Clinical Presentation and Outcomes of Severe Acute Respiratory Syndrome Coronavirus 2–Related Encephalitis: The ENCOVID Multicenter Study
Author:
Pilotto Andrea12, Masciocchi Stefano1, Volonghi Irene1, Crabbio Massimo3, Magni Eugenio3, De Giuli Valeria4, Caprioli Francesca4, Rifino Nicola5, Sessa Maria5, Gennuso Michele6, Cotelli Maria Sofia7, Turla Marinella7, Balducci Ubaldo8, Mariotto Sara9, Ferrari Sergio9, Ciccone Alfonso10, Fiacco Fabrizio11, Imarisio Alberto1, Risi Barbara1, Benussi Alberto1, Premi Enrico12, Focà Emanuele13ORCID, Caccuri Francesca14, Leonardi Matilde15, Gasparotti Roberto16, Castelli Francesco13, Zanusso Gianluigi9, Pezzini Alessandro1, Padovani Alessandro1, Pilotto Andrea, Masciocchi Stefano, Volonghi Irene, Crabbio Massimo, del Zotto Elisabetta, Magni Eugenio, De Giuli Valeria, Caprioli Francesca, Rifino Nicola, Sessa Maria, Gennuso Michele, Cotelli Maria Sofia, Turla Marinella, Balducci Ubaldo, Mariotto Sara, Ferrari Sergio, Ciccone Alfonso, Fiacco Fabrizio, Guindani Massimiliano, Imarisio Alberto, Risi Barbara, Benussi Alberto, Poli Loris, Gipponi Stefano, Filosto Massimiliano, Premi Enrico, Gamba Massimo, Caratozzolo Salvatore, Cristillo Viviana, Libri Ilenia, Cola Francesca Schiano di, Piccinelli Stefano Cotti, Cortinovis Matteo, Scalvini Andrea, Baldelli Enrico, Locatelli Martina, Benini Matteo, Gazzina Stefano, Chiari Erika, Odolini Silvia, Focà Emanuele, Caccuri Francesca, Caruso Arnaldo, Leonardi Matilde, Ambrosi Claudia, Pinelli Lorenzo, Gasparotti Roberto, Gerevini Simonetta, Ciceri Elisa Francesca Maria, Castelli Francesco, Zanusso Gianluigi, Ferraro Bruno, Volta Giorgio Dalla, Pezzini Alessandro, Padovani Alessandro,
Affiliation:
1. Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy 2. Parkinson’s Disease Rehabilitation Centre, Fondazione Europea Ricerca Biomedica ONLUS, S. Isidoro Hospital, Trescore Balneario, Italy 3. Neurology Unit, Poliambulanza Hospital, Brescia, Italy 4. Neurology Unit, Istituti Ospedalieri, Azienda Socio Sanitaria Teritoriale di Cremona, Cremona, Italy 5. Department of Neurology, Azienda Socio Sanitaria Teritoriale di Papa Giovanni XXII, Bergamo, Italy 6. Neurology Unit, Crema Hospital, Crema, Italy 7. Neurology Unit, Azienda Socio Sanitaria Teritoriale della Valcamonica, Esine, Brescia, Italy 8. Neurology Unit, Azienda Socio Sanitaria Teritoriale di Chiari, Chiari, Italy 9. Neurology Unit, Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy 10. Department of Neurology and Stroke Unit, Carlo Poma Hospital, Azienda Socio Sanitaria Teritoriale di Mantova, Mantova, Italy 11. Neurology Unit, Azienda Socio Sanitaria Teritoriale di Bergamo Est, Seriate, Italy 12. Stroke Unit, Azienda Socio Sanitaria Teritoriale Spedali Civili di Brescia, Rescia, Italy 13. University Division of Infectious and Tropical Diseases, University of Brescia and Azienda Socio Sanitaria Teritoriale di Spedali Civili Hospital, Brescia, Italy 14. Microbiology Unit, Department of Molecular and Translational Medicine, University of Brescia and Azienda Socio Sanitaria Teritoriale di Spedali Civili Hospital, Brescia, Italy 15. Neurology, Public Health, Disability Unit, Istituto di Ricerca e Cura a Carattere Scientifico Neurology Institute Besta, Milan, Italy 16. Neuroradiology Unit, Department of Medical and Surgical Specialties, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
Abstract
Abstract
Background
Several preclinical and clinical investigations have argued for nervous system involvement in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Some sparse case reports have described various forms of encephalitis in coronavirus disease 2019 (COVID-19) disease, but very few data have focused on clinical presentations, clinical course, response to treatment, and outcomes.
Methods
The SARS-CoV-2 related encephalopaties (ENCOVID) multicenter study included patients with encephalitis with full infectious screening, cerebrospinal fluid (CSF), electroencephalography (EEG), and magnetic resonance imaging (MRI) data and confirmed SARS-CoV-2 infection recruited from 13 centers in northern Italy. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment, and outcomes were recorded.
Results
Twenty-five cases of encephalitis positive for SARS-CoV-2 infection were included. CSF showed hyperproteinorrachia and/or pleocytosis in 68% of cases whereas SARS-CoV-2 RNA by reverse-transcription polymerase chain reaction resulted negative. Based on MRI, cases were classified as acute demyelinating encephalomyelitis (ADEM; n = 3), limbic encephalitis (LE; n = 2), encephalitis with normal imaging (n = 13), and encephalitis with MRI alterations (n = 7). ADEM and LE cases showed a delayed onset compared to the other encephalitis cases (P = .001) and were associated with previous, more severe COVID-19 respiratory involvement. Patients with MRI alterations exhibited worse response to treatment and final outcomes compared to those with other encephalitis.
Conclusions
SARS-CoV-2 infection is associated with a wide spectrum of encephalitis characterized by different clinical presentation, response to treatment, and outcomes.
Publisher
Oxford University Press (OUP)
Subject
Infectious Diseases,Immunology and Allergy
Cited by
94 articles.
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