Article ; Online: Encephalopathy as a prognostic factor in adults with acute disseminated encephalomyelitis following COVID-19.
2022 Volume 269, Issue 5, Page(s) 2293–2300
Abstract: Numerous reports support the possible occurrence of acute disseminated encephalomyelitis (ADEM) following COVID-19. Herein, we report a case of ADEM in a 53-year-old man 2 weeks after SARS-CoV-2 infection. We reviewed the reports of adult cases of ADEM ... ...
| Abstract | Numerous reports support the possible occurrence of acute disseminated encephalomyelitis (ADEM) following COVID-19. Herein, we report a case of ADEM in a 53-year-old man 2 weeks after SARS-CoV-2 infection. We reviewed the reports of adult cases of ADEM and its variant acute necrotizing hemorrhagic leukoencephalitis (ANHLE) to check for possible prognostic factors and clinical/epidemiological peculiarities. We performed a descriptive analysis of clinical and cerebrospinal fluid data. Ordinal logistic regressions were performed to check the effect of clinical variables and treatments on ADEM/ANHLE outcomes. We also compared ADEM and ANHLE patients. We identified a total of 20 ADEM (9 females, median age 53.5 years) and 23 ANHLE (11 females, median age 55 years). Encephalopathy was present in 80% of ADEM and 91.3% of ANHLE patients. We found that the absence of encephalopathy predicts a better clinical outcome in ADEM (OR 0.027, 95% CI 0.001-0.611, p = 0.023), also when correcting for the other variables (OR 0.032, 95% CI 0.001-0.995, p = 0.05). Conversely, we identified no significant prognostic factor in ANHLE patients. ANHLE patients showed a trend towards a worse clinical outcome (lower proportion of good/complete recovery, 4.5% vs 16.7%) and higher mortality (36.4% vs 11.1%) as compared to ADEM. Compared to pre-pandemic ADEM, we observed a higher median age of people with post-COVID-19 ADEM and ANHLE, a shorter interval between infection and neurological symptoms, and a worse prognosis both in terms of high morbidity and mortality. Despite being affected by the retrospective nature of the study, these observations provide new insights into ADEM/ANHLE following SARS-CoV-2 infection. |
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| MeSH term(s) | Adult ; Brain Diseases ; COVID-19/complications ; Encephalomyelitis, Acute Disseminated/etiology ; Female ; Humans ; Leukoencephalitis, Acute Hemorrhagic/diagnostic imaging ; Leukoencephalitis, Acute Hemorrhagic/epidemiology ; Leukoencephalitis, Acute Hemorrhagic/etiology ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; SARS-CoV-2 | |||||
| Language | English | |||||
| Publishing date | 2022-01-03 | |||||
| Publishing country | Germany | |||||
| Document type | Case Reports ; Journal Article | |||||
| ZDB-ID | 187050-6 | |||||
| ISSN | 1432-1459 ; 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X | |||||
| ISSN (online) | 1432-1459 | |||||
| ISSN | 0340-5354 ; 0012-1037 ; 0939-1517 ; 1619-800X | |||||
| DOI | 10.1007/s00415-021-10947-2 | |||||
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| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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