SARS-CoV-2-associated encephalitis: arguments for a post-infectious mechanism

• Published in: Critical care (London, England) Vol. 24; no. 1; p. 658
• Main Authors: Picod, Adrien, Dinkelacker, Vera, Savatovsky, Julien, Trouiller, Pierre, Guéguen, Antoine, Engrand, Nicolas
• Format: Journal Article
• Language: English
• Published: England BioMed Central 23-11-2020
• Subjects: Cohort analysis; Consent; Coronaviruses; COVID-19; COVID-19 - complications; Critical care; Cytokines; Delirium; Diagnosis, Differential; Electroencephalography; Encephalitis; Encephalitis - virology; Ethics; Female; Humans; Hypertension; Immunology; Infections; Intensive care; Laboratories; Magnetic Resonance Imaging; Metabolism; Middle Aged; Neurology; Patients; Research Letter; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; France; China
• ISSN: 1364-8535; 1466-609X; 1364-8535; 1366-609X
• DOI: 10.1186/s13054-020-03389-1

On day (D) 4, clinical deterioration with myoclonus worsening prompted the insertion of a left retrograde jugular catheter for brain oxygenation monitoring which showed profound desaturation (SjvO2 47%) that persisted despite deep sedation and attempts to increase cerebral oxygen delivery with initiation of vasopressors and red blood cells transfusion, consistent with an increased cerebral metabolic rate. Furthermore, focal lesions and substantially higher CSF interleukine-6 level as compared with serum sample argue for an autochthonous brain inflammatory process rather than a toxic encephalopathy induced by passive transfer of proinflammatory cytokines from the systemic compartment [3]. [...]the efficacy of immunomodulation with corticosteroids supports an immunological mechanism. Rights and permissions Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.