본문 바로가기
KERD
논문KCI 등재

COVID-19-Associated Encephalopathy: Systematic Review of Case Reports

0

조회

0

다운로드

2

인용

0

참고문헌

키워드

초록

Background and Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, but there are also several reports of the involvement of the central nervous system, with one of the manifestations being encephalopathy. The relatively new emergence of COVID-19 means that few studies have investigated the clinical profile of encephalopathy associated with this disease. This study aimed to determine the clinical profile, laboratory, and imaging results of encephalopathy associated with COVID-19. Methods Three databases, namely PubMed/MEDLINE, Embase, and Scopus, were systematically searched for case reports and case series related to COVID-19-associated encephalopathy published from January 1, 2019 to July 20, 2020. Results This review included 24 studies involving 33 cases. The most-reported neurological symptoms were disorientation/confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). Laboratory examinations revealed increases in the C-reactive protein level (48.48%), the lactate dehydrogenase level (30.30%), and lymphopenia (27.27%). Brain imaging did not produce any pathological findings in 51.51% of the cases. Electroencephalography showed generalized slowing in 45.45% of the cases. Elevated protein (42.42%) and lymphocytosis (24.24%) were found in the cerebrospinal fluid. Fifteen patients were reportedly discharged from the hospital in a stable condition, while four cases of mortality were recorded. Conclusions The clinical, laboratory, and imaging findings in this review support the hypothesis that cerebral damage in COVID-19-associated encephalopathy is caused by cytokine-immunemediated inflammation rather than by direct invasion.

Abstract

Background and Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, but there are also several reports of the involvement of the central nervous system, with one of the manifestations being encephalopathy. The relatively new emergence of COVID-19 means that few studies have investigated the clinical profile of encephalopathy associated with this disease. This study aimed to determine the clinical profile, laboratory, and imaging results of encephalopathy associated with COVID-19. Methods Three databases, namely PubMed/MEDLINE, Embase, and Scopus, were systematically searched for case reports and case series related to COVID-19-associated encephalopathy published from January 1, 2019 to July 20, 2020. Results This review included 24 studies involving 33 cases. The most-reported neurological symptoms were disorientation/confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). Laboratory examinations revealed increases in the C-reactive protein level (48.48%), the lactate dehydrogenase level (30.30%), and lymphopenia (27.27%). Brain imaging did not produce any pathological findings in 51.51% of the cases. Electroencephalography showed generalized slowing in 45.45% of the cases. Elevated protein (42.42%) and lymphocytosis (24.24%) were found in the cerebrospinal fluid. Fifteen patients were reportedly discharged from the hospital in a stable condition, while four cases of mortality were recorded. Conclusions The clinical, laboratory, and imaging findings in this review support the hypothesis that cerebral damage in COVID-19-associated encephalopathy is caused by cytokine-immunemediated inflammation rather than by direct invasion.

참고문헌 (57)

  1. "Novel coronavirus (2019-nCoV) situation report-1" (2020)[URL]
  2. Cucinotta D, "WHO declares COVID-19 a pandemic", Acta Biomed, 91, pp.157~160 (2020)
  3. "Coronavirus resource center" (2020)[URL]
  4. Zheng J, "SARS-CoV-2 : an emerging coronavirus that causes a global threat", Int J Biol Sci, 16, pp.1678~1685 (2020)
  5. Pascarella G, "COVID-19 diagnosis and management : a comprehensive review", J Intern Med, 288, pp.192~206 (2020)
  6. Mao L, "Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China", JAMA Neurol, 77, pp.683~690 (2020)
  7. Helms J, "Neurologic features in severe SARS-CoV-2 infection", N Engl J Med, 382, pp.2268~2270 (2020)
  8. Ghannam M, "Neurological involvement of coronavirus disease 2019 : a systematic review", J Neurol, 267, pp.3135~3153 (2020)
  9. Hutton B, "The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions : checklist and explanations", Ann Intern Med, 162, pp.777~784 (2015)
  10. Jeyaraman MM, "Inter-rater reliability and concurrent validity of ROBINS-I : protocol for a cross-sectional study", Syst Rev, 9, pp.12~ (2020)
  11. Duong L, "Meningoencephalitis without respiratory failure in a young female patient with COVID-19 infection in Downtown Los Angeles, early April 2020", Brain Behav Immun, 87, pp.33~ (2020)
  12. Bernard-Valnet R, "Two patients with acute meningoencephalitis concomitant with SARS-CoV-2 infection", Eur J Neurol, 27, pp.e43~e44 (2020)
  13. Ye M, "Encephalitis as a clinical manifestation of COVID-19", Brain Behav Immun, 88, pp.945~946 (2020)
  14. McAbee GN, "Encephalitis associated with COVID-19 infection in an 11-year-old child", Pediatr Neurol, 109, pp.94~ (2020)
  15. Andriuta D, "COVID-19 encephalopathy : detection of antibodies against SARS-CoV-2 in CSF", J Neurol, 267, pp.2810~2811 (2020)
  16. Chaumont H, "Acute meningoencephalitis in a patient with COVID-19", Rev Neurol(Paris), 176, pp.519~521 (2020)
  17. Sohal S, "COVID-19 presenting with seizures", IDCases, 20, pp.e00782~ (2020)
  18. Pilotto A, "Steroid-responsive encephalitis in coronavirus disease 2019", Ann Neurol, 88, pp.423~427 (2020)
  19. Al-Olama M, "COVID-19-associated meningoencephalitis complicated with intracranial hemorrhage: a case report", Acta Neurochir(Wien), 162, pp.1495~1499 (2020)
  20. Moriguchi T, "A first case of meningitis", encephalitis associated with SARS-Coronavirus-2, 2020, pp.94, 55~58
  21. Vandervorst F, "Encephalitis associated with the SARS-CoV-2 virus : a case report", Interdiscip Neurosurg, 22, pp.100821~ (2020)
  22. Wong PF, "a case of rhombencephalitis as a rare complication of acute COVID-19 infection", Clin Med(Lond), 20, pp.293~294 (2020)
  23. Zandifar S, "Acute viral encephalitis associated with SARSCoV-2", Ann Clin Case Rep, 5, pp.1845~ (2020)
  24. Farhadian S, "Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19", BMC Neurol, 20, pp.248~ (2020)
  25. Chalil A, "Acute hemorrhagic encephalitis related to COVID-19", Neurol Clin Pract, 11, pp.e147~e151 (2020)
  26. Afshar H, "Evolution and resolution of brain involvement associated with SARSCoV2infection : a close clinical-paraclinical follow up study of a case", Mult Scler Relat Disord, 43, pp.102216~ (2020)
  27. Bodro M, "Increased CSF levels of IL-1β, IL-6, and ACE in SARS-CoV-2-associated encephalitis", Neurol Neuroimmunol Neuroinflamm, 7, pp.e821~ (2020)
  28. Abdi S, "The association of SARS-CoV-2 infection and acute disseminated encephalomyelitis without prominent clinical pulmonary symptoms", J Neurol Sci, 416, pp.117001~ (2020)
  29. Delamarre L, "COVID-19-associated acute necrotising encephalopathy successfully treated with steroids and polyvalent immunoglobulin with unusual IgG targeting the cerebral fibre network", J Neurol Neurosurg Psychiatry, 91, pp.1004~1006 (2020)
  30. Huang YH, "SARS-CoV-2 detected in cerebrospinal fluid by PCR in a case of COVID-19 encephalitis", Brain Behav Immun, 87, pp.149~ (2020)
  31. Khoo A, "Postinfectious brainstem encephalitis associated with SARS-CoV-2", J Neurol Neurosurg Psychiatry, 91, pp.1013~1014 (2020)
  32. Zambreanu L, "A case of limbic encephalitis associated with asymptomatic COVID-19 infection", J Neurol Neurosurg Psychiatry, 91, pp.1229~1230 (2020)
  33. Panariello A, "Anti-NMDA receptor encephalitis in a psychiatric covid-19 patient : a case report", Brain Behav Immun, 87, pp.179~181 (2020)
  34. Dogan L, "Plasmapheresis treatment in COVID-19-related autoimmune meningoencephalitis : case series", Brain Behav Immun, 87, pp.155~158 (2020)
  35. Sili U, "Herpes simplex virus encephalitis : clinical manifestations, diagnosis and outcome in 106 adult patients", J Clin Virol, 60, pp.112~118 (2014)
  36. Arabi YM, "Severe neurologic syndrome associated with Middle East respiratory syndrome corona virus(MERS-CoV)", Infection, 43, pp.495~501 (2015)
  37. Rodriguez-Morales AJ, "Clinical, laboratory and imaging features of COVID-19 : a systematic review and meta-analysis", Travel Med Infect Dis, 34, pp.101623~ (2020)
  38. Wang L, "C-reactive protein levels in the early stage of COVID-19", Med Mal Infect, 50, pp.332~334 (2020)
  39. Chen N, "Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China : a descriptive study", Lancet, 395, pp.507~513 (2020)
  40. Huang I, "Lymphopenia in severe coronavirus disease-2019(COVID-19) : systematic review and meta-analysis", J Intensive Care, 8, pp.36~ (2020)
  41. Li T, "Significant changes of peripheral T lymphocyte subsets in patients with severe acute respiratory syndrome", J Infect Dis, 189, pp.648~651 (2004)
  42. Xu H, "High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa", Int J Oral Sci, 12, pp.8~ (2020)
  43. He Z, "Effects of severe acute respiratory syndrome(SARS)coronavirus infection on peripheral blood lymphocytes and their subsets", Int J Infect Dis, 9, pp.323~330 (2005)
  44. Katal S, "Neuroimaging and neurologic findings in COVID-19 and other coronavirus infections : a systematic review in 116 patients", J Neuroradiol, 48, pp.43~50 (2020)
  45. Lau KK, "Possible central nervous system infection by SARS coronavirus", Emerg Infect Dis, 10, pp.342~344 (2004)
  46. Hwang CS, "Olfactory neuropathy in severe acute respiratory syndrome : report of A case", Acta Neurol Taiwan, 15, pp.26~28 (2006)
  47. Canham LJW, "Electroencephalographic(EEG)features of encephalopathy in the setting of Covid-19 : a case series", Clin Neurophysiol Pract, 5, pp.199~205 (2020)
  48. Chaudhuri A, "Diagnosis and treatment of viral encephalitis", Postgrad Med J, 78, pp.575~583 (2002)
  49. Baig AM, "Evidence of the COVID-19 virus targeting the CNS : tissue distribution, host–virus interaction, and proposed neurotropic mechanisms", ACS Chem Neurosci, 11, pp.995~998 (2020)
  50. Abboud H, "COVID-19 and SARS-Cov-2 infection : pathophysiology and clinical effects on the nervous system", World Neurosurg, 140, pp.49~53 (2020)
  51. Sedaghat Z, "Guillain Barre syndrome associated with COVID-19 infection : a case report", J Clin Neurosci, 76, pp.233~235 (2020)
  52. Armangue T, "Autoimmune encephalitis as differential diagnosis of infectious encephalitis", Curr Opin Neurol, 27, pp.361~368 (2014)
  53. Ropper AH, "Adams and Victor’s principles of neurology" (2014), McGraw-Hill
  54. Mahmudpour M, "COVID-19 cytokine storm : the anger of inflammation", Cytokine, 133, pp.155151~ (2020)
  55. Song P, "Cytokine storm induced by SARSCoV-2", Clin Chim Acta, 509, pp.280~287 (2020)
  56. Fotuhi M, "Neurobiology of COVID-19", J Alzheimers Dis, 76, pp.3~19 (2020)
  57. Wu D, "TH17 responses in cytokine storm of COVID-19 : an emerging target of JAK2 inhibitor Fedratinib", J Microbiol Immunol Infect, 53, pp.368~370 (2020)

관련 논문AI추천

Acute Necrotizing Encephalopathy in Adult Patients With COVID-19: A Systematic Review of Case Reports and Case SeriesAli Dadjou, Amir Azimi, Amirmohammad Khalaji, Fattaneh Khalaj, Hamid Reihani, Houman Sotoudeh, Mahsa Shirforoush Sattari, Mohammad Amin Habibi, Ramin Shahidi, Reza Nemati, Romina Rafiei, Seyed Ali Forouzannia, Shaghayegh Karami, Soraya Teimori, Vida Sarmadi, Zohreh Tajabadi대한신경과학회 · Journal of Clinical Neurology2023 · 제19권 제6호Acute Confusion as an Initial Presentation of SARS-CoV-2 InfectionButt Isabel, Dawson Charlotte, Gautam Nandan, Geberhiwot Tarekegn, Madathil Shyam, Ochoa-Ferraro Antonio, Sawlani Vijay대한신경과학회 · Journal of Clinical Neurology2021 · 제17권 제3호Neurological Manifestations in Patients with COVID-19: Experiences from the Central Infectious Diseases Hospital in South Korea김현경, 이서영, 조여정대한신경과학회 · Journal of Clinical Neurology2021 · 제17권 제3호Neurological complications during the course of severe COVID-19: Is it just the tip of the iceberg?Arzu Topeli, Burcin Halacli, Gulcin Koc Yamanyar, Mehmet Yildirim대한중환자의학회 · Acute and Critical Care2022 · 제37권 제1호뇌전증지속상태로 내원한 코로나-19 뇌염 환자에서 가역적 변화가 관찰된 세포독성부종김중구, 김홍전, 서수림대한신경과학회 · 대한신경과학회지2024 · 제42권 제2호AI-CoV Study: Autoimmune Encephalitis Associated With COVID-19 and Its Vaccines—A Systematic ReviewAbhishek Chowdhury, Abhishek Gohel, Aritra Chatterjee, Bhavesh Mohan Lal, Debjyoti Dhar, MM Samim, Naznin Parvin, Nibu Varghese, Rutul D. Shah, Sampurna Chowdhury, Shahyan Siddiqui, Sheetal Goyal, Treshita Dey, Vikram Singh대한신경과학회 · Journal of Clinical Neurology2022 · 제18권 제6호

이 간행물의 다른 논문 (21건)