Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19

How to cite: Perrin, P.; Collongues, N.; Baloglu, S.; Bedo, D.; Bassand, X.; Lavaux, T.; Gautier, G.; Keller, N.; Kremer, S.; Fafi-Kremer, S.; Moulin, B.; Benotmane, I.; Caillard, S. Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19. Preprints 2020, 2020060103. https://doi.org/10.20944/preprints202006.0103.v1 Perrin, P.; Collongues, N.; Baloglu, S.; Bedo, D.; Bassand, X.; Lavaux, T.; Gautier, G.; Keller, N.; Kremer, S.; Fafi-Kremer, S.; Moulin, B.; Benotmane, I.; Caillard, S. Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19. Preprints 2020, 2020060103. https://doi.org/10.20944/preprints202006.0103.v1

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MDPI and ACS Style

Perrin, P.; Collongues, N.; Baloglu, S.; Bedo, D.; Bassand, X.; Lavaux, T.; Gautier, G.; Keller, N.; Kremer, S.; Fafi-Kremer, S.; Moulin, B.; Benotmane, I.; Caillard, S. Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19. Preprints 2020, 2020060103. https://doi.org/10.20944/preprints202006.0103.v1

APA Style

Perrin, P., Collongues, N., Baloglu, S., Bedo, D., Bassand, X., Lavaux, T., Gautier, G., Keller, N., Kremer, S., Fafi-Kremer, S., Moulin, B., Benotmane, I., & Caillard, S. (2020). Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19. Preprints. https://doi.org/10.20944/preprints202006.0103.v1

Chicago/Turabian Style

Perrin, P., Ilies Benotmane and Sophie Caillard. 2020 "Cytokine Release Syndrome-Associated Encephalopathy in Patients with COVID-19" Preprints. https://doi.org/10.20944/preprints202006.0103.v1

Abstract

Severe disease and uremia are risk factors for neurological complications of coronavirus disease-2019 (COVID-19). An in-depth analysis of a case series was conducted to describe the neurological manifestations of patients with COVID-19 and gain pathophysiological insights that may guide clinical decision-making – especially with respect to the cytokine release syndrome (CRS). Extensive clinical, laboratory, and imaging phenotyping was performed in five patients. Neurological presentation included confusion, tremor, cerebellar ataxia, behavioral alterations, aphasia, pyramidal syndrome, coma, cranial nerve palsy, dysautonomia, and central hypothyroidism. Neurological disturbances were remarkably accompanied by laboratory evidence of CRS. SARS-CoV-2 was undetectable in the cerebrospinal fluid. Hyperalbuminorachy and increased levels of the astroglial protein S100B were suggestive of blood-brain barrier (BBB) dysfunction. Brain MRI findings comprised evidence of acute leukoencephalitis (n = 3, of whom one with a hemorrhagic form), cytotoxic edema mimicking ischemic stroke (n = 1), or normal results (n = 2). Treatment with corticosteroids and/or intravenous immunoglobulins was attempted – resulting in rapid recovery from neurological disturbances in two cases. Patients with COVID-19 can develop neurological manifestations that share clinical, laboratory, and imaging similarities with those of chimeric antigen receptor-T cell-related encephalopathy. The pathophysiological underpinnings appear to involve CRS, endothelial activation, BBB dysfunction, and immune-mediated mechanisms.

Keywords

clinical medecine; physiopathology; COVID-19; neurological manifestations; kidney disease; cytokine; corticosteroids; intravenous immunoglobulins

Subject

Medicine and Pharmacology, Neuroscience and Neurology

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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