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
Parkinson’s 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.