Huo Liang, Xu Kai-Li, Wang Hua
Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
Department of Pediatric Neurology, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China.
World J Clin Cases. 2021 Feb 16;9(5):1058-1078. doi: 10.12998/wjcc.v9.i5.1058.
Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, numerous studies have been published on SARS-CoV-2-related encephalitis/meningitis, but it has not been established if there are specific clinical characteristics of encephalitis/meningitis associated with SARS-CoV-2 infection.
To identify the specific clinical features of cases of encephalitis/meningitis associated with SARS-CoV-2 infection in the context of this virus infection pandemic and investigate their relationship with SARS-CoV-2 infection.
We searched PubMed, and included single case reports and case series with full text in English, reporting original data of coronavirus disease-19 (COVID-19) patients with encephalitis/meningitis and a confirmed recent SARS-CoV-2 infection. Clinical data were extracted.
We identified 22 articles (18 single case reports and 4 case series) reporting on a total of 32 encephalitis/meningitis patients with confirmed SARS-CoV-2 infection. SARS-CoV-2 infection was confirmed through reverse transcriptase-polymerase-chain-reaction (RT-PCR) in 96.88% of cases. A total of 22 (68.75%) patients had symptoms of SARS-CoV-2 infection in about 1 wk (7.91 d) preceding the onset of neurologic symptoms. The most common neurological symptoms were consciousness disturbance (59.38%), seizure (21.88%), delirium (18.75%), and headache (18.75%). Four cases were confirmed by positive RT-PCR results in cerebrospinal fluid (CSF), one was confirmed by positive RT-PCR results in postoperative brain tissue, and one by the presence of SARS-CoV-2 antibodies in CSF. The mainly damaged targets identified by neuroimaging included the temporal lobe (15.63%), white matter (12.5%), frontal lobe (9.38%), corpus callosum (9.38%), and cervical spinal cord (9.38%). Eighty percent of patients had electroencephalograms that showed a diffuse slow wave. Twenty-eight (87.5%) patients were administered with specific treatment. The majority (65.63%) of patients improved following systemic therapy.
Encephalitis/meningitis is the common neurological complication in patients with COVID-19. The appropriate use of definitions and exclusion of potential similar diseases are important to reduce over-diagnosis of SARS-CoV-2 associated encephalitis or meningitis.
自严重急性呼吸综合征冠状病毒2（SARS-CoV-2）疫情爆发以来，已有大量关于SARS-CoV-2相关脑炎/脑膜炎的研究发表，但与SARS-CoV-2感染相关的脑炎/脑膜炎是否具有特定临床特征尚未明确。
在本次病毒感染大流行背景下，确定与SARS-CoV-2感染相关的脑炎/脑膜炎病例的特定临床特征，并研究它们与SARS-CoV-2感染的关系。
我们检索了PubMed，并纳入了英文全文的单病例报告和病例系列，报告了冠状病毒病19（COVID-19）合并脑炎/脑膜炎且近期确诊感染SARS-CoV-2的患者的原始数据。提取了临床数据。
我们确定了22篇文章（18篇单病例报告和4篇病例系列），共报告了32例确诊感染SARS-CoV-2的脑炎/脑膜炎患者。96.88%的病例通过逆转录聚合酶链反应（RT-PCR）确诊SARS-CoV-2感染。共有22例（68.75%）患者在出现神经系统症状前约1周（7.91天）有SARS-CoV-2感染症状。最常见的神经系统症状是意识障碍（59.38%）、癫痫发作（21.88%）、谵妄（18.75%）和头痛（18.75%）。4例脑脊液（CSF）RT-PCR结果呈阳性得以确诊，1例术后脑组织RT-PCR结果呈阳性得以确诊，1例脑脊液中存在SARS-CoV-2抗体得以确诊。神经影像学确定的主要受损部位包括颞叶（15.63%）、白质（12.5%）、额叶（9.38%）、胼胝体（9.38%）和颈脊髓（9.38%）。80%的患者脑电图显示弥漫性慢波。28例（87.5%）患者接受了特异性治疗。大多数（65.63%）患者经全身治疗后病情好转。
脑炎/脑膜炎是COVID-19患者常见的神经系统并发症。正确使用定义并排除潜在的类似疾病对于减少SARS-CoV-2相关脑炎或脑膜炎的过度诊断很重要。
