Table A.2.
. Cases published on Acute Disseminated Encephalomyelitis in patients with COVID-19 included in systematic review with a summary of the results.
| Study | Age (years) / Sex | Comorbidities | COVID-19 severity | ADEM severity | Interval between Covid-19 symptoms and ADEM diagnosis (Days) | Predominant Neurological Clinic | MRI | COVID-19 diagnostic test | PCR COVID-19 in CSF | CSF: Cells (cells/mm3) & Proteins (mg/dL) |
Other studies carried out | ADEM Treatment | |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Pediatric cases | |||||||||||||
| Abdel-Mannan et al., 2020 | 9 / Male | None | NA | Mild | NA | Encephalopathy, cerebellar signs, proximal leg weakness, urinary retention | WM | PCR (+) | N | C: 2000 P:19 |
Negative culture and virology results, OCB (-) | None | Favorable |
| Abdel-Mannan et al., 2020 | 15 / Female | Obese | NA | Moderate/Severe | NA | Encephalopathy, global proximal weakness, reduced reflexes | WM Microthrombi in cerebrum, brainstem, cerebellum. |
PCR (+), Serum Test (+) ¶ | NA | NA | NA | IVIg 1g/kg, 1 dose | Favorable |
| De Miranda Henriques-Souza et al., 2021 | 12 / Female | None | Mild | Moderate/Severe | 5 | Encephalopathy, oculocephalic, corneal, cough, and gag reflexes were abolished, pyramidal signs. | WM, SC | PCR (+) | N | C: 0 P: 18 |
PCR for arbovirus (-) | MP for 5 days (2 cycles) | Partially favorable |
| Dominguez-Rojas et al., 2020 | 13 / Male | None | Asymptomatic | Moderate/Severe | Indeterminate | Encephalopathy, ataxia, paraparesis | WM, DGM, SC | Serum IgG, IgM Test (+) | NA | C: 40 P: 43 |
PCR enterovirus and herpesvirus (-) | MP 30 mg / Kg /dose for 5 days | Favorable |
| Lindan et al., 2020 | 0.17 / Male | None | Mild | Mild | NA | Seizures | DGM | PCR or antigen test (+) | NA | NA | NA | Supportive measures, Anti-epileptic drugs | Favorable |
| Lindan et al., 2020 | 1.17 / Female | None | NA | Moderate/Severe | Indeterminate | Encephalopathy, dystonic posturing, seizures | DGM, WM, BS | PCR or antigen test (+) | NA | NA | NA | Supportive measures, Anti-epileptic drugs | Favorable |
| Lindan et al., 2020 | 9 / Male | Mild asthma | NA | Moderate/Severe | Indeterminate | Encephalopathy, photophobia, phonophobia, seizures | DGM, WM, Optic chiasm, cerebellum, cortex, BS | PCR or antigen test (+) | NA | NA | NA | IVIg | Favorable |
| Lindan et al., 2020 | 0.25 / Male | None | Mild | Moderate/Severe | 20 | Pyramidal signs, urinary retention | BS, SC | PCR (+) | NA | NA | NA | IVIg | Partially favorable |
| Lindan et al., 2020 | 1.58 / Female | None | Asymptomatic | Moderate/Severe | Indeterminate | Irritability, gait impairment, constipation. | WM SC |
PCR (+) | NA | NA | NA | High dose steroids | Favorable |
| Adult cases | |||||||||||||
| Abdi et al., 2020 | 58 / Male | NA | Asymptomatic | Moderate/Severe | Indeterminate | Encephalopathy, Pyramidal signs, seizure | BS, WM, DGM, cortex | PCR (+) | N | C: 0 P: 15 |
OCB (-), HSV (-), VZV (-), CMV (-), EBV (-) | Dexamethasone 8mg TDS | Unfavorable |
| Assunção et al., 2020 | 49 / Male | None | Severe | Moderate/Severe | 30 | Encephalopathy | BS, WM | PCR (+) | N | NA | NA | NA | NA |
| El Beltagi et al., 2021 | 25 / Male | NA | Mild | Moderate/Severe | 21 | Quadriparesis, ataxia, myalgia | WM, SC, BS | PCR (+) | NA | C: Raised P: Raised |
CSF culture, viral serology panel, TB PCR and autoimmune work-up were all negative | NA | NA |
| Espíndola et al., 2021 | NA | NA | NA | Mild | 4 | Encephalopathy, dysarthria and intracranial hypertension | WM | PCR (+) | P | C: Normal P: Normal |
PCR for arbovirus and herpesvirus (-) | MP 1 g daily for 5 days | Favorable |
| Espíndola et al., 2021 | NA | NA | NA | NA | NA | NA | NA | PCR (+) | N | C: Raised P: Raised |
PCR for arbovirus and herpesvirus (-) | NA | NA |
| Freire-Álvarez et al., 2020 | 39 / Male | NA | Mild | Mild | 14 | Encephalopathy, neck stiffness and paraphasia | WM,DGM,cortex | PCR (+) | N | C: 20 P: 198 |
HSV (-), VZV (-), CMV (-), EBV (-), HHV-6 (-), enterovirus (-), human parechovirus (-). | IVIg 0.4 g /kg / day for 5 days/ Tocilizumab 400 mg/24 hours for 3 days |
Partially favorable |
| Kumar et al., 2020 | 35 / Female | Gastric bypass, iron deficiency anemia | Mild | Moderate/Severe | 60 | Symmetric distal neuropathy, encephalopathy | WM, BS | PCR (+) | NA | C: 1 P: 22 |
AQP4(-), anti-MOG (-); OCB (-), negative meningitis - encephalitis panel (E. coli, H. flu, Listeria, N. Meningitis, S. Agalactaia, S. Pneumo, CMV, Enterovirus, HSV1y2, HHV6, VZV y criptococo) | MP 1 mg/kg for 5 days IVIg 2 g/kg divided over 3 days TPE 5 days |
Unfavorable |
| Langley et al., 2020 | 53 / Male | None | Severe | Mild | 59 | Encephalopathy, hemiparesis | WM, HL | PCR (+) | NA | C: NA P: Normal |
OCB were present in the CSF and serum, CSF bacterial culture was negative, PCR panel (including HSV, VZV, EBV, adenovirus and CMV) were negative | MP 1g/d for 3 days and tapered with oral prednisolone | Partially favorable |
| Lopes et al., 2020 | 59 / Female | HT | Severe | Moderate/Severe | Indeterminate | Encephalopathy, hemiparesis, Bilateral Babinski | WM, DGM, Cerebellum | PCR (+) | N | C: Normal P: Normal |
H1N1(-) | NA | Unfavorable |
| Lopes et al., 2020 | 41 / Male | Diabetes, HT, obesity, smoking | Severe | Moderate/Severe | 20 | Encephalopathy, quadriparesis, moderate subacute sensorimotor polyneuropathy | WM, DGM, HL | PCR (+) | N | C: Normal P: Normal |
OCB (-), microbiological analysis in CSF was negative | NA | Partially favorable |
| McCuddy et al., 2020 | 40 / Female | Diabetes, HT, obesity, pregnancy | Severe | Moderate/Severe | 22 | Pyramidal signs | BS, WM | PCR (+) | N | C: 2 P: 95 |
OCB (-), Meningitis / encephalitis panel negative | Dexamethasone 20mg IV for 5days and 10mg for 5days | Partially favorable |
| McCuddy et al., 2020 | 60 / Male | Diabetes, HT, asthma, chronic kidney disease | Severe | Moderate/Severe | 20 | Encephalopathy, hyporeflexia | Cerebellum, WM | PCR (+) | N | C: 1 P: 55 |
OCB (-) | MP 1 g/d for 5 days IVIg 25g/day for 3 days |
Unfavorable |
| McCuddy et al., 2020 | 70 / Female | Diabetes, HT, chronic kidney disease, obesity, neuropathy | Severe | Moderate/Severe | 16 | Encephalopathy, Pyramidal signs | BS, WM | PCR (+) | N | C: 0 P: 63 |
OCB:3, Meningitis / encephalitis panel negative | MP 1g/d for 5 days IVIg 25g/day for 3 days |
Partially favorable |
| Parsons et al., 2020 | 51 / Female | NA | Severe | Moderate/Severe | 24 | Encephalopathy, hypotonia, hyporeflexia, pyramidal signs | HL, WM | PCR (+) | N | C: 1 P: 62 |
AQP4(-); OCB:4 (both serum and CSF), PCR panel (including HSV, VZV, EBV, and CMV) were negative | MP 1 g daily for 5 days IVIg 0.4 g/kg daily for 5 days |
Partially favorable |
| Paterson et al., 2020 | 52 / Male | NA | Severe | Mild | 9* | Encephalopathy, Pyramidal signs, facial diplegia, areflexia, dysphagia, ophthalmoplegia, | WM, HL | PCR (+) | N | C: 0 P: Raised |
AQP4(-), anti-MOG (-); NMDAR (-), LGI1(-), GAD (-) | MP 1g/daily for 5 days IVIg |
Partially favorable |
| Paterson et al., 2020 | 52 / Male | NA | Severe | Mild | 9* | Encephalopathy, Pyramidal signs | WM, HL | PCR (+) | NA | NA | AQP4(-), anti-MOG (-); NMDAR (-), LGI1 (-), GAD (-), OCB (-) | Supportive | Partially favorable |
| Paterson et al., 2020 | 60/ Male | NA | Severe | NA | 9* | NA | WM, HL | PCR (+) | N | NA | AQP4(-), anti-MOG (-); NMDAR (-), LGI1(-), GAD (-), OCB (-) , viral PCR(-) | MP 1 g for 3 days | Partially favorable. |
| Pilotto et al., 2021 | 65 / Male | NA | NA | Moderate/Severe | 44 | Encephalopathy, motor deficit | WM, BS, DGM | PCR (+) | NA | C: 2 P: 63 |
OCB (-), CSF screening for bacteria and virus infection was negative | high-dose MP | Partially favorable mRS:2 |
| Umapathi et al., 2020 | 59 / Male | HT | Severe | Moderate/Severe | 14 | Encephalopathy, quadriparesis, hyperreflexia, ocular flutter | WM, BS, SC, HL, Cerebellum | PCR (+) | N | C: 6 P: 56 |
AQP4(-), anti-MOG (-); OCB (-), Negative autoimmune encephalitis panel, HSV (-), VZV (-), CMV (-) | IVIG doses were administered for 7 days, then cycles of 2 g/kg at 3-week intervals. | Partially favorable |
| Utukuri et al., 2020 | 44 / Male | None | Asymptomatic | Mild | Indeterminate | Encephalopathy, spinal cord involvement, ataxia | WM, SC | PCR (+) | N | C: 6 P: 36 |
CSF bacterial and viral PCR tests were negative | MP IVIg |
Partially favorable |
| Present Case | 35 / Male | None | Mild | Moderate/Severe | 21 | Pyramidal signs, dysarthria, ophthalmoplegia, sensorineural hearing loss, absent gag reflex, cerebellar symptoms (ataxia). | WM, BS, SC | Serum IgG, IgM Test (+) | NA | C: 1 P: 47 |
AQP4(-), anti-MOG(-); NMDAR(-), AMPA (-), GABAb(-), GABAa(-), mGluR5 (-), mGluR1(-), DPPX(-), IgLON5(-), LGI1(-), CASPR2(-), AQP-4 (-) | MP 1g daily for 5 days (2 cycles) tapered with oral prednisone | Partially favorable |
Table A. 2. Cases published on Acute Disseminated Encephalomyelitis in patients with COVID-19 included in systematic review with a summary of the results. HT: Arterial Hypertension; BS: Brainstem; NA: not available; WM: White matter; DGM: deep gray matter; HL: hemorrhagic lesions, SC: Spinal cord; PCR: Polymerase chain reaction; P & (+): positive, N & (-): negative, ND: Not done, MP: methylprednisolone, IVIg: intravenous immunoglobulin, TPE: therapeutic plasma exchange. C: cell, P: Proteins, *: Average days according to author.