Para-infectious aseptic meningo-encephalitis following SARS-CoV-2 infection: two case reports

Neurological manifestations following COVID-19 have been increasingly reported, yet the pathophysiology of para-infectious processes remains unclear.We present two patients who developed headaches, gait instability, cognitive impairments, and inflammatory cerebrospinal fluid (CSF) changes after SARS-CoV-2 infection. Imaging revealed meningitis and encephalitis, respectively, but there was no direct pathogen detection. After excluding other causes and initiating corticosteroid therapy, both patients showed significant improvement. These cases highlight the relevance of autoimmune mechanisms in neurological complications after COVID-19. Both patients developed their neurological symptoms within four weeks after SARS-CoV-2 infection and thus formally still during the acute phase of COVID-19. In patients with neurological symptoms and inflammatory CSF findings following SARS-CoV-2 infection, para-infectious meningo-encephalitis should be considered, and corticosteroid therapy may be warranted.