Vraka Katerina, Ram Dipak, West Siobhan, Chia Wei Yen Evelyn, Kurup Praveen, Subramanian Gayathri, Tan Hui Jeen
Department of Paediatric Neurology, Rotal Manchester Children's Hospital, Manchester M13 9WL, UK.
Department of Paediatric Intensive Care Unit, Rotal Manchester Children's Hospital, Manchester M13 9WL, UK.
Case Rep Neurol Med. 2021 Mar 24;2021:6658000. doi: 10.1155/2021/6658000. eCollection 2021.
There is increasing evidence that SARS-CoV-2 has neurotropic potential. We report on two paediatric patients who presented with encephalopathy during COVID-19 illness. Both patients had ADEM-like changes in their neuroimaging, negative SARS-CoV-2 RNA PCR in CSF, and paucity of PIMS-TS laboratory findings. However, the first patient was positive for serum MOG antibodies with normal CSF analysis, and the second had negative MOG antibodies but showed significant CSF lymphocytic pleocytosis. We concluded that the first case was a typical case of demyelination, which could have been triggered by different cofactors. In the second case, however, we postulated that the encephalopathic process was triggered by SARS-CoV-2, as no other cause was identified. With these two contrasting cases, we provide evidence that SARS-CoV-2-associated encephalitis can show ADEM-like changes, which can present during the postinfectious phase of COVID-19 illness. As ADEM is a relatively common type of postinfectious encephalitis in children, the distinguishing line between the two conditions of encephalitis and ADEM can be relatively fine. The development of more reliable diagnostic tools (e.g., anti-SARS-CoV-2 antibodies in CSF) might play an assisting role in the differentiation of these encephalopathic processes.
越来越多的证据表明，严重急性呼吸综合征冠状病毒2（SARS-CoV-2）具有嗜神经潜力。我们报告了两名在新冠病毒疾病（COVID-19）期间出现脑病的儿科患者。两名患者的神经影像学检查均有急性播散性脑脊髓炎（ADEM）样改变，脑脊液中SARS-CoV-2 RNA聚合酶链反应（PCR）呈阴性，且儿童多系统炎症综合征（PIMS-TS）实验室检查结果较少。然而，首例患者血清髓鞘少突胶质细胞糖蛋白（MOG）抗体呈阳性，脑脊液分析正常，第二例患者MOG抗体呈阴性，但脑脊液淋巴细胞显著增多。我们得出结论，首例病例是典型的脱髓鞘病例，可能由不同的辅助因素引发。然而，在第二例病例中，由于未发现其他病因，我们推测脑病过程是由SARS-CoV-2引发的。通过这两个形成对比的病例，我们提供了证据表明，SARS-CoV-2相关脑炎可表现出ADEM样改变，这可在COVID-19疾病的感染后阶段出现。由于ADEM是儿童感染后脑炎中相对常见的类型，脑炎和ADEM这两种情况之间的区分界限可能相对细微。开发更可靠的诊断工具（例如脑脊液中的抗SARS-CoV-2抗体）可能有助于区分这些脑病过程。
