Steroid‐Responsive Encephalitis in Coronavirus Disease 2019

  1. Andrea Pilotto
  2. Silvia Odolini
  3. Stefano Masciocchi
  4. Agnese Comelli
  5. Irene Volonghi
  6. Stefano Gazzina
  7. Sara Nocivelli
  8. Alessandro Pezzini
  9. Emanuele Focà
  10. Arnaldo Caruso
  11. Matilde Leonardi
  12. Maria P. Pasolini
  13. Roberto Gasparotti
  14. Francesco Castelli
  15. Nicholas J. Ashton
  16. Kaj Blennow
  17. Henrik Zetterberg
  18. Alessandro Padovani

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Abstract

Coronavirus disease 2019 (COVID‐19) infection has the potential for targeting the central nervous system, and several neurological symptoms have been described in patients with severe respiratory distress. Here, we described the case of a 60‐year‐old patient with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection but only mild respiratory abnormalities who developed an akinetic mutism attributable to encephalitis. Magnetic resonance imaging was negative, whereas electroencephalography showed generalized theta slowing. Cerebrospinal fluid analyses during the acute stage were negative for SARS‐CoV‐2, positive for pleocytosis and hyperproteinorrachia, and showed increased interleukin‐8 and tumor necrosis factor‐α concentrations. Other infectious or autoimmune disorders were excluded. A progressive clinical improvement along with a reduction of cerebrospinal fluid parameters was observed after high‐dose steroid treatment, thus arguing for an inflammatory‐mediated brain involvement related to COVID‐19. ANN NEUROL 2020;88:423–427.

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  1. Version published to 10.1002/ana.25783
  2. ScreenIT

    SciScore for 10.1101/2020.04.12.20062646: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementConsent: The patient provided an informed written consent for the report and the diagnostic/therapeutic procedures were conducted in accordance with institutional and international guidelines for protection of human subjects.
    IRB: The study was approved by the local ethics committee of the ASST Spedali Civili di Brescia Hospital and the requirement for informed consent was waived by the Ethics Commission (NP 4051, approved 06.04.2020).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: An explicit section about the limitations of the techniques employed in this study was not found. We encourage authors to address study limitations.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2020.04.12.20062646v3 on medRxiv
  4. Version published to 10.1101/2020.04.12.20062646v2 on medRxiv
  5. Version published to 10.1101/2020.04.12.20062646v1 on medRxiv