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      Anti-NMDA receptor encephalitis presenting as new onset refractory status epilepticus in COVID-19

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Highlights

          • Autoimmune encephalitis and status epilepticus in COVID-19 can be challenging.

          • Immunotherapy could be useful for anti-NMDAr encephalitis and SARS-Cov-2 infection.

          • Cytokines storm could play a role for NORSE presentation in NDMA-R encephalitis.

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          Most cited references8

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          COVID-19: consider cytokine storm syndromes and immunosuppression

          As of March 12, 2020, coronavirus disease 2019 (COVID-19) has been confirmed in 125 048 people worldwide, carrying a mortality of approximately 3·7%, 1 compared with a mortality rate of less than 1% from influenza. There is an urgent need for effective treatment. Current focus has been on the development of novel therapeutics, including antivirals and vaccines. Accumulating evidence suggests that a subgroup of patients with severe COVID-19 might have a cytokine storm syndrome. We recommend identification and treatment of hyperinflammation using existing, approved therapies with proven safety profiles to address the immediate need to reduce the rising mortality. Current management of COVID-19 is supportive, and respiratory failure from acute respiratory distress syndrome (ARDS) is the leading cause of mortality. 2 Secondary haemophagocytic lymphohistiocytosis (sHLH) is an under-recognised, hyperinflammatory syndrome characterised by a fulminant and fatal hypercytokinaemia with multiorgan failure. In adults, sHLH is most commonly triggered by viral infections 3 and occurs in 3·7–4·3% of sepsis cases. 4 Cardinal features of sHLH include unremitting fever, cytopenias, and hyperferritinaemia; pulmonary involvement (including ARDS) occurs in approximately 50% of patients. 5 A cytokine profile resembling sHLH is associated with COVID-19 disease severity, characterised by increased interleukin (IL)-2, IL-7, granulocyte-colony stimulating factor, interferon-γ inducible protein 10, monocyte chemoattractant protein 1, macrophage inflammatory protein 1-α, and tumour necrosis factor-α. 6 Predictors of fatality from a recent retrospective, multicentre study of 150 confirmed COVID-19 cases in Wuhan, China, included elevated ferritin (mean 1297·6 ng/ml in non-survivors vs 614·0 ng/ml in survivors; p 39·4°C 49 Organomegaly None 0 Hepatomegaly or splenomegaly 23 Hepatomegaly and splenomegaly 38 Number of cytopenias * One lineage 0 Two lineages 24 Three lineages 34 Triglycerides (mmol/L) 4·0 mmol/L 64 Fibrinogen (g/L) >2·5 g/L 0 ≤2·5 g/L 30 Ferritin ng/ml 6000 ng/ml 50 Serum aspartate aminotransferase <30 IU/L 0 ≥30 IU/L 19 Haemophagocytosis on bone marrow aspirate No 0 Yes 35 Known immunosuppression † No 0 Yes 18 The Hscore 11 generates a probability for the presence of secondary HLH. HScores greater than 169 are 93% sensitive and 86% specific for HLH. Note that bone marrow haemophagocytosis is not mandatory for a diagnosis of HLH. HScores can be calculated using an online HScore calculator. 11 HLH=haemophagocytic lymphohistiocytosis. * Defined as either haemoglobin concentration of 9·2 g/dL or less (≤5·71 mmol/L), a white blood cell count of 5000 white blood cells per mm3 or less, or platelet count of 110 000 platelets per mm3 or less, or all of these criteria combined. † HIV positive or receiving longterm immunosuppressive therapy (ie, glucocorticoids, cyclosporine, azathioprine).
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            Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

            The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.
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              • Article: not found

              Frequency, symptoms, risk factors, and outcomes of autoimmune encephalitis after herpes simplex encephalitis: a prospective observational study and retrospective analysis

              Herpes simplex encephalitis can trigger autoimmune encephalitis that leads to neurological worsening. We aimed to assess the frequency, symptoms, risk factors, and outcomes of this complication.
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                Author and article information

                Contributors
                Journal
                Seizure
                Seizure
                Seizure
                British Epilepsy Association. Published by Elsevier Ltd.
                1059-1311
                1532-2688
                15 July 2020
                October 2020
                15 July 2020
                : 81
                : 18-20
                Affiliations
                [a ]Neurology Unit, Ospedale Ramazzini di Carpi, AUSL di Modena, Italy
                [b ]Neurology Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy
                [c ]Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Modena Italy
                [d ]PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
                [e ]Intensive Care Unit, OCB Hospital, Azienda Ospedaliera Universitaria di Modena, Italy
                [f ]Diagnostica patologie autoimmuni - Dipartimento Interaziendale ad Attività Integrata di Medicina di Laboratorio ed Anatomia Patologica, Azienda Ospedaliera Universitaria di Modena, Italy
                [g ]Intensive Care Unit, Ospedale Ramazzini di Carpi, AUSL di Modena, Italy
                Author notes
                [* ]Corresponding author at: Department of Biomedical, Metabolic, and Neural Science, University of Modena and Reggio Emilia, Azienda Ospedaliera Universitaria di Modena - OCB, via Giardini 1355, 41126 Modena, Italy. stefano.meletti@ 123456unimore.it
                Article
                S1059-1311(20)30202-8
                10.1016/j.seizure.2020.07.006
                7362825
                32688169
                bebbd27e-d6bc-46d1-b76a-c9b080b1a7b4
                © 2020 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 20 May 2020
                : 4 July 2020
                : 8 July 2020
                Categories
                Article

                norse,anti-nmda-r encephalitis,covid-19,status epilepticus,autoimmune diseases

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