Long-lasting Cognitive impairment after COVID-19

Background and aims: The potential involvement of the CNS in COVID-19 attracts considerable attention due to the variety of neurological manifestations presented during or as a result of the disease process. HSV-1 most commonly causes encephalitis, and the most common neurological complication of HSV-2 infection is aseptic meningitis. Methods: To present cases of meningitis patients with clinical and CSF findings corresponding to herpes meningitis diagnosed during or shortly after COVID-19 disease and to analyze the potential relationship between the two diseases. Results: We present four cases of patients with clinical and laboratory data for viral meningitis diagnosed during or shortly after SARS-CoV-2 infection. The four patients were young people, without concomitant diseases. We found mild protein-cell dissociation in the CSF. CSF virology rejected the presence of SARS-CoV-2, but all four patients tested positive for CSF for herpes viruses. All four patients were treated according to a viral neuroinfection treatment protocol and had a good clinical response with complete recovery. Conclusion: We compared our experience in terms of clinical course, performed research, treatment and the corresponding response to it, with the cases published so far. Patients were expected to have SARS-CoV-2 meningitis with a history of epidemiology. Despite the lack of evidence for SARS-CoV-2 in CSF, we hypothesize an indirect link between infection and the onset of herpes meningitis. The probable cause is that severe infection with SARS-Cov 2, similar to other severe viral infections, results in a change in the T-cell response. This process leads to increased susceptibility to other viral infections.