Central nervous system autoimmune diseases associated with COVID-19: Comprehensive review

Document Type : Review Article


1 School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 School of Medicine, Tehran University of Medical Sciences, Tehran, Iran

3 School of Medicine, Shahid Beheshti University of Medical Sciences

4 School of Medicine, Tehran University of Medical Science, Tehran, Iran

5 Department of Clinical Nutrition and Dietetics, Faculty of Nutrition and Food Technology, National Nutrition and Food Technology Research Institute, Shahid Beheshti University of Medical Sciences, Tehran, Iran

6 Department of Neurology, School of Medicine, MS Research Center, Neuroscience Institute, Sina Hospital, Tehran University of Medical Science, Tehran, Iran.


The first appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) named coronavirus disease 2019 (COVID-19) was reported from Wuhan in December 2019. While this virus displays several respiratory manifestations such as severe pneumonia and acute respiratory distress syndrome, there are several reports of nervous system involvement in the affected patients. Currently, there is a growing number of cases with central nervous system (CNS) autoimmune diseases (ADs) including autoimmune encephalitis (AE), neuromyelitis optica spectrum disorder (NMOSD), CNS vasculitis, acute disseminated encephalomyelitis (ADEM), and multiple sclerosis (MS) secondary to COVID-19 infection. Symptoms of these diseases vary from mainly drowsiness, delirium, and motor deficits in ADEM, MS, and AE and also visual impairment, and sensory problems in NMOSD and transverse myelitis patients. The severity of COVID-19 symptoms was also different from disease to disease. Based on the previous studies moderate corticosteroid therapy or other medication such as intravenous human immunoglobulins (IVIG), and plasma exchange (PLEX) is suggested for the treatment of CNS ADs in COVID patients. Also, patients with a previous history of ADs and other comorbidities such as hypertension, diabetes mellitus, hypercholesterolemia, and ischemic heart disease are at greater risk to develop severe complications of COVID compared to other patients. Current pieces of evidence demonstrated that CNS ADs can occur due to COVID-19 infection and the healthcare system should attention to CNS ADs as a complication of COVID-19. However, further investigations are strongly needed to confirm these findings.


Main Subjects


The first appearance of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) named coronavirus disease 2019 (COVID-19) was reported from Wuhan in December 2019 which lead to one of the greatest pandemics in the history of the world (1). While this virus displays several respiratory manifestations such as severe pneumonia and acute respiratory distress syndrome (ARDS), there are several reports of nervous system involvement in the affected patients (2). These neurological manifestations included a range from neurodegenerative disorders to autoimmune diseases including Guillain–Barre syndrome, encephalitis, stroke, seizure, and headache (2).

Currently, shreds of evidence indicate that COVID-19 may cause neurological disorders via direct viral attack or indirectly trigger immune-inflammatory mechanisms which leads to immune-mediated neurological disorders (3, 4). Furthermore, there is a growing number of cases with central nervous system (CNS) autoimmune diseases (ADs) including autoimmune encephalitis, neuromyelitis optica, CNS vasculitis, optica neuritis, acute disseminated encephalomyelitis (ADEM), myelitis, and multiple sclerosis (MS) secondary to COVID-19 infection which can illustrate the potential role of this virus in the pathophysiology of such disorders (5-8). In addition to inflammatory processes, it seems that neurodegeneration is also involved in the onset of these disorders secondary to COVID-19 (9-11). However, there is no clear and comprehensive evidence on the prevalence, risk factors, clinical symptoms, and management of patients who develop CNS ADs due to COVID-19 infection.

In this review, we will summarize the available evidence regarding the CNS ADs associated with COVID-19 infection to guide management protocols and clinical practice. Also, we will specifically discuss the pathological mechanisms between CNS ADs and COVID-19, and we will highlight the demographical features and comorbidities which make a person susceptible to developing CNS ADs. 


Does any relationship exist between autoimmune disease and developing COVID-19 infection?

 The SARS-CoV-2 infection causes a dysregulated immune response and enhanced expression of inflammatory cytokines, resulting in the production of autoantibodies and loss of immune tolerance, which could lead to the development of autoimmune diseases (ADs) (9). Several studies have reported the development of ADs as a complication of SARS-CoV-2 infection. Acute transverse myelitis, autoimmune encephalitis, acute necrotizing myelitis, and CNS vasculitis are among ADs COVID-19 complications (10-13). Bonometti et al. reported the first case of systemic lupus erythematosus (SLE) following COVID-19 infection (14). Moreover, these patients should be re-evaluated at viral infection resolution to assure that there is not trigger towards ADs development (14). Another reported the first case of Guillain-Barre syndrome (GBS) triggered by SARS-CoV-2 infection (15). According to this report, GBS could develop after paucisymptomatic infection or even in an asymptomatic patient. Furthermore, genetic predisposition of DRB1*03:01, HLA-A33, and DBQ1*05:01 in this patient could also contribute to the development of SARS-CoV-2-induced Guillain-Barre syndrome (Si-GBS). And at last, the ELISA assay revealed a significant increase in IL-8 levels in CSF, proposing the possible IL-8 pathway in the pathogenesis of Si-GBS.  Therefore, in COVID-19 infected patients suspected of autoimmune diseases; genetic testing could be considered to distinguish these patients from the differential diagnosis. Moreover, autoimmune diseases could develop in asymptomatic COVID-19 infection, which could be confirmed by detecting inflammatory cytokines and autoantibodies in cerebrospinal fluid (CSF) of patients (15). However, in the major number of COVID-19 patients with neurological manifestations, SARS-CoV-2 RNA could not be detected in CSF.

As we know viral infections plays an important role in development of some CNS autoimmune disease such as NMOSD and MS (16). As well, during the SARS-CoV-2 pandemic there were reports of CNS ADs disease secondary to COVID-19 infection which may suggested the possible role of this virus in pathophysiology of these diseases (13, 17-19).

One of the suggested links between CNS ADs and COVID-19 is the direct attack of virus to the CNS via entering host cells and causing neurological manifestation due to binding with Angiotensin-converting enzyme 2 (ACE2) (20). However, while most of the patients who developed CNS ADs were negative for SARS-CoV-2 PCR in CSF, the virus may lead to CNS ADs via other possible mechanisms.

SARS-CoV-2 can leads to demyelinating via decrease number of immune cells such as CD4+ T cells, CD8+ T cells, B cells, and NK cells or provoke autoimmune reactions (21). In autoimmune reaction scenario the antibodies which produced against SARS-CoV-2, attacks neurons and vessels endothelial cells resulted in autoimmune encephalitis or cerebral edema (22). Another mechanism is the cytokine storm causes by toll-like receptors (TLRs) activated by SARS-CoV-2 (23). These cytokines cause neuronal and oligodendrocyte death and finally demyelination (24).


CNS autoimmune diseases prevalence in COVID-19

Besides neurological manifestations of COVID-19, growing attention to neuroimmune manifestations has emerged. CNS Neuroimmune disorders in COVID-19 patients compromise a spectrum of complications including encephalitis, myelitis, optic neuritis, acute disseminated encephalomyelitis (ADEM), and other atypical diseases.

Infections, as well as SARS-COV-2, can trigger autoimmune reactions and make several diseases more prevalent than before (25). According to a systematic review, autoimmune encephalitis had the highest prevalence among CNS autoimmune diseases in hospitalized COVID-19 patients accounting for 0.1-0.2% followed by myelitis and optic neuritis with a prevalence of 0.1% (26).


Autoimmune encephalitis

Encephalopathy in COVID-19 patients is a condition that results from multiple factors including hypoxia, toxic metabolites, medications, multi-organ failure in sepsis, seizures, and immune dysregulation (27). Various types of autoimmune encephalitis have been reported in COVID-19 patients including Limbic encephalitis, Anti-NMDA receptor encephalitis (28), autoimmune encephalitis presenting as new-onset refractory status epilepticus (NORSE) (29), and Steroid-responsive encephalitis. The development of encephalitis mostly occurred after COVID-19 initial symptoms (28). To distinguish encephalitis with autoimmune origin from primary infection of the CNS, here we present pieces of evidence from reported cases that support the encephalitis autoimmune origin hypothesis. First, the occurrence of encephalitis was mostly after the infection symptoms disappearance and the reverse-transcription polymerase chain reaction (RT-PCR) was turn to negative (30).  Second, high titer of IgG antineuronal autoantibodies in some cases (30), however, this observation seems to be controversial, since there were also reports of “antibody-negative” autoimmune encephalitis. Third, clinical resolution of symptoms after immunomodulatory treatments like steroid therapies (11).

According to diagnostic criteria of autoimmune encephalitis, MRI markers are used for encephalitis diagnosis (31) and in SARS-COV-2 infected patients with normal MRI, fluorodeoxyglucose (18F) positron emission tomography (F-FDG PET) revealed diffuse cortical hypometabolism pattern. This observation suggests a potential role of PET as an early diagnostic tool (30).

Reports from Anti-NMDA receptor encephalitis were more concerned with prominent psychotic disorders and seizures (28). Interestingly also in these cases, MRI did not show any remarkable changes in patients with positive anti-NMDA receptors antibodies on CSF (32).


Neuromyelitis Optica

Neuromyelitis Optica spectrum disorder (NMOSD) is another autoimmune disturbance that can be secondary to COVID-19, which involves autoantibodies most commonly against water channel aquaporin-4 (Anti AQP-4 IgG1)(33). Viral infections as well as COVID-19, allow passage of the antibodies with increasing blood-brain barrier (BBB) permeability. This autoimmune reaction results in damage to optic nerves and the spinal cord (34). Also, the pieces of evidence showed that the total number of cases with NMOSD due to COVID-19 is higher compared to other CNS ADs (17-19).



Myelitis, especially transverse myelitis (TM) is caused by infections, autoimmune diseases of CNS, systemic autoimmune disorders, and also it can occur with an unknown origin which results in inflammation of the spinal cord and damage to the myelin (35). SARS-CoV-2 may possibly increase risk of TM, via autoimmune reactions (36). While one of the suggested mechanism for ADs due to viral infections is the direct attack of virus, but the reported myelitis cases did not detect virus in CSF which indicated that the autoimmune response may be involved in the pathophysiology of the disease (10, 37-40). There is a hypothesis revealed that several factors including IL-2, 6, 7, and 10, and tumor necrotizing α factor (TNF- α) causing damage to myelin, and considered as initiators of inflammation in this setting (40). Most of the cases of myelitis reported after the active phase of COVID-19 infection and ventral horn affection pattern was reported in these patients, which favors viral myelitis (40, 41). As our knowledge, there are more than 10 cases reported with myelitis along with COVID-19 infections (37-40)


CNS vasculitis

Less frequently, there were some reports of CNS vasculitis proven by radiological evidence, which were alleviated by steroid therapy and IL-1 and IL-6 pathway blockage (42). MRI patterns suggesting inflammation and ischemia in CNS can be detected in these patients (13). There are few cases of CNS vasculitis in COVID-19 patients which are considered as a unique neurological manifestation of the coronavirus (43).

3.5.          Multiple sclerosis (MS)

While other CNS ADs including NMOSD, ADEM, and myelitis reported following COVID-19, MS exacerbation after COVID-19 infection was limited to few studies (44-46). The MS exacerbation may be caused by inflammation initiated by Toll-like receptors (TLRs) which recognize invading virus, cytokine storm in severe cases with disruption of BBB, direct invasion of the virus, and a potential demyelinating reaction caused by COVID-19 (46).


Optic Neuritis

Optic neuritis is the most common demyelinating disorder of the optic nerve which is usually associated with MS and occurs with sudden visual loss and pain in the affected eye (47). While the ocular manifestation secondary to COVID-19 is a rare condition, there are few cases of optic neuritis due to COVID-19 infection (5, 48, 49). Bilateral optic neuritis is a rare phenomenon that is observed in a patient with confirmed COVID-19 infection (49). It seems that COVID-19 infection may trigger the production of MOG antibodies and autoimmune response which resulted in optic neuritis (50).


Acute disseminated encephalomyelitis (ADEM)

ADEM is another reported immune-mediated neurological manifestation of COVID-19 infection which is recognized by encephalopathy, neurological symptoms, and abnormal demyelinating in brain MRI (7). ADEM is mostly observed due to viral infection and rarely vaccination while, since the SARS-COV-2 outbreak, there was an emerging body of cases reported with ADEM after COVID-19 infection which is assumed to be due to immune response (51). In these patients, the MRI abnormalities may be caused by the direct viral attack, demyelinating process, or toxic metabolic components (6, 52-54).


CNS Autoimmune disease symptoms in COVID-19 patients

Most COVID-19 infected patients remained without any signs and symptoms, but the most serious effect of COVID-19 is observed in the respiratory system resulting in severe acute respiratory syndrome (SARS) (55). However, various neurologic manifestations have been reported during the pandemic associated with COVID-19. This has been remarkable enough to include COVID-19 in differential diagnosis for the patients presented with neurologic symptoms during the COVID-19 outbreak (56). Different theories were suggested for explaining this association. Direct viral invasion may be possible due to the presence of Angiotensin-converting enzyme 2 (ACE2) receptors (main receptor for beta coronavirus entry) in CNS, particularly in the brain stem; however, most studies observed no presence of viral nucleic acid in CSF RT-PCR (57). Furthermore, it was demonstrated that virus attacks supporting cells in the olfactory epithelium, rather than the neurons which indicates that the direct viral invasion is not feasible for explaining these symptoms (58). Another theory in this regard is the immune-mediated damage either due to autoimmunity or hyper-inflammation syndrome (57). This seems more plausible because of the prevailing presence of anti-CNS-specific antigens and high titers of cytokines in these patients (58).

Here we provide neurologic symptoms of multiple types of CNS autoimmune diseases. It is noteworthy to mention that different investigators have used various terms to describe these neurologic conditions which can make it harder to compare present data. Therefore, we have relied on general descriptions more.


Autoimmune encephalitis

Studies have mainly focused on 3 types of encephalitis which were suspected to have autoimmune causes in patients with COVID-19: Limbic encephalitis (LE), Anti-NMDA receptor encephalitis, and autoimmune encephalitis presenting as new-onset refractory status epilepticus (NORSE).

The most common symptoms in these patients included mental confusion, drowsiness, delirium, deficits in motor functions, and seizures. However, all of these symptoms weren't constantly present in all of the cases and a various clinical presentation was rather observed (4, 11, 28-30, 32, 59-67).

Disease symptoms for LE were mostly similar to other encephalitis types at the beginning. However, the onset of these symptoms was delayed. Also, abnormalities were detected in CSF analyses of these patients (such as hyperproteinorrachia, pleocytosis, etc.). Also, RT-PCR results were negative for COVID-19 viral nucleic acid in CSF according to studies in LE. In reported cases, metabolic functions were evaluated as normal, and acute onset delirium, altered mental status, cognitive impairment, status epilepticus, focal motor deficits, confusion, diaphoresis, dysphasia, and impaired orientation were observed as well (4, 60, 61, 63, 64, 66).

Most Anti-NMDA receptor encephalitis cases were reported with insomnia, increased psychomotor activity (such as orofacial dyskinesias), cognitive impairment, and seizures, indicating a simultaneous presentation of neurologic and psychiatric symptoms. Autoantibody testing demonstrated NMDAR-IgG positivity in the CSF, however, the results for the serum test weren't consistent. Early MRI Images didn't show any significant changes in the brain in any of the recently reported cases (28, 32, 62, 65, 67).

COVID-19 patients with autoimmune encephalitis presenting as NORSE commonly developed status epilepticus as the first neurologic symptoms. CSF analysis for abnormalities was negative except for one case of positive onconeural antibody and anti-neuronal surface antigens antibody. Also, MRIs were negative at the early stages of reported cases while Electroencephalography (EEG) results showed impaired delta waves. Furthermore, there were no signs of cerebral thrombosis in any of these cases (29, 59).

Some other cases of encephalitis were also reported with no evidence of autoimmune bases, such as steroid-responsive encephalitis, indicating a rather CNS inflammatory-mediated involvement (60).


CNS vasculitis

Few cases of COVID-19 patients with neurologic manifestations were reported to develop CNS vasculitis to date. Along with other respiratory and immunologic symptoms associated with COVID-19, drowsiness and impairment of arousal were seen in these patients. CT images revealed blood related hyperdensities in various cortical and subcortical brain regions while multiple hypodensities were reported in one of the cases (43). MRI complied with these results which showed extensive ischemic lesions with restricted diffusion in multiple brain areas. Moreover, electroencephalogram revealed theta and delta pattern. Tetraplegia with bilateral mute plantar response was reported in one of the cases as well (13, 43).  In one of the cases, Angiography was performed and no abnormality in intra and extra cranial vessels were found (43).


Multiple Sclerosis

Very few observations of MS being developed or exacerbated due to a COVID-19 infection have been reported.  In one case, decreased visual acuity was reported following COVID infection. Moreover, MRI indicated demyelinating lesions of CNS along with right optic nerve inflammation suggesting a connection between MS and COVID-19 (45). Despite the well-established connection between Toll-Like receptors and MS, in addition to the role of these receptors in recognizing pathogens, there is not enough evidence to support this association (46). In another reported case with onset of MS concurrent with COVID-19, the blurred vision described as a first sign of MS and then loss the smell and taste sense. In addition, eye movement was painful and visual acuity was decreased (44). Furthermore, chest CT scan was normal, and brain MRI showed periventricular and pericallosal lesions which were not enhanced with gadolinium and also optic nerve involvement was reported (44).



Acute transverse, acute flaccid, and acute necrotizing myelitis with acute motor axonal neuropathy have been reported as neurologic complications of COVID-19 involving the spinal cord. Tingling and numbness in fingers and toes were usually present at the onset of the disease. Later on, paresthesia progressed to quadriplegia in the upper and lower extremities in addition to the loss of sensation (10, 36, 38, 39, 41, 68-73), while some cases were reported with paraparesis (10, 39, 40, 74). In the most reported patients with myelitis, affected sphincter functions resulted in urinary retention, constipation, bowel or urinary incontinence. It is noteworthy to mention that impaired sphincter functions (especially urinary retention) were the most common reason for hospital admission in these patients (36, 68, 70, 73). Furthermore, cerebral functions were evaluated as normal. In nearly all of these patients, T2 patchy hyperintensities were observed in the mostly lower cervical and upper thoracic regions. The lymphocyte pleocytosis was the only abnormality detected in the CSF analysis of these patients. In addition, CSF PCR analysis for any viral nucleic acid or bacteria was negative (10, 36, 38, 39, 41, 68-73). Interestingly, in a case reported by Zachariadis et al, no abnormalities were found in the brain and spinal cord MRI, however, severe neurologic symptoms were still present (37).


Neuromyelitis Optica

Considering the rarity of NMOSD, very few reports have been published concerning the symptoms of COVID-19 patients who developed these disorders. The onset of the disease usually involved visual impairment and the rest of the symptoms were similar to those of acute myelitis including numbness of fingers, weakness of lower limbs, and sensory deficits indicating thoracic levels. In one case, urinary incontinence was observed as well. The MRI revealed no intracranial abnormalities in these patients while spinal abnormalities were consistently reported. In most of these cases, CSF analyses for aquaporin-4 immunoglobulin G (AQP4-IgG) were positive (18, 75), except one case with the positive result of the anti-MOG-IgG test (34). Common COVID-19 disease symptoms such as cough, fever, headache, fatigue, and myalgia were present in most of the patients who already had NMOSD before COVID-19 infection while gastrointestinal complications were also frequent (76).


Optic neuritis

All of the reported cases of optic neuritis were administered to care due to visual problems with the onset of symptoms such as ocular pain and blurred vision. In the two cases, visual symptoms appeared in one eye initially and then progressed to the other one, resulting in bilateral visual impairment (49, 77). Optic disc edema was also commonly seen among these patients. In a progressed optic neuritis case, the temporary complete visual loss was reported as well (49).  Also, there are no symptoms of CNS inflammation such as limb weakness in these patients. Cranial and spine MRI were unremarkable, whereas optic nerves were affected. Multiple markers such as enhancement, thickening, hyperintensity, and edema of optic nerve suggested optic neuritis in these patients (5, 48, 49, 77).

4.7.          Acute Disseminating Encephalomyelitis (ADEM)

As a rare presentation of autoimmune inflammation of CNS, ADEM has been reported in numerous cases of COVID-19 with loss of consciousness, ataxia, and motor weakness (6, 7, 51, 52, 54, 78, 79). In most of these cases, deep tendon reflexes were depressed or asymmetric (6, 52, 54, 79). Moreover, visual disturbances were reported in some of the cases (7, 51). According to reported cases, there are no signs of sphincter abnormalities in any of the COVID-19 patients developing ADEM. Brain MRI showed hyperintense lesions involving various locations such as cortical, subcortical, juxtacortical, deep white, and gray matter in these patients (6, 51, 54, 78, 79). Furthermore, CSF analyses were normal except for oligoclonal bands which were reported positive in some of the cases (7, 51, 78). In cases with evaluated EEG, diffuse slowing without epileptiform abnormalities was also reported (51, 52).


The severity of COVID-19 infection in patients with CNS autoimmune diseases

The severity of COVID-19 infection in patients manifesting neurologic symptoms varies greatly. Due to the different nature of these symptoms, different outcomes were seen. Some of the patients experienced only mild respiratory symptoms while tested positive for COVID-19 and had serious neurologic manifestations (60), also cases with respiratory failure along with neurologic symptoms were reported as well (59).

Most of the patients diagnosed with autoimmune encephalitis were presented with mild to moderate respiratory symptoms at onset, while the main reason for hospital admission was neurologic symptoms (especially seizures) (4, 11, 30, 62, 63, 66). However, in some patients with comorbidities such as arterial hypertension or higher age, severe respiratory failure symptoms were observed (4, 59, 64). In a study of 29 COVID-19 patients with neurologic manifestations, it was demonstrated that 27% required critical care admission, although, most of them which were diagnosed with ischemic stroke and fewer had an inflammatory basis for their symptoms (61). Interestingly, in numerous cases, neurologic manifestations were seen without any severe respiratory symptoms, especially in pediatric patients and the biggest threat for these patients was mostly neurological complications (62, 67).

Observed cases of CNS vasculitis and COVID-19 were usually aged higher than 60 suggesting the possibility of a more severe disease course due to higher age. The inflammatory syndrome was seen in these patients, including fever, cough, and fatigue. Chest CT also confirmed the presence of pneumonia (13, 43). Also, a one CNS vasculitis patient with a history of hypertension presenting with cough and fever required intubation on day 3 of hospital admission (13).

Nearly all of the patients who were diagnosed with acute myelitis were administered to the hospital due to neurologic symptoms, especially limb weakness. Most of the observations indicated mild flu-like symptoms such as cough and fever at onset (10, 36, 38, 39, 68, 71). Likewise, most of the patients with NMOSD didn’t experience respiratory symptoms severe enough to seek medical attention (17, 76). However, various presentations of COVID-19 were still observed, including fever, chills, cough, shortness of breath, and gastrointestinal complications (34, 76). This pattern was similarly seen among patients with optic neuritis while most of the reports indicated that these patients were generally healthy at admission except for visual problems (5, 49, 50, 80).

CT results were usually indicative of pulmonary pneumonia in ADEM patients with COVID-19. In addition, dyspnea and fever were commonly seen in ADEM patients (6, 7, 54, 78, 79), while also some cases reported respiratory failure due to COVID-19 which required intubation (51, 52, 81).

Overall, it seems that the severity of COVID-19 in patients manifesting autoimmune-related neurologic symptoms depends mostly on known factors linked with disease severity in normal patients, such as higher age and concomitant metabolic and heart diseases. Furthermore, the immunosuppressive therapies in these patients play a critical role in further respiratory status.


Treatment and management of patients with CNS autoimmune diseases during COVID-19 pandemic

While previous studies suggested that corticostreids should be prescribed with caution in this patients, recent investigations revealed that these patients should receive corticosteroids due to possible benefits (82-84). These patients could be administered with intravenous human immunoglobulins (IVIG), plasma exchange (PLEX), and immunotherapy if possible (85). Based on Vaschetto et al. study, IVIG and thereafter prescription of methylprednisolone improved cerebral nervous system vasculitis in a COVID-19 patient (13).  Also, in Munz et al. report, methylprednisolone was administered due to the absence of active infection and persistent symptoms in COVID-19 patients with acute transverse myelitis after SARS-CoV-2 infection, resulting in rapid improvement (10). Practitioners should notice that moderate steroid therapy should be done while considering SARS-CoV-2 elimination. Based on a case series of para-infection anti-GD2/GD3 IgM myelitis related to COVID-19 infection, administration of corticosteroids, immunoglobulins, PLEX, and rituximab could be beneficial in acute transverse myelitis (10). It should be considered that corticosteroids should be used as soon as possible the active infection is eliminated. If corticosteroid treatment fails, PLEX can be the second option in this population (33). Reports of AE due to COVID-19 mainly treated with methylprednisolone and IVIG (4, 30, 67). These patients are also administered anti-seizure medications such as levetiracetam, clonazepam, and intravenous valproate sodium (11). In addition, other medications such as acyclovir, as an anti-viral drug, sertraline, and risperidone as medications for mood and mental disorders (30, 67). As we discussed, there are few cases of NMOSD secondary to COVID-19 infection, but intravenous methylprednisolone seems to be a good choice in these patients and leading to a significant improvement according to Naomi et al. study (34). Furthermore, another study used IVIG to decrease the risk of prophylaxis for deep vein thrombosis and thromboembolism due to COVID-19 infection. Also, they used combination therapies such as oseltamivir, chloroquine, paracetamol, azithromycin, ceftriaxone, and then meropenem, ciprofloxacin, and teicoplanin (18). According to our knowledge there are only two cases reported with CNS vasculitis due to COVID-19 infection and only one of them described the therapeutic approach which included IVIG and metilprednisolone (13).


Demographical features, comorbidities, and risk factors

Regarding the demographic factors of patients presented with autoimmune encephalitis as a possible complication of COVID-19, the mean age of patients was 59.4 years (86). Also, 71.7% of patients had at least one comorbidity such as hypertension (45.5%) followed by hyperlipidemia (24%) and diabetes mellitus (16%) (86). Anti-NMDAR encephalitis is the most common type of autoimmune encephalitis regardless of COVID-19 infection (87), while reports of anti-NMDAR encephalitis were with no limitation of age, affecting 23 months (28) old patient to 50 years old patients (32) and mostly presented with acute psychosis and to lesser extend acute ataxia (88). According to a recent systematic review of 5 definite cases of COVID-19 related autoimmune Limbic encephalitis, 3 subjects were women and 2 were men with a mean age of 73.8 years (ranged 66 to 80 years) (64). Based on our search, autoimmune encephalitis presenting as NORSE seems to be more prevalent in elderly men but there is no documented evidence for this hypothesis (29, 59).

In non-pandemic conditions, NMOSD affects 0.5-10 people per 100.000, mostly in the 4th - 5th decade of their life, and also it seems to be more frequent in females (89). During the current pandemic, although there are reports of cases without prior risk factors, patients with preexisting autoimmune disease especially Sjögren's syndrome, and patients with a history of any type of malignancy are more susceptible to developing NMOSD (34). Also, Patients with an increased expanded Disability Status Scale (EDSS), higher age, and also patients with longer duration of disease onset had poorer prognosis and more need for ICU care (90). 

To our knowledge, there were limited cases of CNS vasculitis, but reports were mostly observed in elderlies with dominance in men (91). Cardiovascular and metabolic risk factors including the history of hypertension, diabetes mellitus, hypercholesterolemia, and ischemic heart disease may be present in these patients, which may be due to higher age in these patients (42, 92).

As patients with MS are generally younger and also dominantly female, it is expected that they are at lower risks of hospitalization but according to a recent meta-analysis, the hospitalization rate due to COVID-19 is higher among MS patients, with a rate of 10% (91). Similar to the normal population studies have shown higher age, having at least 1 comorbidity and male sex is associated with a higher hospitalization rate (93). There are few reports of MS exacerbation and development due to COVID-19 infection, so the demographical features of MS patients with COVID-19 cannot be defined by previous investigations.



In this study, we aimed to review the overall prevalence, management, risk factors, and potential pathways of several ADs including MS, AE, myelitis, CNS vasculitis, NMOSD, optic neuritis, and ADEM secondary to COVID-19 infection.

Symptoms of these diseases vary from main drowsiness, delirium, and motor deficits in ADEM, MS, and AE and also visual impairment, and sensory problems in NMOSD and TM patients. Furthermore, there was a higher number of NMOSD cases secondary to COVID-19 infection compared to other CNS ADs. However, there are several limitations in our study such as lack of access to all cases because not all patients were reported before and remained unknown.

On the other hand, several diseases such as optic neuritis and CNS vasculitis were very rarely reported due to COVID-19 in previous studies. The severity of COVID-19 symptoms was also different from disease to disease. Cases with NMOSD and TM experienced almost no significant respiratory stress and the main cause of hospitalization in these groups was due to the neurologic problems and limb weaknesses while subjects with ADEM administrated to the hospital mainly because of respiratory failure and shortness of breath. Based on the previous studies moderate corticosteroid therapy or other medication such as IVIG and PLEX is suggested for the treatment of CNS ADs in the COVID patients.

Current shreds of evidence demonstrated that CNS ADs can occur due to COVID-19 infection and the health care system should attention to CNS ADs as a complication of COVID-19. While recent investigation introduces neurological manifestation as a COVID-19 complication, it seems that ADs might be at the top of the list due to the potential immune pathways and autoimmune nature of these diseases. However, further investigations are strongly needed to confirm these findings.





We do not have any financial support for this study.


Conflict of interest

The author declares no conflict of interest regarding the publication of this paper.


Ethical approval

Not applicable


Availability of data and material

The datasets analyzed during the current study are available upon request with no restriction.


Consent for publication

This manuscript has been approved for publication by all authors.

1. Khan M, Adil SF, Alkhathlan HZ, Tahir MN, Saif S, Khan M, et al. COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules (Basel, Switzerland). 2020;26(1).
PMid:33374759 PMCid:PMC7795815
2. Schirinzi T, Landi D, Liguori C. COVID-19: dealing with a potential risk factor for chronic neurological disorders. Journal of neurology. 2021;268(4):1171-8.
PMid:32852580 PMCid:PMC7450256
3. Boziki MK, Mentis AA, Shumilina M, Makshakov G, Evdoshenko E, Grigoriadis N. COVID-19 Immunopathology and the Central Nervous System: Implication for Multiple Sclerosis and Other Autoimmune Diseases with Associated Demyelination. Brain sciences. 2020;10(6).
PMid:32512702 PMCid:PMC7349282
4. Nabizadeh F, Balabandian M, Sodeifian F, Rezaei N, Rostami MR, Naser Moghadasi A. Autoimmune encephalitis associated with COVID-19: A systematic review. Multiple Sclerosis and Related Disorders. 2022;62:103795.
PMid:35472834 PMCid:PMC8983076
5. Zambreanu L, Lightbody S, Bhandari M, Hoskote C, Kandil H, Houlihan CF, et al. A case of limbic encephalitis associated with asymptomatic COVID-19 infection. Journal of neurology, neurosurgery, and psychiatry. 2020;91(11):1229-30.
6. Parvez Y, AlZarooni F, Khan F. Optic Neuritis in a Child With COVID-19: A Rare Association. Cureus. 2021;13(3):e14094.
7. Parsons T, Banks S, Bae C, Gelber J, Alahmadi H, Tichauer M. COVID-19-associated acute disseminated encephalomyelitis (ADEM). Journal of neurology. 2020;267(10):2799-802.
PMid:32474657 PMCid:PMC7260459
8. Novi G, Rossi T, Pedemonte E, Saitta L, Rolla C, Roccatagliata L, et al. Acute disseminated encephalomyelitis after SARS-CoV-2 infection. Neurology(R) neuroimmunology & neuroinflammation. 2020;7(5).
PMid:32482781 PMCid:PMC7286650
9. Naser Moghadasi A. COVID-19-related autoimmune disorders of central nervous system (CRAD-C): Is it a new entity? Autoimmun Rev. 2021;20(9):102888-.
PMid:34229045 PMCid:PMC8253721
10. Nabizadeh F, Ramezannezhad E, Kazemzadeh K, Khalili E, Ghaffary EM, Mirmosayyeb O. Multiple sclerosis relapse after COVID-19 vaccination: A case report-based systematic review. Journal of Clinical Neuroscience. 2022;104:118-25.
PMid:36029752 PMCid:PMC9388441
11. Nabizadeh F, Pirahesh K, Rafiei N, Afrashteh F, Ahmadabad MA, Zabeti A, et al. Autologous Hematopoietic Stem-Cell Transplantation in Multiple Sclerosis: A Systematic Review and Meta-Analysis. Neurology and Therapy. 2022;11(4):1553-69.
PMid:35902484 PMCid:PMC9333355
12. Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Current Opinion in Rheumatology. 2021;33(2):155.
PMid:33332890 PMCid:PMC7880581
13. Munz M, Wessendorf S, Koretsis G, Tewald F, Baegi R, Krämer S, et al. Acute transverse myelitis after COVID-19 pneumonia. Journal of neurology. 2020;267:2196-7.
PMid:32458198 PMCid:PMC7250275
14. Ayatollahi P, Tarazi A, Wennberg R. Possible autoimmune encephalitis with claustrum sign in case of acute SARS-CoV-2 infection. Canadian Journal of Neurological Sciences. 2021;48(3):430-2.
PMid:32938510 PMCid:PMC7653487
15. Maideniuc C, Memon AB. Acute necrotizing myelitis and acute motor axonal neuropathy in a COVID-19 patient. Journal of neurology. 2020:1-3.
PMid:32772172 PMCid:PMC7415129
16. Vaschetto R, Cena T, Sainaghi PP, Meneghetti G, Bazzano S, Vecchio D, et al. Cerebral nervous system vasculitis in a Covid-19 patient with pneumonia. Journal of Clinical Neuroscience. 2020;79:71-3.
PMid:33070922 PMCid:PMC7366960
17. Bonometti R, Sacchi M, Stobbione P, Lauritano E, Tamiazzo S, Marchegiani A, et al. The first case of systemic lupus erythematosus (SLE) triggered by COVID-19 infection. Eur Rev Med Pharmacol Sci. 2020;24(18):9695-7.
18. Gigli GL, Bax F, Marini A, Pellitteri G, Scalise A, Surcinelli A, et al. Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster? Journal of neurology. 2021;268:1195-7.
PMid:32430572 PMCid:PMC7236438
19. Tarlinton RE, Martynova E, Rizvanov AA, Khaiboullina S, Verma S. Role of Viruses in the Pathogenesis of Multiple Sclerosis. Viruses. 2020;12(6):643.
PMid:32545816 PMCid:PMC7354629
20. Tomczak A, Han MH. The impact of COVID-19 on patients with neuromyelitis optica spectrum disorder; a pilot study. Multiple sclerosis and related disorders. 2020;45:102347.
21. Batum M, Kisabay Ak A, Mavioğlu H. Covid-19 infection-induced neuromyelitis optica: a case report. The International journal of neuroscience. 2020:1-7.
22. Yin H, Zhang Y, Xu Y, Peng B, Cui L, Zhang S. The Impact of COVID-19 on Patients With Neuromyelitis Optica Spectrum Disorder Beyond Infection Risk. Frontiers in Neurology. 2021;12(351).
PMid:33828524 PMCid:PMC8019749
23. Wan Y, Shang J, Graham R, Baric RS, Li F. Receptor Recognition by the Novel Coronavirus from Wuhan: an Analysis Based on Decade-Long Structural Studies of SARS Coronavirus. Journal of virology. 2020;94(7).
PMid:31996437 PMCid:PMC7081895
24. Cao X. COVID-19: immunopathology and its implications for therapy. Nature reviews Immunology. 2020;20(5):269-70.
PMid:32273594 PMCid:PMC7143200
25. Shabani Z. Demyelination as a result of an immune response in patients with COVID-19. Acta neurologica Belgica. 2021:1-8.
PMid:33934300 PMCid:PMC8088756
26. Henry BM, Vikse J, Benoit S, Favaloro EJ, Lippi G. Hyperinflammation and derangement of renin-angiotensin-aldosterone system in COVID-19: A novel hypothesis for clinically suspected hypercoagulopathy and microvascular immunothrombosis. Clinica chimica acta; international journal of clinical chemistry. 2020;507:167-73.
PMid:32348783 PMCid:PMC7195008
27. Li L, Acioglu C, Heary RF, Elkabes S. Role of astroglial toll-like receptors (TLRs) in central nervous system infections, injury and neurodegenerative diseases. Brain, behavior, and immunity. 2021;91:740-55.
PMid:33039660 PMCid:PMC7543714
28. Bhagavati S. Autoimmune Disorders of the Nervous System: Pathophysiology, Clinical Features, and Therapy. Front Neurol. 2021;12:664664.
PMid:33935958 PMCid:PMC8079742
29. Tang K-T, Hsu B-C, Chen D-Y. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Front Immunol. 2021;12:645013-.
PMid:33777042 PMCid:PMC7994612
30. Khoo A, McLoughlin B, Cheema S, Weil RS, Lambert C, Manji H, et al. Postinfectious brainstem encephalitis associated with SARS-CoV-2. Journal of neurology, neurosurgery, and psychiatry. 2020;91(9):1013-4.
31. Panariello A, Bassetti R, Radice A, Rossotti R, Puoti M, Corradin M, et al. Anti-NMDA receptor encephalitis in a psychiatric Covid-19 patient: A case report. Brain, behavior, and immunity. 2020;87:179-81.
PMid:32454137 PMCid:PMC7255176
32. Dono F, Carrarini C, Russo M, De Angelis MV, Anzellotti F, Onofrj M, et al. New-onset refractory status epilepticus (NORSE) in post SARS-CoV-2 autoimmune encephalitis: a case report. Neurol Sci. 2021;42(1):35-8.
PMid:33145624 PMCid:PMC7608104
33. Grimaldi S, Lagarde S, Harlé JR, Boucraut J, Guedj E. Autoimmune Encephalitis Concomitant with SARS-CoV-2 Infection: Insight from (18)F-FDG PET Imaging and Neuronal Autoantibodies. Journal of nuclear medicine : official publication, Society of Nuclear Medicine. 2020;61(12):1726-9.
PMid:32709734 PMCid:PMC8679632
34. Graus F, Titulaer MJ, Balu R, Benseler S, Bien CG, Cellucci T, et al. A clinical approach to diagnosis of autoimmune encephalitis. Lancet Neurol. 2016;15(4):391-404.
35. Monti G, Giovannini G, Marudi A, Bedin R, Melegari A, Simone AM, et al. Anti-NMDA receptor encephalitis presenting as new onset refractory status epilepticus in COVID-19. Seizure. 2020;81:18-20.
PMid:32688169 PMCid:PMC7362825
36. Hamdy SM, Abdel-Naseer M, Shehata HS, Shalaby NM, Hassan A, Elmazny A, et al. Management Strategies of Patients with Neuromyelitis Optica Spectrum Disorder During the COVID-19 Pandemic Era. Ther Clin Risk Manag. 2020;16:759-67.
PMid:32884277 PMCid:PMC7443007
37. de Ruijter NS, Kramer G, Gons RAR, Hengstman GJD. Neuromyelitis optica spectrum disorder after presumed coronavirus (COVID-19) infection: A case report. Multiple sclerosis and related disorders. 2020;46:102474-.
PMid:32892062 PMCid:PMC7462544
38. Beh SC, Greenberg BM, Frohman T, Frohman EM. Transverse myelitis. Neurologic clinics. 2013;31(1):79-138.
PMid:23186897 PMCid:PMC7132741
39. Águila-Gordo D, Manuel Flores-Barragán J, Ferragut-Lloret F, Portela-Gutierrez J, LaRosa-Salas B, Porras-Leal L, et al. Acute myelitis and SARS-CoV-2 infection. A new etiology of myelitis? J Clin Neurosci. 2020;80:280-1.
PMid:33099361 PMCid:PMC7525324
40. Zachariadis A, Tulbu A, Strambo D, Dumoulin A, Di Virgilio G. Transverse myelitis related to COVID-19 infection. Journal of neurology. 2020;267(12):3459-61.
PMid:32601756 PMCid:PMC7322383
41. Maideniuc C, Memon AB. RETRACTED ARTICLE: Acute necrotizing myelitis and acute motor axonal neuropathy in a COVID-19 patient. Journal of neurology. 2021;268(2):739-.
PMid:32772172 PMCid:PMC7415129
42. Masuccio FG, Barra M, Claudio G, Claudio S. A rare case of acute motor axonal neuropathy and myelitis related to SARS-CoV-2 infection. Journal of neurology. 2021;268(7):2327-30.
PMid:32940797 PMCid:PMC7497229
43. Baghbanian SM, Namazi F. Post COVID-19 longitudinally extensive transverse myelitis (LETM)-a case report. Acta neurologica Belgica. 2020:1-2.
PMid:32948995 PMCid:PMC7500496
44. Abdelhady M, Elsotouhy A, Vattoth S. Acute Flaccid Myelitis in COVID-19. BJR Case Rep. 2020;6(3):20200098.
PMid:32922857 PMCid:PMC7465751
45. Dixon L, Coughlan C, Karunaratne K, Gorgoraptis N, Varley J, Husselbee J, et al. Immunosuppression for intracranial vasculitis associated with SARS-CoV-2: therapeutic implications for COVID-19 cerebrovascular pathology. Journal of neurology, neurosurgery, and psychiatry. 2020.
46. Hanafi R, Roger PA, Perin B, Kuchcinski G, Deleval N, Dallery F, et al. COVID-19 Neurologic Complication with CNS Vasculitis-Like Pattern. AJNR American journal of neuroradiology. 2020;41(8):1384-7.
PMid:32554425 PMCid:PMC7658880
47. Naser Moghadasi A. A 31-year-old female patient with concurrent clinical onset of multiple sclerosis and COVID-19: Possible role of SARS-CoV-2 in the pathogenesis of multiple sclerosis. Autoimmun Rev. 2021;20(5):102803-.
PMid:33737090 PMCid:PMC7960029
48. Palao M, Fernández-Díaz E, Gracia-Gil J, Romero-Sánchez CM, Díaz-Maroto I, Segura T. Multiple sclerosis following SARS-CoV-2 infection. Multiple sclerosis and related disorders. 2020;45:102377-.
PMid:32698095 PMCid:PMC7340057
49. Sadeghmousavi S, Rezaei N. COVID-19 and Multiple Sclerosis: Predisposition and Precautions in Treatment. SN Compr Clin Med. 2020:1-6.
PMid:32895640 PMCid:PMC7467844
50. Toosy AT, Mason DF, Miller DH. Optic neuritis. Lancet Neurol. 2014;13(1):83-99.
51. Benito-Pascual B, Gegúndez JA, Díaz-Valle D, Arriola-Villalobos P, Carreño E, Culebras E, et al. Panuveitis and Optic Neuritis as a Possible Initial Presentation of the Novel Coronavirus Disease 2019 (COVID-19). Ocular immunology and inflammation. 2020;28(6):922-5.
52. Sawalha K, Adeodokun S, Kamoga GR. COVID-19-Induced Acute Bilateral Optic Neuritis. Journal of investigative medicine high impact case reports. 2020;8:2324709620976018.
PMid:33238757 PMCid:PMC7705770
53. Gold DM, Galetta SL. Neuro-ophthalmologic complications of coronavirus disease 2019 (COVID-19). Neuroscience letters. 2021;742:135531.
PMid:33248158 PMCid:PMC7687583
54. Langley L, Zeicu C, Whitton L, Pauls M. Acute disseminated encephalomyelitis (ADEM) associated with COVID-19. BMJ case reports. 2020;13(12).
PMid:33318286 PMCid:PMC10577777
55. Lopes CCB, Brucki SMD, Passos Neto CEB, Corazza LA, Baima JPS, Fiorentino MD, et al. Acute Disseminated Encephalomyelitis in COVID-19: presentation of two cases and review of the literature. Arquivos de neuro-psiquiatria. 2020;78(12):805-10.
56. Assunção FB, Fragoso DC, Donoso Scoppetta TLP, Martins Maia AC. COVID-19-Associated Acute Disseminated Encephalomyelitis-Like Disease. AJNR American journal of neuroradiology. 2020;42(4):E21-3.
PMid:33272954 PMCid:PMC8041009
57. de Miranda Henriques-Souza AM, de Melo A, de Aguiar Coelho Silva Madeiro B, Freitas LF, Sampaio Rocha-Filho PA, Gonçalves FG. Acute disseminated encephalomyelitis in a COVID-19 pediatric patient. Neuroradiology. 2021;63(1):141-5.
PMid:33001220 PMCid:PMC7527786
58. Gallo Marin B, Aghagoli G, Lavine K, Yang L, Siff EJ, Chiang SS, et al. Predictors of COVID-19 severity: A literature review. Reviews in medical virology. 2021;31(1):1-10.
PMid:32845042 PMCid:PMC7855377
59. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020;77(6):683-90.
PMid:32275288 PMCid:PMC7149362
60. Bridwell R, Long B, Gottlieb M. Neurologic complications of COVID-19. The American journal of emergency medicine. 2020;38(7):1549.e3-.e7.
PMid:32425321 PMCid:PMC7229718
61. Solomon T. Neurological infection with SARS-CoV-2 - the story so far. Nat Rev Neurol. 2021;17(2):65-6.
PMid:33414554 PMCid:PMC7789883
62. Manganotti P, Furlanis G, Ajčević M, Moras C, Bonzi L, Pesavento V, et al. Intravenous immunoglobulin response in new-onset refractory status epilepticus (NORSE) COVID-19 adult patients. Journal of neurology. 2021:1-5.
PMid:33709220 PMCid:PMC7951121
63. Pilotto A, Masciocchi S, Volonghi I, Crabbio M, Magni E, De Giuli V, et al. Clinical Presentation and Outcomes of Severe Acute Respiratory Syndrome Coronavirus 2-Related Encephalitis: The ENCOVID Multicenter Study. J Infect Dis. 2021;223(1):28-37.
PMid:32986824 PMCid:PMC7543535
64. Dhillon PS, Dineen RA, Morris H, Tanasescu R, Nikfekr E, Evans J, et al. Neurological Disorders Associated With COVID-19 Hospital Admissions: Experience of a Single Tertiary Healthcare Center. Front Neurol. 2021;12:640017.
PMid:33679593 PMCid:PMC7934891
65. Sánchez-Morales AE, Urrutia-Osorio M, Camacho-Mendoza E, Rosales-Pedraza G, Dávila-Maldonado L, González-Duarte A, et al. Neurological manifestations temporally associated with SARS-CoV-2 infection in pediatric patients in Mexico. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2021:1-8.
PMid:33751228 PMCid:PMC7943407
66. Hosseini AA, Shetty AK, Sprigg N, Auer DP, Constantinescu CS. Delirium as a presenting feature in COVID-19: Neuroinvasive infection or autoimmune encephalopathy? Brain, behavior, and immunity. 2020;88:68-70.
PMid:32531427 PMCid:PMC7282789
67. Pizzanelli C, Milano C, Canovetti S, Tagliaferri E, Turco F, Verdenelli S, et al. Autoimmune limbic encephalitis related to SARS-CoV-2 infection: Case-report and review of the literature. Brain, behavior, & immunity - health. 2021;12:100210.
PMid:33521691 PMCid:PMC7830195
68. Moideen S, Thomas R, Suresh Kumar PN, Uvais NA, Ul Haq Katshu MZ. Psychosis in a patient with anti-NMDA-receptor antibodies experiencing significant stress related to COVID-19. Brain, behavior, & immunity - health. 2020;7:100125.
PMid:32835301 PMCid:PMC7415166
69. Bhagat R, Kwiecinska B, Smith N, Peters M, Shafer C, Palade A, et al. New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review. Journal of investigative medicine high impact case reports. 2021;9:2324709620986302.
PMid:33648382 PMCid:PMC7930644
70. Burr T, Barton C, Doll E, Lakhotia A, Sweeney M. N-Methyl-d-Aspartate Receptor Encephalitis Associated With COVID-19 Infection in a Toddler. Pediatr Neurol. 2021;114:75-6.
PMid:33246132 PMCid:PMC7546658
71. AlKetbi R, AlNuaimi D, AlMulla M, AlTalai N, Samir M, Kumar N, et al. Acute myelitis as a neurological complication of Covid-19: A case report and MRI findings. Radiol Case Rep. 2020;15(9):1591-5.
PMid:32685076 PMCid:PMC7275163
72. Valiuddin H, Skwirsk B, Paz-Arabo P. Acute transverse myelitis associated with SARS-CoV-2: A Case-Report. Brain, behavior, & immunity - health. 2020;5:100091.
PMid:32835294 PMCid:PMC7275168
73. Chow CCN, Magnussen J, Ip J, Su Y. Acute transverse myelitis in COVID-19 infection. BMJ case reports. 2020;13(8).
PMid:32784242 PMCid:PMC7418849
74. Moreno-Escobar MC, Kataria S, Khan E, Subedi R, Tandon M, Peshwe K, et al. Acute transverse myelitis with Dysautonomia following SARS-CoV-2 infection: A case report and review of literature. J Neuroimmunol. 2021;353:577523.
PMid:33640717 PMCid:PMC7895682
75. Chakraborty U, Chandra A, Ray AK, Biswas P. COVID-19-associated acute transverse myelitis: A rare entity. BMJ case reports. 2020;13:238668.
PMid:32843475 PMCid:PMC7449353
76. Rodríguez de Antonio LA, González-Suárez I, Fernández-Barriuso I, Rabasa Pérez M. Para-infectious anti-GD2/GD3 IgM myelitis during the Covid-19 pandemic: Case report and literature review. Multiple sclerosis and related disorders. 2021;49:102783.
PMid:33513521 PMCid:PMC7826058
77. Fumery T, Baudar C, Ossemann M, London F. Longitudinally extensive transverse myelitis following acute COVID-19 infection. Multiple sclerosis and related disorders. 2021;48:102723.
PMid:33388559 PMCid:PMC7836254
78. Shaw VC, Chander G, Puttanna A. Neuromyelitis optica spectrum disorder secondary to COVID-19. Br J Hosp Med (Lond). 2020;81(9):1-3.
79. Mortazavi H, Akbari M, Sahraian MA, Jahromi AA, Shafiei S. Salivary profile and dental status of patients with multiple sclerosis. Dental and Medical Problems. 2020;57(1):25-9.
80. Zhou S, Jones-Lopez EC, Soneji DJ, Azevedo CJ, Patel VR. Myelin Oligodendrocyte Glycoprotein Antibody-Associated Optic Neuritis and Myelitis in COVID-19. J Neuroophthalmol. 2020;40(3):398-402.
PMid:32604245 PMCid:PMC7382408
81. Shahmirzaei S, Naser Moghadasi A. Association of COVID-19 and Acute Disseminated Encephalomyelitis (ADEM) in the absence of pulmonary involvement. Autoimmun Rev. 2021;20(3):102753.
PMid:33476819 PMCid:PMC7836812
82. Abdi S, Ghorbani A, Fatehi F. The association of SARS-CoV-2 infection and acute disseminated encephalomyelitis without prominent clinical pulmonary symptoms. J Neurol Sci. 2020;416:117001.
PMid:32590204 PMCid:PMC7301801
83. Tisdale AK, Chwalisz BK. Neuro-ophthalmic manifestations of coronavirus disease 19. Curr Opin Ophthalmol. 2020;31(6):489-94.
84. Reichard RR, Kashani KB, Boire NA, Constantopoulos E, Guo Y, Lucchinetti CF. Neuropathology of COVID-19: a spectrum of vascular and acute disseminated encephalomyelitis (ADEM)-like pathology. Acta Neuropathol. 2020;140(1):1-6.
PMid:32449057 PMCid:PMC7245994
85. Baral PK, Nuruzzaman M, Uddin MS, Ferdous M, Chowdhury IH, Smrity SZ. Severe acute respiratory syndrome coronavirus 2 invasion in the central nervous system: a host-virus deadlock. Acta virologica. 2021;65(2):115-26.
86. Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, et al. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2020;192(27):E756-e67.
PMid:32409522 PMCid:PMC7828900
87. Fadel R, Morrison AR, Vahia A, Smith ZR, Chaudhry Z, Bhargava P, et al. Early Short-Course Corticosteroids in Hospitalized Patients With COVID-19. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2020;71(16):2114-20.
PMid:32427279 PMCid:PMC7314133
88. Kovvuru S, Nalleballe K, Onteddu SR, Sharma R, Jasti M, Kapoor N, et al. Immunosuppression in chronic autoimmune neurological disorders during the COVID-19 pandemic. J Neurol Sci. 2021;420:117230.
PMid:33256952 PMCid:PMC7837234
89. Siow I, Lee KS, Zhang JJY, Saffari SE, Ng A. Encephalitis as a neurological complication of COVID-19: A systematic review and meta-analysis of incidence, outcomes, and predictors. Eur J Neurol. 2021.
PMid:33341565 PMCid:PMC7834121
90. Saraya AW, Worachotsueptrakun K, Vutipongsatorn K, Sonpee C, Hemachudha T. Differences and diversity of autoimmune encephalitis in 77 cases from a single tertiary care center. BMC Neurology. 2019;19(1):273.
PMid:31694559 PMCid:PMC6833261
91. Sarigecili E, Arslan I, Ucar HK, Celik U. Pediatric anti-NMDA receptor encephalitis associated with COVID-19. Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery. 2021:1-4.
PMid:33852058 PMCid:PMC8045445
92. Lana-Peixoto MA, Talim N. Neuromyelitis Optica Spectrum Disorder and Anti-MOG Syndromes. Biomedicines. 2019;7(2).
PMid:31212763 PMCid:PMC6631227
93. Alonso R, Silva B, Garcea O, Diaz PEC, Dos Passos GR, Navarro DAR, et al. COVID-19 in multiple sclerosis and neuromyelitis optica spectrum disorder patients in Latin America: COVID-19 in MS and NMOSD patients in LATAM. Multiple sclerosis and related disorders. 2021;51:102886.
PMid:33744758 PMCid:PMC7937038
94. Lersy F, Anheim M, Willaume T, Chammas A, Brisset J-C, Cotton F, et al. Cerebral vasculitis of medium-sized vessels as a possible mechanism of brain damage in COVID-19 patients. J Neuroradiol. 2021;48(3):141-6.
PMid:33340640 PMCid:PMC7833894
95. Oliveira RMC, Santos DH, Olivetti BC, Takahashi JT. Bilateral trochlear nerve palsy due to cerebral vasculitis related to COVID-19 infection. Arquivos de neuro-psiquiatria. 2020;78(6):385-6.
96. Barzegar M, Mirmosayyeb O, Gajarzadeh M, Afshari-Safavi A, Nehzat N, Vaheb S, et al. COVID-19 Among Patients With Multiple Sclerosis: A Systematic Review. Neurology(R) neuroimmunology & neuroinflammation. 2021;8(4):e1001.
PMid:34016734 PMCid:PMC8142838
Volume 1, Issue 2
December 2022
Pages 69-77
  • Receive Date: 08 December 2022
  • Accept Date: 28 December 2022