Encephalopathy in patients with COVID‐19: A review. Issue 1 (11th July 2020)

• Record Type: Journal Article
• Authors: Garg, Ravindra Kumar; Paliwal, Vimal Kumar; Gupta, Ankit
• Other Names: Luo Guangxiang (George) guestEditor.; Ly Hinh guestEditor.; Gao Shou‐Jiang guestEditor.
• Is Part Of: Journal of medical virology. Volume 93:Issue 1(2021)
• Page Start: 206
• Page End: 222
• Publication Date: 2020-07-11
• Subjects: brain -- COVID‐19 -- encephalitis -- encephalopathy -- magnetic resonance imaging -- SARS‐COV‐2; Virology -- Periodicals; 616
• DOI: 10.1002/jmv.26207
• Languages: English
• ISSNs: 0146-6615

Abstract

Abstract: Encephalopathy and encephalitis are major and devastating severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) virus‐associated central nervous system complications. Hypoxic/metabolic changes produced by intense inflammatory response against the virus triggers cytokine storm and subsequently acute respiratory distress syndrome and multiple organ failure. Hypoxic/metabolic changes result in encephalopathy. The presence of comorbidities predisposes to hypoxic/metabolic changes responsible for encephalopathy. Altered consciousness, ranging from mild confusion, delirium, to deep coma, is hallmark clinical features. Cortical and subcortical T2/FLAIR signal changes are common neuroimaging abnormalities. In a few isolated case reports of SARS‐CoV‐2 encephalitis, the virus has been demonstrated in cerebrospinal fluid. The presence of anosmia and ageusia can help in differentiation from other encephalopathies. We analyzed published reports on coronavirus disease 2019‐associated encephalopathy. Encephalopathy is common in older patients, the majority are more than 50 years of age. The patients having encephalopathy/encephalitis are either severely or critically ill. Many patients were already on mechanical ventilation. Lung abnormalities are noted in almost all of the patients, presenting with encephalopathy. Encephalopathy is always preceded by commoner clinical features, like, fever, cough, dyspnoea, and headache. In majority, patients are already in the intensive care unit, when encephalopathy develops. Highlights: Encephalopathy and encephalitis are complications of COVID‐19. Hypoxic/metabolic changes triggers cytokine storm resulting in encephalopathy. Altered consciousness is hallmark clinical feature of COVID‐19 encephalopathy. Cortical and subcortical T2/FLAIR signal changes are common neuroimaging abnormalities. The patients having COVID‐19 encephalopathy are usually critically ill. Prognosis is poor.