Introduction
COVID-19 has a very broad variety of clinical manifestations and signs and symptoms. Initially it was thought of affecting only the respiratory system but now it is known that it can affect a wide variety of body systems and manifest in a variety of ways. Acute respiratory distress syndrome (ARDS), thromboembolic syndrome, severe metabolic syndromes, severe acute tubular necrosis, electrolyte abnormalities, neurologic syndromes, and cardiac events, including myocarditis and arrhythmias, have all been linked to this new virus [1,13-14]. In March 2020, Beijing Ditan announced the first incidence of viral encephalitis linked to COVID-19 and through genome sequencing of the cerebrospinal fluid (CSF), COVID-19 presence was identified [2]. COVID-19 can cause non-specific symptoms such as headache, dizziness, taste and olfactory sensory disturbances, as well as particular syndromes such as encephalitis, acute transverse myelitis, meningitis, and stroke [3]. The neurological manifestations of COVID-19 can be caused by either direct invasion of the cells or by indirect mechanisms like inflammatory response and cytokine storm [4].
Our primary interest is that of encephalitis in COVID-19 affected patients. The presentation of COVID-19 encephalitis is the same as any other cause of encephalitis with patients showing features of fever, confusion, seizures and focal neurological signs. It can be diagnosed via MRI brain and CSF Polymerase Chain Reaction (PCR) for COVID-19 genome. A variety of treatments including IV steroids, IV immunoglobulins and IV rituximab have been tried with variable outcomes [5].
We now present a case series of 5 patients who presented with COVID-19 encephalitis. It is important for physicians to be vary of the different neurological manifestations of COVID-19 and our case series will add more knowledge to it.