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Background <p>COVID-19 manifests with diverse systemic symptoms, including central nervous system involvement. Acute necrotizing encephalopathy (ANE), acute hemorrhagic leukoencephalitis (AHLE), and acute disseminated encephalomyelitis (ADEM) exhibit overlapping clinical features, creating diagnostic challenges. This study characterizes COVID-19-associated neuroinflammatory syndromes in patients without apparent respiratory symptoms.</p> Methods <p>We conducted a retrospective case series analysis of four patients with confirmed COVID-19 and acute neurological decline. Diagnostic evaluation included brain MRI, cerebrospinal fluid analysis, autoimmune/paraneoplastic antibody panels, and exclusion of alternative etiologies through microbiological/metabolic testing.</p> Results <p>Four cases were identified: two with ANE, one with ADEM, and one with AHLE. All patients tested SARS-CoV-2-positive by RT-PCR despite absent respiratory symptoms. Magnetic resonance imaging revealed characteristic patterns: Symmetric thalamic lesions in ANE (Cases 1–2), hemorrhagic lesions in basal ganglia and bilateral cerebellar hemispheres in AHLE (Case 3), widespread cortical and subcortical demyelination in ADEM (Case 4).</p> Conclusions <p>ANE, AHLE, and ADEM are critical neuroinflammatory complications of COVID-19 requiring urgent differentiation. It is imperative to maintain a high level of clinical suspicion when patients present with acute encephalopathy in the absence of respiratory symptoms, as this enables timely intervention.</p>

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Acute haemorrhagic necrotizing encephalopathy and inflammatory demyelinating encephalopathy associated with COVID-19 in adults in Southern China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月7日

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  • Sha Tan,
  • Chunping Cui,
  • En-Peng Song,
  • Yilong Shan,
  • Yanyu Chang,
  • Wei Qiu,
  • Zhengqi Lu

摘要

Background

COVID-19 manifests with diverse systemic symptoms, including central nervous system involvement. Acute necrotizing encephalopathy (ANE), acute hemorrhagic leukoencephalitis (AHLE), and acute disseminated encephalomyelitis (ADEM) exhibit overlapping clinical features, creating diagnostic challenges. This study characterizes COVID-19-associated neuroinflammatory syndromes in patients without apparent respiratory symptoms.

Methods

We conducted a retrospective case series analysis of four patients with confirmed COVID-19 and acute neurological decline. Diagnostic evaluation included brain MRI, cerebrospinal fluid analysis, autoimmune/paraneoplastic antibody panels, and exclusion of alternative etiologies through microbiological/metabolic testing.

Results

Four cases were identified: two with ANE, one with ADEM, and one with AHLE. All patients tested SARS-CoV-2-positive by RT-PCR despite absent respiratory symptoms. Magnetic resonance imaging revealed characteristic patterns: Symmetric thalamic lesions in ANE (Cases 1–2), hemorrhagic lesions in basal ganglia and bilateral cerebellar hemispheres in AHLE (Case 3), widespread cortical and subcortical demyelination in ADEM (Case 4).

Conclusions

ANE, AHLE, and ADEM are critical neuroinflammatory complications of COVID-19 requiring urgent differentiation. It is imperative to maintain a high level of clinical suspicion when patients present with acute encephalopathy in the absence of respiratory symptoms, as this enables timely intervention.