehirn oder das Rückenmark scheint keine relevante Rolle zu spielen. Eine exakte klinische Phänotypisierung und Einleitung von Zusatzdiagnostik, auch zum Ausschluss anderer Ursachen, ist empfohlen. Bislang existieren noch keine medikamentösen Therapieoptionen zur Behandlung von ZNS-Manifestationen beim Long-COVID(„coronavirus disease“)-Syndrom. Erste Befunde zu Inflammation und Autoimmunität sind jedoch vielversprechend und könnten zu neuen Therapieansätzen führen.

Keywords: Autoantibodies; Encephalitis; Hyperinflammation; Immunotherapy; Myelitis.

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