Abstract
Numerous reports support the possible occurrence of acute disseminated encephalomyelitis (ADEM) following COVID-19. Herein, we report a case of ADEM in a 53-year-old man 2 weeks after SARS-CoV-2 infection. We reviewed the reports of adult cases of ADEM and its variant acute necrotizing hemorrhagic leukoencephalitis (ANHLE) to check for possible prognostic factors and clinical/epidemiological peculiarities. We performed a descriptive analysis of clinical and cerebrospinal fluid data. Ordinal logistic regressions were performed to check the effect of clinical variables and treatments on ADEM/ANHLE outcomes. We also compared ADEM and ANHLE patients. We identified a total of 20 ADEM (9 females, median age 53.5 years) and 23 ANHLE (11 females, median age 55 years). Encephalopathy was present in 80% of ADEM and 91.3% of ANHLE patients. We found that the absence of encephalopathy predicts a better clinical outcome in ADEM (OR 0.027, 95% CI 0.001-0.611, p = 0.023), also when correcting for the other variables (OR 0.032, 95% CI 0.001-0.995, p = 0.05). Conversely, we identified no significant prognostic factor in ANHLE patients. ANHLE patients showed a trend towards a worse clinical outcome (lower proportion of good/complete recovery, 4.5% vs 16.7%) and higher mortality (36.4% vs 11.1%) as compared to ADEM. Compared to pre-pandemic ADEM, we observed a higher median age of people with post-COVID-19 ADEM and ANHLE, a shorter interval between infection and neurological symptoms, and a worse prognosis both in terms of high morbidity and mortality. Despite being affected by the retrospective nature of the study, these observations provide new insights into ADEM/ANHLE following SARS-CoV-2 infection.
Keywords: ADEM; ANHLE; Acute disseminated encephalomyelitis; Acute necrotizing hemorrhagic leukoencephalitis; COVID-19; Encephalopathy; SARS-CoV-2.
【저자키워드】 COVID-19, SARS-CoV-2, Encephalopathy, ADEM, ANHLE, Acute disseminated encephalomyelitis, Acute necrotizing hemorrhagic leukoencephalitis, 【초록키워드】 Treatment, SARS-CoV-2, Mortality, SARS-COV-2 infection, variant, Infection, Clinical outcome, outcomes, Patient, Descriptive analysis, Prognostic factors, Logistic regression, Encephalopathy, morbidity and mortality, Neurological symptoms, cerebrospinal fluid, patients, predict, retrospective, Acute disseminated encephalomyelitis, Encephalomyelitis, Prognostic factor, Hemorrhagic Leukoencephalitis, Support, observation, Hemorrhagic, clinical variables, 95% CI, median age, worse prognosis, females, other variables, Disseminated encephalomyelitis, Occurrence, performed, affected, proportion, absence, Numerous, clinical variable, other variable, 【제목키워드】 Acute disseminated encephalomyelitis, Prognostic factor,