ABSTRACT
Immune-Mediated Necrotizing Myopathy (IMNM) after vaccination has been reported previously, however it is rare after COVID-19 vaccination. We report the first case of IMNM two weeks after vaccination with the AstraZeneca (AZD1222) COVID-19 vaccine. There was a probable temporal relationship between the COVID-19 vaccination and the development of IMNM due to lack of known causative factors for IMNM. This may have been due to 1) autoimmunity directly caused by the vaccine, 2) exacerbation of autoimmunity triggered by the vaccine or 3) autoimmune syndrome triggered by the vaccine adjutants. Further studies are needed to assess the underlying mechanisms.
Subject(s)
Autoimmune Diseases , COVID-19 Vaccines , COVID-19 , Muscular Diseases , Humans , Autoimmune Diseases/chemically induced , Autoimmune Diseases/drug therapy , ChAdOx1 nCoV-19 , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Muscular Diseases/chemically induced , Vaccination/adverse effectsABSTRACT
Complications are increasingly recognized with SARS-CoV-2, the causative pathogen for COVID-19. Various mechanisms have been proposed to justify the cause of seizures in Covid-19 patients. To our knowledge, 13 cases of status epilepticus (SE) associated with COVID-19 have been reported so far. Here, we present a single-center case series, including the clinical, laboratory, and imaging characteristics, and the EEG and the outcome of SE in 5 Iranian patients with laboratory-confirmed SARS-CoV-2 virus. SE was para-infectious in four patients and post-infectious in one other patient. In Three patients, the causes of seizure were included severe hyponatremia, acute ischemic stroke, and meningoencephalitis. However, in two other patients, no specific reason for seizure was found, but there are possibilities for lesser-known mechanisms of Covid-19 that play roles in developing SE. Two of the patients recovered, and three patients, older and with higher comorbidities, failed to recover and died.
ABSTRACT
Objective: In this study we aimed to evaluate the clinical and imaging characteristics of a cohort of COVID-19 patients with stroke. Background: Cerebrovascular diseases comprise a significant portion of neurological disorders related to COVID-19. Design/Methods: In this cross-sectional study, ninety-five COVID-19 patients with stroke were included between October 2020 and January 2021. Patients were evaluated based on the following clinical and imaging features: severity of COVID-19 (critical/non-critical), stroke type, presence or absence of clinical suspicion of stroke (suspicious/non-suspicious), medical risk factors, Fazekas scale, ASCOD criteria classification, and presence or absence of watershed infarction. Clinical outcomes were assessed based on Modified Rankin Scale (MRS) and mortality (during hospitalization and within three months of discharge). Chi-square test, independent t-test, and one-way ANOVA were used to compare variables. Multivariable logistic regression was applied to evaluate the effects of relevant factors on the likelihood that participants have watershed infarction. Results: Ischemic stroke (n=79, 83.1%) and intracerebral hemorrhage (n=7, 7.4%) were the most prevalent types of stroke. According to ASCOD classification, most common causes of ischemic stroke were cardioembolic (n=21, 26.6%) or other determined causes (n=18, 22.8%). Watershed infarction was the most common etiology among other determined causes (16/18, 88.9%). Watershed infarction was significantly associated with being clinically non-suspicious (OR=8.46, p<0.001) and death after discharge (OR=12, p<0.001). Patients with watershed infarction had a higher odds of having a high Fazekas score (OR=6.42, p=0.002) which was confirmed by logistic regression model (adjusted OR=26.1, p=0.006). Conclusions: Watershed infarct is one of the common causes of Ischemic stroke in COVID-19 patients, which should be considered in patients with critical COVID-19 and those without obvious clinical symptoms of stroke. Patients with chronic small vessel disease are more susceptible to watershed infarctions. Early neuroimaging can play an important role to better identify these patients.
ABSTRACT
Coronavirus (COVID-19) is a worldwide epidemic. Although the main target of COVID-19 is the respiratory system, it is known that the virus can cause neurological complications. Previous studies have shown that its neurological manifestations are usually seen in critically ill patients. In this study, we introduced patients who developed COVID-induced encephalitis despite their good general condition and mild symptoms. The only symptoms of encephalitis in these patients were cognitive impairment, that persisted for more than 6 months. This disorder was confirmed by Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG) test results in patients. While previous studies have shown that COVID-induced cognitive impairment improves over time. Therefore, it is recommended that the diagnosis and treatment of encephalitis be considered in patients with COVID-19 who have mild cognitive and behavioral symptoms.