Background

Since the declaration of COVID-19 pandemic, several case reports of demyelination of both peripheral and central nervous systems have been published. The association between CNS demyelination and viral infection has long been documented, and this link was recently reported following SARS-CoV-2 infection as well.

Objectives

In this systematic review, we aim to investigate the existing literature on CNS demyelination associated with SARS-CoV-2, and the proposed pathophysiological mechanisms.

Methods

We conducted a systematic review of articles in PubMed, SCOPUS, EMBASE, Cochrane, Google Scholar and Ovid databases, from 1 January 2020 until June 15, 2021. The following keywords were used: “COVID-19”, “SARS-CoV-2”, “demyelination”, “demyelinating disease”, “multiple sclerosis”, “neuromyelitis optica”, and “transverse myelitis”.

Results

A total of 60 articles were included in the final analysis of this systematic review and included 102 patients: 52 (51%) men and 50 (49%) women, with a median age of 46.5 years. The demyelination mimicked a variety of conditions with a picture of encephalitis/encephalomyelitis being the most common. At the same time other patterns were less frequently reported such as MS, NMOSD and even MOGAD. Longitudinally extensive transverse myelitis (LETM) was the most frequently reported pattern of spinal cord involvement.

Conclusion

A growing body of literature has shown an association between SARS‐CoV‐2 infection and the development of different types of CNS demyelination. Although causality cannot readily be inferred, this review may suggest a probable causal relationship, through a para-infectious or post-infectious immune-mediated etiology in COVID-19 patients. This relationship needs to be clarified in future research.

中文翻译：

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中枢神经系统脱髓鞘与 COVID-19 感染的关联：更新的系统评价

背景

自宣布 COVID-19 大流行以来，已经发表了几起外周和中枢神经系统脱髓鞘的病例报告。中枢神经系统脱髓鞘与病毒感染之间的关联早已有文献记载，最近在 SARS-CoV-2 感染后也报道了这种关联。

目标

在本系统综述中，我们旨在调查与 SARS-CoV-2 相关的中枢神经系统脱髓鞘的现有文献，以及提出的病理生理机制。

方法

从 2020 年 1 月 1 日到 2021 年 6 月 15 日，我们对 PubMed、SCOPUS、EMBASE、Cochrane、Google Scholar 和 Ovid 数据库中的文章进行了系统评价。使用了以下关键词：“COVID-19”、“SARS-CoV-2 ”、“脱髓鞘”、“脱髓鞘病”、“多发性硬化”、“视神经脊髓炎”和“横贯性脊髓炎”。

结果

该系统评价的最终分析共纳入 60 篇文章，包括 102 名患者：52 名（51%）男性和 50 名（49%）女性，中位年龄为 46.5 岁。脱髓鞘模拟了多种情况，其中最常见的是脑炎/脑脊髓炎。同时，其他模式的报告频率较低，例如 MS、NMOSD 甚至 MOGAD。纵向广泛性横贯性脊髓炎（LETM）是最常见的脊髓受累模式。

结论

越来越多的文献表明，SARS-CoV-2 感染与不同类型的中枢神经系统脱髓鞘的发展之间存在关联。尽管无法轻易推断因果关系，但本综述可能通过 COVID-19 患者的副感染或感染后免疫介导的病因学表明可能存在因果关系。这种关系需要在未来的研究中加以阐明。