Discussion
Neurological manifestations are reported in 6-36% of patients with Covid-19. They could be divided in to direct(viral), secondary and post (para) infections(autoimmune)(5). Studies carried out since the Covid-19 outbreak have revealed conflicting statistics on the incidence of meningoencephalitis in various countries(6). It may be speculated that cases of meningoencephalitis related to Covid-19 may not actually reflect direct viral invasion to CNS, post-/para-infection immune pathologies might come in to play in some of the clinical presentations(7). 28 articles reporting 48 patients with infectious or immune-mediated Covid-19 CNS-disease, 5 patients presented with meningoencephalitis and 11 cases with autoimmune encephalitis(8). Zamani et. al, 2021 conducted a systematic review of 26 case reports on Covid-19 related meningoencephalitis that all patients presented with altered mental status and mild/moderate pleocytosis or proteinorrhachia in CSF (4). Anti-GAD antibody is found in some neurological syndromes, including stiff-person syndrome (60-80%), Limbic encephalitis (17%), cerebellar ataxia (2%), epilepsy (2.1-5.4%) and Miller Fisher syndrome, eye movement disorders, palatal myoclonus and Parkinsons disease rarely occur(9–11). But, no cases have reported with anti-GAD65 meningitis, so far (Table 2). The interesting finding of our case is presentation of GAD-65 with meningoencephalitis after Covid-19 infection.