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Abstract Details

Clinical Course of Possible Encephalitis with COVID-19: A Systemic Review
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
061

To study the clinical course of cases with COVID-19 associated possible encephalitis.  

There is sparse evidence to directly support definite encephalitis from COVID-19, whereas cases with possible encephalitis are uncommon.

A systematic review was done using Pubmed and Embase database from Jan 2020 to Sept 2020 using the search terms “COVID-19”, “ SARS-CoV-2”, “encephalitis”, modified as per requirements for the search tool of each database.

Total cases found were 14 with mean age 47.3±17 (male 64.3%). 10 cases (71.4%) had initial respiratory symptoms and 6 cases (42.8%) had fever. Common neurological manifestations included altered sensorium (92.8%), headache (42.8%), new onset seizure (35.7%), and dizziness (14.2%). Other features were behavioral issues, mutism, left sided paresis and paresthesia, ataxia, diplopia, bilateral facial weakness, hyposmia and ageusia. Six cases reported meningeal signs among which 71.4% had features of meningism. Out of twelve cases who had CSF analysis, four (33.3%) had normal findings, while the others had elevated CSF opening pressure and/or lymphocytic pleocytosis with elevated protein. Three cases had elevated CSF interleukin levels. SARS-CoV-2 was detected in the CSF of two cases. Eleven cases had MRI Brain imaging among which five cases were reported to have normal findings (45.5%), three cases had temporal lobe T2 hyperintensity (27.3%), one case had necrotizing hemorrhagic encephalitis, and one case had rhombencephalitis. Most of the patients were managed with empirical antibiotics, acyclovir, hydroxychloroquine, steroids, and anti-epileptics. Majority of the patients had complete and early recoveries with median time to recovery of 11 days (IQR 3-12.5). One case died with refractory seizure.

Altered sensorium was the commonest neurological manifestation noted with COVID-19 related possible encephalitis while new onset seizure was seen in >1/3rd cases. Majority of cases managed with empiric antivirals, steroids and antiepileptics had early and complete neurological recovery.

Authors/Disclosures
Riwaj Bhagat, MD (Conemaugh Memorial Medical Center)
PRESENTER
Dr. Bhagat has nothing to disclose.