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
ARTICLE HIGHLIGHTS
Research background

Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has quickly spread around the world and become a global health emergency. There were over 47690000 confirmed coronavirus disease-19 (COVID-19) cases and 1210000 reported deaths in 216 countries worldwide.

Research motivation

SARS-CoV-2 may cause severe neurological complications, such as encephalopathy and encephalitis. However, it has not been established if there are specific clinical characteristics of encephalitis/meningitis after SARS-CoV-2.

Research objectives

The objective of this study was to identify specific clinical features of cases of encephalitis/meningitis associated with SARS-CoV-2 infection in the context of this virus pandemic and investigate their relationship with SARS-CoV-2 infection.

Research methods

We conducted a search of the medical literature using MEDLINE (accessed from PubMed) and Google Scholar from December 1, 2019 to September 13, 2020 through terms “COVID-19 and encephalitis, meningitis” and “SARS-CoV-2 and encephalitis, meningitis”. Then we analyzed clinical features of COVID-19 patients complicated with encephalitis/meningitis in these articles.

Research results

We identified 22 articles that included a total of 32 encephalitis/meningitis patients with confirmed SARS-CoV-2 infection. Approximately 68.75% had symptoms of SARS-CoV-2 infection in about 1 wk preceding the onset of neurological symptoms. The most common neurological symptoms were consciousness disturbance, seizure, delirium, and headache. The mainly damaged targets identified by neuroimaging included the temporal lobe, white matter, frontal lobe, corpus callosum, and cervical spinal cord (9.38%). Eighty percent of patients had EEGs that showed a diffuse slow wave, and 65.63% of patients improved following systemic therapy.

Research conclusions

Encephalitis/meningitis is the common neurological complication in patients with COVID-19. From the perspective of infectious diseases of the central nervous system, the cases of SARS-CoV-2-associated encephalitis that were reported lack direct evidence of SARS invading the nervous system, while the cases of COVID-19 patients who were tested for cerebrospinal fluid while excluding other potential diagnoses were only accidental reports. 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.

Research perspectives

We should conduct appropriate investigations to exclude other identified brain infections and parainfluenza before attributing a condition to SARS-CoV-2. 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.