Clinical features of SARS-CoV-2-associated encephalitis and meningitis amid COVID-19 pandemic

BACKGROUND: Since the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemic, numerous studies have been published on SARS-CoV-2-related encephalitis/meningitis, but it has not been established if there are specific clinical characteristics of encephalitis/meningitis associated with SARS-CoV-2 infection. AIM: To identify the specific clinical features of cases of encephalitis/meningitis associated with SARS-CoV-2 infection in the context of this virus infection pandemic and investigate their relationship with SARS-CoV-2 infection. METHODS: We searched PubMed, and included single case reports and case series with full text in English, reporting original data of coronavirus disease-19 (COVID-19) patients with encephalitis/meningitis and a confirmed recent SARS-CoV-2 infection. Clinical data were extracted. RESULTS: We identified 22 articles (18 single case reports and 4 case series) reporting on a total of 32 encephalitis/meningitis patients with confirmed SARS-CoV-2 infection. SARS-CoV-2 infection was confirmed through reverse transcriptase-polymerase-chain-reaction (RT-PCR) in 96.88% of cases. A total of 22 (68.75%) patients had symptoms of SARS-CoV-2 infection in about 1 wk (7.91 d) preceding the onset of neurologic symptoms. The most common neurological symptoms were consciousness disturbance (59.38%), seizure (21.88%), delirium (18.75%), and headache (18.75%). Four cases were confirmed by positive RT-PCR results in cerebrospinal fluid (CSF), one was confirmed by positive RT-PCR results in postoperative brain tissue, and one by the presence of SARS-CoV-2 antibodies in CSF. The mainly damaged targets identified by neuroimaging included the temporal lobe (15.63%), white matter (12.5%), frontal lobe (9.38%), corpus callosum (9.38%), and cervical spinal cord (9.38%). Eighty percent of patients had electroencephalograms that showed a diffuse slow wave. Twenty-eight (87.5%) patients were administered with specific treatment. The majority (65.63%) of patients improved following systemic therapy. CONCLUSION: Encephalitis/meningitis is the common neurological complication in patients with COVID-19. The appropriate use of definitions and exclusion of potential similar diseases are important to reduce over-diagnosis of SARS-CoV-2 associated encephalitis or meningitis.