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Proceedings SNO “Percorsi clinici in Neuroscienze”

dis, Escherichia coli K1) were detected in CSF. Anti- associated with COVID19 infection, including acute
bodies related to autoimmune encephalitis (e.g. anti demyelinating encephalomyelitis, limbic encephali-
GAD, AMPA1, AMPA2, CASPR2, NMDAr, GABA tis, encephalitis with normal imaging and with MRI
B1, GluR3 A/B and DPPX) likewise were negative. alterations. Also in this cohort, viral PCR resulted
Despite the lack of fever or respiratory symptoms, negative in CSF. Patients with brain MRI abnormali-
nasopharyngeal swab was positive for SARS-CoV-2. ties showed worse responses to treatment . Likewise,
(7)
Blood gas analysis was within the normal range, but another Italian study on 30 cases of encephalitis in
chest X-ray showed bilateral lung interstitium accen- COVID19 patients did not detect SARS-CoV-2 in the
tuation. No SARS-CoV-2 RNA was detected in the cerebrospinal fluid. Therefore, authors considered a
CSF using RT-PCR. The patient gradually improved direct invasion of CNS unlikely and theorized a role
without requiring any treatment. Confusion resolved of inflammation related to cytokine storm or a dys-
after a week and control brain MRI results normal. regulation of the immune system . Lumbar puncture
(2)
However, she remained amnesic for what had occur- did not detect SARS-CoV-2 RNA in the cere-
red at home. brospinal fluid of both our patients, consistent with
current literature and the hypothesis of an immune-
mediated pathogenesis. Notably, our subject dis-
DISCUSSION played a spontaneous full recovery, posing a doubt on
the usefulness of immunotherapy in selected cases.
Right now, we can only speculate about the relation- Furthermore, neither of our subjects had a clinically
ship between COVID19 and neurological symptoms, relevant respiratory disease, even in the presence of
whether it is attributable to a direct attack of the virus, radiological signs of pulmonary disease. Further ex-
a cytokine-mediated damage or an autoimmune man- tensive studies are required in order to define
ifestation triggered by the infection. Regarding our etiopathogenesis and best treatment of encephalitis
first subject, also Emamikhah et al. reported seven and neurological syndrome in COVID-19 patients.
(3)
cases of opsoclonus-myoclonus syndrome associated Moreover, studies on drugs against COVID19 should
with COVID-19 disease. Only one subject was tested take into account CNS penetration, even in the ab-
for SARS-CoV-2 in CSF and the result was negative. sence of positive CSF, since the virus was shown to
The nature of their symptoms was assumed to be be present in autoptic samples .
(9)
parainfectious with COVID-19 as the initial trigger
infection. Most of the patients received immunother-
apy with clinical improvement, suggesting an im-
REFERENCES
mune-mediated mechanism . About the second pa-
(3)
tient, a few authors described cases of autoimmune
1. Chiveri L, Verrengia E, Muscia F, Nuzzaco G, Raimondi
limbic encephalitis in patients with COVID-19 infec- E, Vecchio E, Bompane D, Mazzone A, Fociani P,
tion. The degree of pulmonary involvement was vari- Corbellino M, Prelle A. Limbic encephalitis in a COVID-
able. EEG showed abnormal findings and brain MRI 19 patient? J Neurovirol 2021; 27 (3): 498-500.
was consistent with limbic encephalitis in most of the 2. Colombo A, Martinelli Boneschi F, Sessa M, Guidetti D
cases. SARS-CoV-2 was never detected in the CSF of et al. Le encefaliti come complicanze dell’infezione da
these subjects. Presuming an autoimmune mecha- COVID-19. Analisi di 30 casi raccolti dal gruppo di ricer-
nism, the majority of the patients were treated with ca della SNO - Sezione Lombardia. Bollettino SNO N. 18
- marzo 2021. Available from: http://www.bollettinosno.
immunomodulating therapy, such as corticosteroids,
it/archivio/bollsno_18_2021.pdf
intravenous immunoglobulins or plasma exchange,
with outcomes ranging from complete recovery to 3. Emamikhah M, Babadi M, Mehrabani M, Jalili M,
Pouranian M, Daraie P, Mohaghegh F, Aghavali S,
persistent disability (8,10) . Moreover, a review of the lit-
Zaribafian M, Rohani M. Opsoclonus-myoclonus syn-
erature analyzed more than 50 patients with en- drome, a post-infectious neurologic complication of
cephalopathy/encephalitis and concomitant severe COVID-19: case series and review of literature. J
respiratory involvement, most of them on mechanical Neurovirol 2021; 27 (1): 26-34.
ventilation. Only two isolated case reports demon- 4. Garg RK, Paliwal VK, Gupta A. Encephalopathy in pa-
strated viral PCR in cerebrospinal fluid . The SARS- tients with COVID-19: A review. J Med Virol 2021; 93
(4)
CoV-2 related encephalopathies (ENCOVID) multi- (1): 206-222.
center study included 25 Italian cases of encephalitis 5. Giorgetti A, Corengia E, Leva S, Servida M, Politini L,

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