Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2021; 9(5): 1058-1078
Published online Feb 16, 2021. doi: 10.12998/wjcc.v9.i5.1058
Clinical features of SARS-CoV-2-associated encephalitis and meningitis amid COVID-19 pandemic
Liang Huo, Kai-Li Xu, Hua Wang
Liang Huo, Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Kai-Li Xu, Department of Pediatric Neurology, Children’s Hospital Affiliated to Zhengzhou University, Zhengzhou 450018, Henan Province, China
Kai-Li Xu, Department of Pediatric Neurology, Henan Children’s Hospital, Zhengzhou 450018, Henan Province, China
Hua Wang, Department of Pediatric Neurology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Huo L designed the study, analyzed the data, and drafted the paper; Xu KL analyzed the data and drafted the paper; Wang H collected the data; all authors read and approved the final manuscript.
Supported by Liaoning Provincial Department of Education Scientific Research Project, No. QNZR2020012; Henan Neural Development Engineering Research Center for Children Foundation, No. SG201905; and the National Key Research and Development Program of China, No. 2016YFC1306203.
Conflict-of-interest statement: All the authors declare that they have no conflicts of interest to report.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liang Huo, MD, PhD, Associated Professor, Department of Pediatrics, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. huol@sj-hospital.org
Received: November 5, 2020
Peer-review started: November 5, 2020
First decision: November 23, 2020
Revised: December 1, 2020
Accepted: December 23, 2020
Article in press: December 23, 2020
Published online: February 16, 2021
Processing time: 86 Days and 5.6 Hours
Abstract
BACKGROUND

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.

AIM

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

Keywords: COVID-19; SARS-CoV-2; Encephalitis; Meningitis; Clinical features; System review

Core Tip: Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, although many cases or cases series of SARS-CoV-2-related encepha-litis/meningitis have been reported, the specific clinical characteristics of SARS-CoV-2-relatedencephalitis/meningitis have not been systematically described. We retrospectively analyzed and summarized the comprehensive clinical characteristics of SARS-CoV-2-related encephalitis/meningitis, including demographic characteristics, diagnostic investigations, and outcomes.