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1.
Neurological Sciences ; 43(Supplement 1):S65, 2022.
Article in English | EMBASE | ID: covidwho-2174316

ABSTRACT

Background: Creutzfeldt-Jakob disease (CJD) is a rare disorder with known phenotypic variability. A small number of cases presents without cognitive decline in the early stages, and approximately 5% with isolated ataxia, leading to a major risk of postponed or mistaken diagnosis. Case report: Two weeks after a symptomatic SARS-CoV-2 infection, a 60-year-old man developed left arm ataxia and distal paresthesias, followed by mild postural instability, dysarthria and diplopia. He was admitted to the local hospital where he underwent CSF analysis (albuminocytological dissociation), neurophysiological study (mild polyneuropathy) and an autoimmune/paraneoplastic encephalitides antibodies panel (negative). The patient was diagnosed with post-infective Miller-Fisher syndrome and treated with intravenous immunoglobulin (IVIg). The symptoms progressively worsened, and, when, one month later, the patient presented to our clinic neurological examination revealed a severe cerebellar syndrome: dysmetric ocular saccades, scanning speech, asymmetrical limb ataxia and markedly unsteady gait. A totalbody CT-scan excluded neoplasms. A 3-tesla MRI revealed cortical ribbon hyperintensities in T2/FLAIR and diffusion restriction in insular and frontal cortices, cingulate gyri and right parieto-occipital lobe, FLAIR/ DWI abnormalities of the right caudate nucleus and vermian atrophy. EEG showed biphasic PSIDDs. CSF examination detected the presence of 14-3-3 protein, a very high level of tau protein with normal phosphotau and a slightly reduced Abeta1-42 with normal Abeta42/40 ratio. Based on proposed CDC criteria, a diagnosis of probable sporadic CJD was performed. Over two weeks, the patient deteriorated to akinetic mutism, ophthalmoplegia, dysphagia, severe generalized hypertonia and myoclonic jerks. He died within two months of disease onset. Discussion(s): Our case report describes an atypical presentation of CJD preceded by SARS-CoV2 infection.A pandemic, such as the COVID-19, can complicate the CJD differential diagnosis, suggesting in first place a post-infectious inflammatory disorder. In our case, the dramatic rapid worsening of the ataxic syndrome and unresponsiveness to IVIg suggested an alternative paraneoplastic or neurodegenerative hypothesis. In the subsequent diagnostic work-up, cerebral MRI was of paramount importance and led to the assessment of specific CJD biomarkers in CSF. Furthermore, the redirection towards CJD diagnosis raised a question about SARS-COV-2 infection: is its temporal correlation with disease onset coincidental, constituting only a potential misleading factor during the diagnostic process, or could systemic inflammatory responses to SARS-Cov-2 hasten the neurodegeneration process? To our knowledge, other 3 cases have been reported describing CJD temporally related to Covid-19. Further studies are needed to elucidate this problem.

2.
Neurological Sciences ; 43(Supplement 1):S219, 2022.
Article in English | EMBASE | ID: covidwho-2174296

ABSTRACT

Objectives: We performed a multicenter, prospective and retrospective, observational study, to evaluate the risk of disease relapse after COVID-19 vaccination in patients with chronic inflammatory neuropathies and the safety and tolerability of COVID-19 vaccines in these patients. Materials: Study subjects were chosen from among patients with CIDP or MMN included in the Italian CIDP and MMN databases. Method(s):We invited to participate CIDP and MMN patients fulfilling the EFNS/PNS criteria for probable/definite diagnosis who had been in a stable maintenance treatment or in remission without ongoing active treatment in the three months prior to the commencement of the study. We assessed the relative risk (RR) of relapse associated with COVID-19 vaccination by comparing patients who underwent or did not undergo vaccination. We also compared the frequency of relapse in CIDP and MMN patients undergoing vaccination for COVID-19 in the three months prior and after vaccination and evaluated safety and tolerability of the COVID-19 vaccines. Subjects were evaluated using objective outcome measures and a specific questionnaire. Result(s): A total of 336 patients were included (278 CIDP;58MMN). 307 (91%) patients underwent COVID-19 vaccination, including 269 (88%) with Pfizer/BioNTech, 28 (9%) with Moderna, and 10 (3%) with AstraZeneca. Twenty-nine patients (9%) did not undergo vaccination. Clinical relapse was observed in 16 (5.2%) patients (13 CIDP;3 MMN) who underwent COVID-19 vaccination and in none of the patients who did not undergo vaccination (RR= 3.21, 95% confidence interval [CI] 0.19-52.25). Compared to the 3-month control period preceding baseline, during which 4 (1.3%) of the 307 vaccinated patients had a disease relapse, the relative risk of relapse was increased. (RR: 4.00;95% CI, 1.35 to 11.82). The specific RR for Pfizer/BioNTech was 2.77 (95% CI, 0.16 - 45.74), and for Moderna was 9.31 (95% CI, 0.52 -165.33). None of the 10 patients who received the Astrazeneca vaccine had a relapse. The specific RR of relapse associated with COVID-19 vaccination in CIDP patients was 1.96 (95% CI, 0.12 to 31.81), while inMMN patients was 1.75 (95% CI, 0.09 - 31.64). The safety profile of the COVID-19 vaccines was similar to that observed in the general population. There were no serious adverse events. Discussion(s): Vaccination for COVID-19 in patients with CIDP and MMN seems to be associated with a small increased risk of disease relapse, and with an acceptable short-term safety profile. Conclusion(s): The benefits of COVID-19 vaccination in CIDP and MMN patients outweigh the risk of disease relapse.

5.
Minerva Dental and Oral Science ; 71(2):96-100, 2022.
Article in English | MEDLINE | ID: covidwho-1847996

ABSTRACT

BACKGROUND: Italy has been the first affected country in the western hemisphere by SARS-CoV-2 with over 200,000 cases during the first months of the pandemics. To control the spread of the virus, the whole country was placed under lockdown with limitations in the circulation of people and vehicles from March 2020 to the first half of the month of May. METHODS: We aimed to analyze the incidence and type of facial traumas referred to our tertiary care hospital during the months of Italy lockdown due to SARS-CoV-2 spread compared with those during the same months of 2019 to determine eventual variations in the incidence, type and causes of trauma. RESULTS: During the 2 months of COVID-19-related lockdown, a dramatic decrease in facial trauma patients was observed at our tertiary care hospital with a shift toward older age ranges. Regarding the causes of trauma, the largest percentage reduction was found in road, sports and work accidents;this percentage reduction was not found in aggressions. CONCLUSIONS: A small increase in the percentage was also found regarding surgical indications, likely because more severe cases were more prone to be referred to the hospital despite the fear of being infected.

7.
Minerva Stomatol ; 2020.
Article in English | PubMed | ID: covidwho-948299

ABSTRACT

OBJECTIVES: Italy has been the first affected country in the western haemisphere by SARS-COV 2 with over 200.000 cases during the first months o the pandemica. To control the spread of the virus, the whole country was placed under lockdown with limitations in the circulation of people and vehicles from March 2020 to the first half of the month of May. MATERIALS AND METHODS: We aimed to analyze the incidence and type of facial traumas referred to our tertiary care hospital during the months of Italy lockdown due to SARS - COVID 2 spread compared with those during the same months of 2019 to determine eventual variations in the incidence, type and causes of trauma. RESULTS AND CONCLUSIONS: During the 2 months of COVID-19-related lockdown, a dramatic decrease in facial trauma patients was observed at our tertiary care hospital with a shift toward older age ranges. Regarding the causes of trauma, the largest percentage reduction was found in road, sports and work accidents;this percentage reduction was not found in aggressions. A small increase in the percentage was also found regarding surgical indications, likely because more severe cases were more prone to be referred to the hospital despite the fear of being infected.

9.
Eur J Neurol ; 27(11): 2361-2370, 2020 11.
Article in English | MEDLINE | ID: covidwho-787766

ABSTRACT

Guillain-Barré syndrome (GBS) incidence can increase during outbreaks of infectious illnesses. A few cases of GBS associated with coronavirus disease 2019 (COVID-19) infection have been reported. The aim was to identify specific clinical features of GBS associated with COVID-19. PubMed, Embase and Cochrane were searched from 1 November 2019 to 17 May 2020 and included all papers with full text in English, Spanish, French or Italian, reporting original data of patients with GBS and COVID-19. Data were extracted according to a predefined protocol. A total of 18 patients reported in 14 papers were included in this review. All the patients were symptomatic for COVID-19, with cough and fever as the most frequently reported symptoms. The interval between the onset of symptoms of COVID-19 and the first symptoms of GBS ranged from -8 to 24 days (mean 9 days; median 10 days). Most of the patients had a typical GBS clinical form predominantly with a demyelinating electrophysiological subtype. Mechanical ventilation was necessary in eight (44%) patients. Two (11%) patients died. Published cases of GBS associated with COVID-19 report a sensorimotor, predominantly demyelinating GBS with a typical clinical presentation. Clinical features and disease course seem similar to those observed in GBS related to other etiologies. These results should be interpreted with caution since only 18 cases have been heterogeneously reported so far.


Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/etiology , COVID-19/mortality , Demyelinating Diseases/etiology , Guillain-Barre Syndrome/mortality , Humans
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