Acute Disseminated Encephalomyelitis in COVID 19- Systematic Review

Abstract

Introduction: There has been a concerning increase in the prevalence of COVID-19 associated acute disseminated encephalomyelitis (ADEM). ADEM is a rare autoimmune disorder, often post-viral and primarily attacks children and can potentially lead to long-lasting neurological sequelae. As such, accurate diagnosis and timely management are of paramount clinical significance. Hence in the present study, we aim to determine the incidence, risk factors, clinical features, laboratory findings, management & fatality of ADEM in covid-19 patients.

Material And Methods: A systematic search adhering to PRISMA guidelines was performed from electronic databases (Medline, Google Scholar, OpenGray, Cochrane Library, NYAM) from inception until October 12, 2020. Renowned preprint servers like medRxiv, bioRxiv were also searched. Published case reports/series of proven/presumed ADEM in COVID-19 patients were included.

Results: Fourteen case reports/series were included. The mean age was 50.6±15.2 years, with a male to female ratio of 1:1. Most cases reported signs/symptoms of neurological nature prior to respiratory, the most common being: headaches, paresthesia, movement disorders, positive Babinski's sign and absent Deep tendon reflexes. Hypertension was the most common comorbidity.

Conclusions: Neurological symptoms were the main presentation of COVID-19, which did not correlate with the severity of respiratory symptoms. The high incidence of ADEM with hemorrhage (n=3) is striking. A rise in the prevalence of ADEM in adults in contrast to children is also concerning. Brain inflammation is likely caused by an immune response to the disease rather than neurotropism. Clinicians need to be vigilant as early diagnosis can improve patient outcomes.