ABSTRACT
Background and aims: Rare neurological syndromes have been associated with SARS-CoV-2 vaccination. Despite the growing number of cases reported, the characteristics of neurological diagnosis following SARS-CoV-2 vaccination and the underlying etiologic mechanisms still need further investigations. The aim of this study is to evaluate the association between specific neurological symptoms and syndromes and SARS-CoV-2 vaccination. Methods: In this retrospective, single center cohort study, we included all adult inpatients consecutively admitted to the Department of Clinical and Experimental Sciences, Neurology Unit, of the ASST Spedali Civili Hospital, Brescia, from January 2021 to August 2021. Results: Out of 871 consecutive patients admitted to Neurology Department, 102 and 61 subjects reported SARS-CoV-2 vaccination within 60 and 30 days, respectively. The most common neurological diagnosis following vaccination included cerebrovascular diseases (n=32), transient medical/neurological unexplained symptoms with negative instrumental tests (MUS, n=25), epileptic disorders (n=11) and demyelinating diseases (n=10). When compared to non-vaccinated cases, MUS emerged as the only diagnosis with higher prevalence in post-vaccine cases at 60 and 30 days (24,5% and 38% vs 7,2% of whole cohort). Conclusion: Unexplained transient neurological symptoms appeared to be the most common neurological condition following SARS-CoV-2 vaccination in comparison to nonvaccinated cases.
ABSTRACT
Background. COVID-19 is caused by SARS-CoV-2 virus and in many cases lead to a pneumonia. However a number of neumuscular manifestations have been associated to SARS-CoV-2 infection. Furthermore, multiorgan symptoms after COVID-19 are being reported by increasing numbers of patients, ranging from cough to fatigue and muscle pain. However, the long-term health consequences of COVID-19 remain largely unclear. Methods: We evaluated 124 patients hospitalized between march and May 2020 for SARS-COV-2 associated pneumonia at 6 and 12 months. We retrospectively collected clinical, laboratory and radiological information available. for each patient, cognitive tests, scales for depression and anxiety and a specific Fatigue Severity Scale (FSS) were performed. Results. Twenty-five patients died during hospitalization. At 12 months follow up 85 patient were evaluated. Eighty-seven (70%) patiens were male and mean age was 67.3 years. During hospitalization 43 (36.5%) of patients complain of myalgia. This patients had higher CK levels than patients who did not (534 U/L vs 93 U/l, p < 0.001). At 12 months 42% of patients complain about myalgia while 34% about fatigue. Mean FSS value were 32.93, and were significatively higher in patiets who complain about fatigue (41.52 vs 27.08 p < 0.001) and Muscle pain (40.84 vs 26.80, p < 0.001) compared to who did not. Conclusions. During hospitalization for COVID-19 myalgia was associated with an higher level of CK, suggesting a possible muscle involvement. At 12 month myalgia and fatigue were present in a more than a third of patient suggesting that this manifestation could be one of the main COVID-19 sequelae.
ABSTRACT
Background and aims: Objective: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection. No data about clinical, imaging and biomarkers presentations as well as long-term outcomes are available for SARS-CoV-2 encephalitis in comparison with infectious and autoimmune encephalitis. Methods: The ENCOVID European registry included patients with probable or definite diagnosis of encephalitis with and without SARS-CoV-2 infection admitted for hospitalization in the European recruiting centers between February 1st 2020 and March 30th, 2021. Each patient underwent a standardized assessment including full infectious screening, CSF, EEG, MRI data. Clinical presentation and laboratory markers, severity of COVID-19 disease, response to treatment and outcomes were recorded. Results: Results – Out of 155 cases screened, forty-five cases of encephalitis positive for SARS-CoV-2 infection and 63 without COVID-19 with full available data were included. SARS-CoV-2 encephalitis exhibited common presentation with aphasia and dysarthria compared to non-COVID- encephalitis and exhibited higher prevalence of patients with normal MRI but mild hyperproteinorracchia/pleocytosis. Most SARS-CoV-2 cases appeared during the onset of COVID-19 and exhibited different response to treatment and long-term outcomes compared to non COVID encephalitis. Conclusions: Conclusions –The registry identified a wide spectrum of encephalitis associated with COVID19 infection, with clinical characteristics and course different from classical infectious and autoimmune encephalitis. Biomarkers studies are warranted in order to evaluate the specific inflammatory pathways associated with SARS-Cov-2 encephalitis.
ABSTRACT
Objective: To assess Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) specific IgA/G seropositivity in patients with suspected autoimmune central nervous system (CNS) disorders. Background: Inflammatory/autoimmune disorders can be triggered by viral infections, as described in patients with antibodies to neuronal surface proteins or myelin oligodendrocyte glycoprotein (MOG). Whether SARS-CoV-2 infection induces such conditions is unknown, although widely hypothesised. Design/Methods: We retrospectively analysed consecutive samples referred for antibody screening to the Neuropathology Laboratory, Verona, for SARS-COV-2 IgA and IgG testing, from March 1 2020 to August 31 2020. Clinical information of seropositive cases was extracted from clinical records or provided by referring physicians. Results: Among 332 patients referred for antibody testing, 26 showed either SARS-CoV-2 IgA and/or IgG (IgA n=12, IgG n=1, IgA and IgG n=13). Among 22/26 available CSF, 4 were positive (IgG n=3, IgG and IgA n=1). Median age of seropositive cases was 61 years (range 27- 82) and 16 were female. Clinical features, available in 23 cases, revealed encephalopathy (n=15) and seizures (n=8) as common manifestations and, in four cases, myelitis, predominantly with lower limbs weakness. 19/23 patients were systemically asymptomatic. Brain MRI showed FLAIR-T2 hyperintensities in 13/18 patients. EEG showed alterations including epileptic discharges (n=5) and/or generalized slowing (n=12). CSF pleocytosis (>5 cells/μL) was reported in 9/19 investigated cases. Autoimmune neurology screening revealed one patient with serum titin autoantibodies, one with limbic encephalitis and seizures had serum and CSF amphiphys in antibodies, and one presenting with acute disseminated encephalomyelitis had serum and CSF MOG antibodies. Conclusions: The incidence of SARS-CoV-2 IgG/IgA positivity in our referred cohort, which was higher (7.8%, 18% when considering only patients with suspected encephalitis) than that reported in the Italian population (2.5%) and the observed clinical spectrum of disorders suggest that SARS-CoV2 could trigger inflammatory CNS processes, usually not associated with wellknown autoantibodies. Case-control studies are now required.