Objective: To report three patients infected with COVID-19 with severe respiratory syndrome requiring intubation, who developed acute demyelinating encephalomyelitis (ADEM). Method: Patient data were obtained from medical records from the North Memorial Health Hospital, Robbinsdale, MN, USA Results: Three patients (two men and one woman, aged 38 - 63) presented with fatigue, cough and fever leading to development of acute respiratory distress syndrome secondary to COVID-19 infection requiring intubation and ventilatory support. Two patients were unresponsive, one with strong eye deviation to the left and the third patient had severe diffuse weakness. MRI in all patients showed findings consistent with ADEM. CSF showed elevated protein in all patients with normal cell count and no evidence of infection, including negative COVID-19 PCR. All three of the patients received Convalescent plasma therapy for COVID-19. All patients were treated with intravenous corticosteroids and improved, although two responded minimally. Two patients treated with IVIG showed no further improvement. Conclusion: Neurological complications from COVID-19 are being rapidly recognized. Our three cases highlight the occurrence of ADEM as a postinfectious/immune mediated complication of COVID-19 infection, which may be responsive to corticosteroid treatment. Early recognition of this complication and treatment is important to avoid long term complications.

中文翻译：

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COVID-19感染中的急性脱髓鞘性脑脊髓炎（ADEM）：病例系列。

目的：报告三例感染了需要插管的严重呼吸道综合症感染COVID-19的患者，这些患者发展为急性脱髓鞘性脑脊髓炎（ADEM）。方法：从美国明尼苏达州罗宾斯代尔市北纪念健康医院的病历中获取患者数据。结果：3例患者（两男一女，年龄38-63岁）表现出疲劳，咳嗽和发烧，导致了急性呼吸道疾病的发展COVID-19感染继发的窘迫综合征，需要插管和通气支持。两名患者无反应，一名左眼强烈偏斜，第三名患有严重弥漫性无力。所有患者的MRI表现均与ADEM一致。CSF在所有细胞计数正常且无感染迹象的患者中显示蛋白升高，包括COVID-19 PCR阴性。所有三名患者均接受了COVID-19的恢复期血浆疗法。所有患者均接受了皮质类固醇静脉注射治疗，并且有所改善，尽管其中两名患者的反应很小。两名接受IVIG治疗的患者无进一步改善。结论：来自COVID-19的神经系统并发症正在得到迅速认识。我们的三例病例均突出显示了ADEM是COVID-19感染的后感染/免疫介导并发症，可能对皮质类固醇激素治疗有反应。尽早认识到这种并发症和治疗对避免长期并发症很重要。来自COVID-19的神经系统并发症正在得到迅速认识。我们的三例病例都突出显示了ADEM是COVID-19感染的后感染/免疫介导并发症，可能对皮质类固醇激素治疗有反应。尽早认识到这种并发症和治疗对避免长期并发症很重要。来自COVID-19的神经系统并发症正在得到迅速认识。我们的三例病例均突出显示了ADEM是COVID-19感染的后感染/免疫介导并发症，可能对皮质类固醇激素治疗有反应。尽早认识到这种并发症和治疗对避免长期并发症很重要。