背景:冠状病毒病2019(COVID-19)的神经系统表现越来越被认可,包括脑病,尽管SARS-CoV-2对大脑的直接感染仍存在争议。我们在此报告了患有严重SARS-CoV-2相关脑病并表现出失语的患者的临床病程和细胞因子谱。
方法:一名81岁的男子在SARS-CoV-2感染后几天出现急性意识障碍和癫痫状态。在用雷得西韦和地塞米松治疗后,他的意识和癫痫发作有所改善;然而,失语和失写症仍然存在。甲泼尼龙脉冲和静脉注射免疫球蛋白后两个月,他的神经缺陷改善了.我们发现白细胞介素(IL)-6,IL-8和单核细胞趋化蛋白-1(MCP-1)的水平升高,但不是血清和脑脊液(CSF)中的IL-2和IL-10,血清IL-6和MCP-1水平远高于脑脊液。免疫治疗后脑脊液中IL-8水平是免疫治疗前的4倍。
结论:我们患者的细胞因子谱与严重SARS-CoV-2相关性脑病相似。我们证明(i)特征性失语症可以作为与SARS-CoV-2相关脑病相关的局灶性神经功能缺损而发生,和(ii)IL8介导的中枢神经系统炎症跟随SARS-CoV-2相关脑病的全身性炎症,并且即使在免疫治疗后也可以持续并恶化。监测脑脊液中的IL-8,治疗SARS-CoV-2相关性脑病可能需要长期使用皮质类固醇。
BACKGROUND: Neurological manifestations of coronavirus disease 2019 (COVID-19) are increasingly recognized and include encephalopathy, although direct infection of the brain by SARS-CoV-2 remains controversial. We herein report the clinical course and cytokine profiles of a patient with severe SARS-CoV-2-related encephalopathy presenting aphasia.
METHODS: An 81-year-old man developed acute consciousness disturbance and status epileptics several days after SARS-CoV-2 infection. Following treatment with remdesivir and dexamethasone, his consciousness and epileptic seizures improved; however, amnestic aphasia and agraphia remained. Two months after methylprednisolone pulse and intravenous immunoglobulin, his neurological deficits improved. We found increased levels of interleukin (IL)-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1), but not IL-2 and IL-10 in the serum and cerebrospinal fluid (CSF), and the levels of serum IL-6 and MCP-1 were much higher than those in the CSF. The level of IL-8 in the CSF after immunotherapy was four times higher than that before immunotherapy.
CONCLUSIONS: The cytokine profile of our patient was similar to that seen in severe SARS-CoV-2-related encephalopathy. We demonstrated (i) that the characteristic aphasia can occur as a focal neurological deficit associated with SARS-CoV-2-related encephalopathy, and (ii) that IL8-mediated central nervous system inflammation follows systemic inflammation in SARS-CoV-2-related encephalopathy and can persist and worsen even after immunotherapy. Monitoring IL-8 in CSF, and long-term corticosteroids may be required for treating SARS-CoV-2-related encephalopathy.