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2.
J Neurol Neurosurg Psychiatry ; 92(7): 751-756, 2021 07.
Article in English | MEDLINE | ID: covidwho-1269801

ABSTRACT

OBJECTIVE: Single cases and small series of Guillain-Barré syndrome (GBS) have been reported during the SARS-CoV-2 outbreak worldwide. We evaluated incidence and clinical features of GBS in a cohort of patients from two regions of northern Italy with the highest number of patients with COVID-19. METHODS: GBS cases diagnosed in 12 referral hospitals from Lombardy and Veneto in March and April 2020 were retrospectively collected. As a control population, GBS diagnosed in March and April 2019 in the same hospitals were considered. RESULTS: Incidence of GBS in March and April 2020 was 0.202/100 000/month (estimated rate 2.43/100 000/year) vs 0.077/100 000/month (estimated rate 0.93/100 000/year) in the same months of 2019 with a 2.6-fold increase. Estimated incidence of GBS in COVID-19-positive patients was 47.9/100 000 and in the COVID-19-positive hospitalised patients was 236/100 000. COVID-19-positive patients with GBS, when compared with COVID-19-negative subjects, showed lower MRC sum score (26.3±18.3 vs 41.4±14.8, p=0.006), higher frequency of demyelinating subtype (76.6% vs 35.3%, p=0.011), more frequent low blood pressure (50% vs 11.8%, p=0.017) and higher rate of admission to intensive care unit (66.6% vs 17.6%, p=0.002). CONCLUSIONS: This study shows an increased incidence of GBS during the COVID-19 outbreak in northern Italy, supporting a pathogenic link. COVID-19-associated GBS is predominantly demyelinating and seems to be more severe than non-COVID-19 GBS, although it is likely that in some patients the systemic impairment due to COVID-19 might have contributed to the severity of the whole clinical picture.


Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/epidemiology , Adult , Aged , COVID-19/diagnosis , COVID-19/therapy , Female , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/therapy , Hospitalization , Humans , Incidence , Italy , Male , Middle Aged , Referral and Consultation , Retrospective Studies
3.
Neurology ; 95(7): e910-e920, 2020 08 18.
Article in English | MEDLINE | ID: covidwho-1115264

ABSTRACT

OBJECTIVE: To report clinical and laboratory characteristics, treatment, and clinical outcomes of patients admitted for neurologic diseases with and without coronavirus disease 2019 (COVID-19). METHODS: In this retrospective, single-center cohort study, we included all adult inpatients with confirmed COVID-19 admitted to a neuro-COVID unit beginning February 21, 2020, who had been discharged or died by April 5, 2020. Demographic, clinical, treatment, and laboratory data were extracted from medical records and compared (false discovery rate corrected) to those of neurologic patients without COVID-19 admitted in the same period. RESULTS: One hundred seventy-three patients were included in this study, of whom 56 were positive and 117 were negative for COVID-19. Patients with COVID-19 were older (77.0 years, interquartile range [IQR] 67.0-83.8 years vs 70.1 years, IQR 52.9-78.6 years, p = 0.006), had a different distribution regarding admission diagnoses, including cerebrovascular disorders (n = 43, 76.8% vs n = 68, 58.1%), and had a higher quick Sequential Organ Failure Assessment (qSOFA) score on admission (0.9, IQR 0.7-1.1 vs 0.5, IQR 0.4-0.6, p = 0.006). In-hospital mortality rates (n = 21, 37.5% vs n = 5, 4.3%, p < 0.001) and incident delirium (n = 15, 26.8% vs n = 9, 7.7%, p = 0.003) were significantly higher in the COVID-19 group. Patients with COVID-19 and without COVID with stroke had similar baseline characteristics, but patients with COVID-19 had higher modified Rankin Scale scores at discharge (5.0, IQR 2.0-6.0 vs 2.0, IQR 1.0-3.0, p < 0.001), with a significantly lower number of patients with a good outcome (n = 11, 25.6% vs n = 48, 70.6%, p < 0.001). In patients with COVID-19, multivariable regressions showed increasing odds of in-hospital death associated with higher qSOFA scores (odds ratio [OR] 4.47, 95% confidence interval [CI] 1.21-16.5, p = 0.025), lower platelet count (OR 0.98, 95% CI 0.97-0.99, p = 0.005), and higher lactate dehydrogenase (OR 1.01, 95% CI 1.00-1.03, p = 0.009) on admission. CONCLUSIONS: Patients with COVID-19 admitted with neurologic disease, including stroke, have a significantly higher in-hospital mortality and incident delirium and higher disability than patients without COVID-19.


Subject(s)
Coronavirus Infections/epidemiology , Inpatients/statistics & numerical data , Nervous System Diseases/epidemiology , Pneumonia, Viral/epidemiology , Aged , Aged, 80 and over , Betacoronavirus/isolation & purification , COVID-19 , Case-Control Studies , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/mortality , Female , Hospital Mortality , Humans , Italy/epidemiology , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/mortality , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/mortality , Retrospective Studies , SARS-CoV-2 , Severity of Illness Index
4.
Neurophysiol Clin ; 51(2): 183-191, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1087170

ABSTRACT

OBJECTIVE: To assess whether patients with acute inflammatory demyelinating polyneuropathy (AIDP) associated with SARS-CoV-2 show characteristic electrophysiological features. METHODS: Clinical and electrophysiological findings of 24 patients with SARS-CoV-2 infection and AIDP (S-AIDP) and of 48 control AIDP (C-AIDP) without SARS-CoV-2 infection were compared. RESULTS: S-AIDP patients more frequently developed respiratory failure (83.3% vs. 25%, P=0.000) and required intensive care unit (ICU) hospitalization (58.3% vs. 31.3%, P=0.000). In C-AIDP, distal motor latencies (DMLs) were more frequently prolonged (70.9% vs. 26.2%, P=0.000) whereas in S-AIDP distal compound muscle action potential (dCMAP) durations were more frequently increased (49.5% vs. 32.4%, P=0.002) and F waves were more often absent (45.6% vs. 31.8%, P=0.011). Presence of nerves with increased dCMAP duration and normal or slightly prolonged DML was elevenfold higher in S-AIDP (31.1% vs. 2.8%, P=0.000);11 S-AIDP patients showed this pattern in 2 nerves. CONCLUSION: Increased dCMAP duration, thought to be a marker of acquired demyelination, can also be oserved in critical illness myopathy. In S-AIDP patients, an increased dCMAP duration dissociated from prolonged DML, suggests additional muscle fiber conduction slowing, possibly due to a COVID-19-related hyperinflammatory state. Absent F waves, at least in some S-AIDP patients, may reflect α-motor neuron hypoexcitability because of immobilization during the ICU stay. These features should be considered in the electrodiagnosis of SARS-CoV-2 patients with weakness, to avoid misdiagnosis.


Subject(s)
COVID-19/complications , COVID-19/physiopathology , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Action Potentials , Adult , Aged , Aged, 80 and over , Critical Care/statistics & numerical data , Electrodiagnosis , Electrophysiological Phenomena , Female , Hospitalization/statistics & numerical data , Humans , Male , Middle Aged , Motor Neurons , Muscle, Skeletal/physiopathology , Neural Conduction , Respiratory Insufficiency/etiology , Sensory Receptor Cells
5.
Neurol Sci ; 41(12): 3471-3474, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-888211

ABSTRACT

A wide range of neurological signs and symptoms have been associated with SARS-CoV-2 infection. In the present report, we described two Italian patients diagnosed with diaphragmatic myoclonus after COVID-19. In both cases, mild lymphocytosis at cerebrospinal fluid analysis and no structural brain changes were reported. The pathophysiological origin of the myoclonus in the two cases was different. In case 1, electroencephalogram did not reveal any cortical correlates and brain imaging of the spine was unremarkable, while in case 2, cortical origin of myoclonus was demonstrated. With the present two cases, we confirm and extend the neurological manifestations of SARS-CoV-2 infection.


Subject(s)
Coronavirus Infections/complications , Diaphragm/physiopathology , Myoclonus/virology , Pneumonia, Viral/complications , Aged, 80 and over , Betacoronavirus , COVID-19 , Female , Humans , Male , Middle Aged , Pandemics , SARS-CoV-2
6.
J Neurol Neurosurg Psychiatry ; 92(2): 218-220, 2021 02.
Article in English | MEDLINE | ID: covidwho-873577
7.
Ann Neurol ; 88(2): 423-427, 2020 08.
Article in English | MEDLINE | ID: covidwho-600958

ABSTRACT

Coronavirus disease 2019 (COVID-19) infection has the potential for targeting the central nervous system, and several neurological symptoms have been described in patients with severe respiratory distress. Here, we described the case of a 60-year-old patient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection but only mild respiratory abnormalities who developed an akinetic mutism attributable to encephalitis. Magnetic resonance imaging was negative, whereas electroencephalography showed generalized theta slowing. Cerebrospinal fluid analyses during the acute stage were negative for SARS-CoV-2, positive for pleocytosis and hyperproteinorrachia, and showed increased interleukin-8 and tumor necrosis factor-α concentrations. Other infectious or autoimmune disorders were excluded. A progressive clinical improvement along with a reduction of cerebrospinal fluid parameters was observed after high-dose steroid treatment, thus arguing for an inflammatory-mediated brain involvement related to COVID-19. ANN NEUROL 2020;88:423-427.


Subject(s)
Akinetic Mutism/physiopathology , Antiviral Agents/therapeutic use , Coronavirus Infections/drug therapy , Encephalitis/drug therapy , Glucocorticoids/therapeutic use , Methylprednisolone/therapeutic use , Pneumonia, Viral/drug therapy , Betacoronavirus , COVID-19 , Coronavirus Infections/cerebrospinal fluid , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Drug Combinations , Electroencephalography , Encephalitis/cerebrospinal fluid , Encephalitis/complications , Encephalitis/physiopathology , Humans , Hydroxychloroquine/therapeutic use , Interleukin-6/cerebrospinal fluid , Interleukin-8/cerebrospinal fluid , Lopinavir/therapeutic use , Magnetic Resonance Imaging , Male , Middle Aged , Pandemics , Pneumonia, Viral/cerebrospinal fluid , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Ritonavir/therapeutic use , SARS-CoV-2 , Treatment Outcome , Tumor Necrosis Factor-alpha/cerebrospinal fluid , beta 2-Microglobulin/cerebrospinal fluid
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