Three Cases of Encephalopathy / Disseminated Encephalomyelitis in SARS-COV-2 Infection

• Published in: Acta Medica Bulgarica 2022-04, Vol.49 (1), p.51-56
• Main Authors: Metodiev, D., Toshev, Y., Anachkov, K., Sarbyanova, N., Nachev, S.
• Format: Article
• Language: English
• Subjects: Encephalitis; encephalopathy; Guillain-Barre syndrome; Infections; Nervous system; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2
• ISSN: 2719-5384; 2719-5384; 0324-1750
• DOI: 10.2478/amb-2022-0009

Аs many other viral pandemics, the current SARS-CoV-2 is also characterized by nervous system involvement, mainly in elderly patients with comorbidities. Recent scientific reports indicate that involvement of the nervous system is manifested by a variety of clinical symptoms related to the severity and extent of brain damage. Encephalopathy, encephalitis and polyneuritis are among the complications reported in patients with SARSCoV- 2. These complications have been morphologically proven. As an immune-privileged structure, neural tissue is particularly vulnerable to autoimmune attacks. Therefore, various neurological diseases such as MS, Guillain-Barre syndrome, as well as autoimmune encephalitis and psychosis have also been reported in patients with SARS-CoV-2 infection. Herein, we present three cases of patients who died after infection with the SARS-CoV-2 virus. We emphasize on the pathomorphological changes found in a detailed study of the brain and cervical spine. The analysis of the inflammatory findings, mainly manifested by perivenous lymphocytic infiltrates, serodiapedesis and erythrocyte depots around the vessels, showed a presence of initial demyelination (in two of the cases). The blood supply of most venous vessels with different size and a pronounced “sludge” phenomenon were the most impressive findings, as in some sections these changes were demonstrated by a presence of thrombosis. Inflammatory manifestations were also observed in the brainstem near to the stem nuclei. The SARS-CoV-2 virus induces a variety of immune system responses. In some patients there is a negligible or no reaction, while in others there is a “cytokine storm” with a system damage of multiple organs – often including the brain.