SARS-CoV-2 Impairs Vision.

OBJECTIVES: Affection of the central nervous system and the eyes is increasingly recognized as manifestations of a SARS-CoV-2 infection (COVID-19). This review aims at summarizing and discussing recent advances concerning causes and locations of impaired vision because of an infection with SARS-CoV-2. METHODS: On a literature search through PubMed and ScholarOne, all available publications about COVID-19 patients with impaired vision were retrieved. RESULTS: Visual impairment in SARS-CoV-2-infected patients may be due to infection of lacrimal glands (dacryoadenitis), conjunctivitis, tonic pupils, vitritis, central retinal artery/venous occlusion, retinitis, retinal bleeding, panuveitis, anterior ischemic optic neuropathy, optic nerve stroke, optic neuritis, optic perineuritis, or occipital ischemic stroke. Visual impairment may be the initial manifestation of SARS-CoV-2. CONCLUSIONS: This mini review shows that impaired vision may be the initial manifestation of COVID-19, that all sections of the visual tract may be affected and causative for visual impairment in COVID-19 patients, and that SARS-CoV-2 manifests along the visual tract with ischemia, focal infection, and immunological reactions.

Necrotizing pancreatitis, microangiopathic hemolytic anemia and thrombocytopenia following the second dose of Pfizer/BioNTech COVID-19 mRNA vaccine.

Implementing vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a major asset in slowing down the coronavirus disease 2019 (COVID-19) pandemic. For mRNA vaccines, the main severe adverse events reported in pharmacovigilance systems and post-authorization studies were anaphylaxis and myocarditis. Pancreatitis after Pfizer/BioNTech COVID-19 vaccination has been reported only in 10 patients.We report a 31-year-old female with a history of borderline personality disorder, intravenous drug abuse, allergic asthma, eating disorder, psoriatic arthritis treated with tofacitinib, neurogenic bladder disturbance, cholecystectomy, recurrent thoracic herpes zoster, vaginal candida infections and urinary tract infections, who developed pancreatitis associated with thrombotic microangiopathy and hemolytic-uremic syndrome 10 days after the second vaccination, whereas the first has been well tolerated. She was treated by plasma exchange, and eventually by transgastric drainage with implantation of a plastic stent to remove fluid abdominal retentions. She was discharged after 19 days. Since then her condition has improved continuously. Computed tomography after 12 months did not reveal retentions anymore.As other causes of pancreatitis have been excluded, this case of acute pancreatitis, microangiopathic hemolytic anemia and thrombocytopenia, temporally associated with the Pfizer-BioNTech COVID-19 vaccine, suggests a causal link.

The Spectrum of Neuro-COVID is Broader than Frequently Anticipated.

The spectrum of neuro-COVID is broader than anticipated. Neurological disease in COVID-19 may be due to a direct attack of the virus, due to the immune response against the virus, secondary due to affection of the heart or arteries, or due to side effects from the treatment applied against COVID-19. How to cite this article: Finsterer J. The Spectrum of Neuro-COVID is Broader than Frequently Anticipated. Indian J Crit Care Med 2023;27(5):366-367.

Neurological implications of cardiac compromise in COVID-19.

OBJECTIVES: There is increasing evidence that particularly in patients with severe SARS-CoV-2 infection (COVID-19) the heart can be primarily or secondarily compromised. Neurological disease as a complication of SARS-CoV-2 associated cardiac disease is conceivable. This review aims at summarising and discussing previous and recent advances in the clinical presentation, pathophysiology, diagnosis, treatment, and outcome of cardiac complications and its implications on the brain of SARS-CoV-2 infected patients. METHOD: Literature review using appropriate search terms and applying inclusion and exclusion criteria. RESULTS: Cardiac complications in SARS-CoV-2 infected patients not only include myocardial injury, myocarditis, Takotsubo cardiomyopathy (TTS), coagulation abnormalities, heart failure, cardiac arrest, arrhythmias, acute myocardial infarction, or cardiogenic shock, but a number of other more rarely occurring cardiac abnormalities. Additionally considered should be endocarditis due to superinfection, viral or bacterial pericarditis, aortic dissection, pulmonary embolism from the right atrium, ventricle or outflow tract, and cardiac autonomic denervation. Cardiac damage due to side effects from the anti-COVID medication should not be neglected. Several of these conditions may be complicated by ischemic stroke, intracerebral bleeding, or dissection of cerebral arteries. CONCLUSION: The heart can be definitively affected in severe SARS-CoV-2 infection. Heart disease in COVID-19 may be complicated by stroke, intracerebral bleeding, or dissection of cerebral arteries. Treatment of SARS-CoV-2 associated cardiac disease is not at variance from that of cardiac disease without this infection.

SARS-CoV-2-Associated Guillain-Barre Syndrome is Common but Under- recognised and Under- reported.

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