Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature

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posted on 2021-03-24, 06:53 authored by Cesar Castello Branco Lopes, Sonia Maria Dozzi Brucki, Carlos Eduardo Borges Passos Neto, Luiza Alves Corazza, José Pedro Soares Baima, Matheus Dalben Fiorentino, João Fellipe Santos Tatsch, Maria da Graça Morais Martin, Leandro Tavares Lucato, Hélio Rodrigues Gomes, Maria Sheila Guimarães Rocha, Ida Fortini, Ricardo Nitrini, Luiz H. Castro

ABSTRACT Background: Neurological manifestations of COVID-19 are still incompletely understood. Neurological manifestations may be due to direct viral effect on neurons and glial cells, to an immune-mediated response to the virus, or to a hypercoagulable state and associated endothelial damage, as well as to severe systemic disease with prolonged intensive care unit stay. Objective: To describe two patients with severe SARS-CoV-2 infection and delayed recovery of consciousness after sedation withdrawal, in whom MRI disclosed multifocal white matter brain lesions, compatible with the diagnosis of acute disseminated encephalomyelitis. Methods: Observational report of two cases of severe COVID-19 infection in patients from two tertiary hospitals in São Paulo, Brazil. Results: These patients underwent neurologic and systemic evaluation for delayed awakening after sedation withdrawal. MRI displayed multifocal centrum semiovale lesions, suggestive of demyelinating inflammation. Cerebrospinal fluid (CSF) polymerase chain reaction (PCR) for SARS-CoV-2 was negative in both cases. Conclusion: A recurrent pattern of multifocal white matter lesions can occur in COVID-19 patients, possibly associated with delayed awakening. Additional studies are necessary to elucidate the role of the viral infection and of inflammatory and immune-mediated associated changes in neurological manifestations of COVID-19.