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2.
J Neurovirol ; 2022 Jul 25.
Article in English | MEDLINE | ID: covidwho-1959179

ABSTRACT

Vestibular neuritis was first reported in 1952 by Dix and Hallpike, and 30% of patients reporting a flu-like symptom before acquiring the disorder. The most common causes are viral infections, often resulting from systemic viral infections or bacterial labyrinthitis. Here we presented a rare case of acute vestibular neuritis after the adenoviral vector-based COVID-19 vaccination. A 51-year-old male pilot awoke early in the morning with severe vertigo, nausea, and vomiting after receiving the first dose of the ChAdOx1 nCoV-19 vaccine 11 days ago. Nasopharyngeal SARS-CoV-2 RT-PCR test and chest CT scan were inconclusive for COVID-19 pneumonia. Significant findings were a severe spontaneous and constant true-whirling vertigo which worsened with head movement, horizontal-torsional spontaneous nystagmus, abnormal caloric test, positive bedside head impulse tests, and inability to tolerate head-thrust test. PTA, MRI of the brain and internal auditory canal, and cerebral CT arteriography were normal. According to the clinical, imaging, and laboratory findings, he was admitted to the neurology ward and received treatment for vestibular neuritis. His vertigo increased gradually over 6-8 h, peaking on the first day, and gradually subsided over 7 days. Ten days later, the symptoms became tolerable; the patient was discharged with advice for home-based vestibular rehabilitation exercises. Despite the proper treatment and rehabilitation, signs of dynamic vestibular imbalances persisted after 1 year. Based on the Federal Aviation Administration (FAA) regulations, the Air Medical Council (AMC) suspended him from flight duties until receiving full recovery. Several cases of vestibular neuritis have been reported in the COVID-19 patients and after the COVID-19 vaccination. This is the first case report of acute vestibular neuritis after the ChAdOx1 nCoV-19 vaccination in a healthy pilot without past medical history. However, the authors believe that this is a primary clinical suspicion that must be considered and confirmed after complete investigations.

3.
Clin Exp Vaccine Res ; 11(2): 217-221, 2022 May.
Article in English | MEDLINE | ID: covidwho-1912136

ABSTRACT

Lacunar strokes occur when a branch of a large cerebral artery is blocked. The thalamus is often affected, causing uncontrollable motions. A 72-year-old previously healthy man presented with involuntary motions in the right limbs, which were present at rest, and exacerbated during voluntary actions. He had received the first dose of the adenoviral vector-based coronavirus disease 2019 vaccine (ChAdOx1 nCoV-19) 9 days ago. Severe thrombocytopenia and elevated levels of lactate dehydrogenase, ferritin, C-reactive protein, and D-dimer were found, without any evidence of connective tissue disease. Electromyography demonstrated typical choreiform movements, and the brain magnetic resonance imaging indicated a small high signal lesion on the left side of the thalamus. Detection of the immunoglobulin G antibodies against platelet factor 4 in the blood, negative heparin-induced platelet activation (HIPA) test, and positive modified HIPA test confirmed the thalamic stroke due to the vaccine-induced prothrombotic immune thrombocytopenia (VIPIT). He was admitted to the intensive care unit and received nadroparin, sodium ozagrel, edaravone, methylprednisolone, and haloperidol. His hemi-chorea improved gradually over 2 weeks, and he was discharged after 21 days with rehabilitation advice. VIPIT due to the ChAdOx1 nCoV-19 is a novel immune-mediated response that needs clinicians' awareness and further investigations.

4.
Air Med J ; 41(4): 402-405, 2022.
Article in English | MEDLINE | ID: covidwho-1850584

ABSTRACT

A 43-year-old male Bell 214C helicopter pilot presented to the emergency ward with flu-like syndrome. His nasopharyngeal severe acute respiratory syndrome coronavirus 2 real-time polymerase chain reaction test was positive, and a chest computed tomographic scan confirmed coronavirus disease 2019 pneumonia. He was admitted, received treatment, was discharged, and returned to flying. During the mission debrief, copilots who had flown with him reported that he experienced episodes of in-flight dizziness and blacked out. They occurred briefly during the cruise and hovering flight, perhaps for a few seconds of disorientation and unconsciousness. Rapid identification of the copilot and control of the helicopter prevented any incident or accident. Afterward, he explained the sudden onset and unexpected brief periods of loss of consciousness after a headache. The flight safety office referred him to the aviation medical center for further investigations. The cardiovascular, neurologic, laboratory, and toxicologic assessments were inconclusive with the approach to sudden-onset transient loss of consciousness. The only abnormal finding was hippocampus lesions on brain magnetic resonance imaging (MRI). Because of the possible diagnosis of transient global amnesia, the aviation medical examiner suspended him from flight duties until complete recovery and the absence of any probable complications.


Subject(s)
Amnesia, Transient Global , COVID-19 , Adult , Amnesia, Transient Global/diagnosis , Amnesia, Transient Global/etiology , Brain , Humans , Male , Tomography, X-Ray Computed/adverse effects , Unconsciousness/complications
5.
Medical Journal Armed Forces India ; 2022.
Article in English | ScienceDirect | ID: covidwho-1851800

ABSTRACT

Hypoxia is an operational concern in military aviation, and fighter pilots should undertake altitude hypoxia training. Anisocoria is a significant clinical dilemma and may remain a diagnostic challenge for specialists. We present a case of atraumatic unilateral mydriasis during hypobaric chamber training. Our diagnostic dilemma is novel and unique because the authors reported no similar presentation yet, it occurred in a fighter pilot whose occupational future depends on having normal vision, and second, the presence of hypoxia seems to trigger symptoms.

6.
Arch Acad Emerg Med ; 10(1): e10, 2022.
Article in English | MEDLINE | ID: covidwho-1743129

ABSTRACT

Introduction: Although neurologic involvement and neuroimaging abnormalities have been frequently identified in COVID-19 patients, the underlying factors remain unclear. In this study, we assessed the association of the neurological manifestations and neuroimaging features of hospitalized COVID-19 patients with their clinical, laboratory, and imaging characteristics. Methods: This multicenter cross-sectional study was conducted between September 2020 and March 2021 at two large academic hospitals in Tehran, Iran. We used census sampling from medical records to enroll hospitalized patients with a positive COVID-19 Polymerase chain reaction (PCR) test who underwent brain imaging due to presenting any acute neurologic symptom during hospital stay. Results: Of the 4372 hospitalized patients with COVID-19, only 211 met the inclusion criteria (35.5% with severe infection). Central nervous system and psychiatric manifestations were significantly more common in severe cases (p ≤ 0.044). Approximately, 30% had a new abnormality on their neuroimaging, with ischemic (38/63) and hemorrhagic (16/63) insults being the most common. The most frequent reasons that provoked cranial imaging were headache (27%), altered consciousness (25.6%), focal neurologic signs (19.9%), and delirium (18%). Analysis revealed a positive correlation for age, neutrophilia, lymphopenia, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) with the emergence of neuroimaging abnormalities (p ≤ 0.018). In addition, patients with new neuroimaging abnormalities had a significantly higher lung CT score than those without any pathologic findings (11.1 ± 4.8 vs. 5.9 ± 4.8, p < 0.001). Conclusion: Approximately 30% of the study population had various acute neuroimaging findings. The lung CT score, neutrophil count, and age were strong predictors of acute neuroimaging abnormalities in hospitalized COVID-19 patients.

7.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-312173

ABSTRACT

Background: SARS-CoV-2 (COVID-19) is a new human pathogen, and currently, the world has been plagued by its pandemic and there are no specific treatment options, mostly affects the respiratory system, ranging from mild flu-like symptoms to severe acute respiratory syndrome (SARS), but extra respiratory multi-systemic involvement has also been reported. Case presentation: A 63-yr-old Caucasian male veteran (retired army colonel), known case of controlled Type 2 diabetes, chronic renal failure and ischemic heart disease, about 4 days after the onset of flu-like syndrome (with no trauma history) experienced loss of control over both lower limbs, absent sensation from the chest below with constipation and urinary retention. Due to world SARS-CoV-2 (COVID-19) outbreak, his nasopharyngeal specimen was tested for COVID-19 reverse transcription polymerase chain reaction (RT-PCR) and positive result obtained. Chest x-ray and HRCT suggested severe pulmonary involvement. Immediately, he was admitted at emergency ward, treated based national COVID-19 protocol and a series of diagnostic procedures were started up to find out the cause of his non-heterogeneous peripheral (spinal) neuromuscular manifestations. Brain CT scan and MRI were normal, but spinal MRI with gadolinium contrast agent showing extensive increased T2 signal involves central grey matter and dorsal columns, extension between C7 and T12 with linear sagittally oriented enhancement posteriorly within the cord in the mid and lower thoracic cord. The CSF specimen obtained from LP shown pleocytosis, positive RT-PCR for SARS-CoV-2 and elevated IgG index. Clinical presentations, MRI, CSF and laboratory findings, after ruled out the other numerous possible causes with specific methods, suggested the Acute Transverse Myelitis (ATM) as a probably complication of COVID-19 infection. Intravenous methylprednisolone and then human immunoglobulin was added to treatment regimen. At the end, complete resolution of dysaesthesia, urinary retention and constipation were achieved. After continuous and long respiratory and motor rehabilitation programs, he was discharged home asymptomatic. Conclusions: : We believe that SARS-CoV-2 has a potential to produces different extra respiratory multi-systemic involvement as immune-mediated process and complexes, and this should be kept in mind whenever encounter a patient with acute onset of neurological manifestations, especially after microbial infections or vaccinations.

8.
Med J Armed Forces India ; 77: S494-S498, 2021 Jul.
Article in English | MEDLINE | ID: covidwho-1525894

ABSTRACT

World health care systems are affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and its associated disease, coronavirus disease 2019 (COVID-19). This new human pathogen mostly affects the respiratory system, but various extrapulmonary pathologies have been reported in the literature. It seems that the gastrointestinal system is one of the target organs for SARS-CoV- 2. Diarrhea as a long-term bowel symptom is not rare, although its occurrence is not as high as that of fever and cough.

9.
Eur J Transl Myol ; 31(3)2021 Aug 31.
Article in English | MEDLINE | ID: covidwho-1468559

ABSTRACT

A 56-year-old man was referred to the emergency department for the subacute onset of and weakness in the lower extremities, paraesthesia and pain. He was diagnosed with SARS-CoV-2 pneumonia and then, he received the necessary treatment according to national protocol. Radiographic, laboratory, and electroneurographic findings indicated an acute polyradiculoneuritis with prominent demyelination and suggesting the diagnosis of Guillain-Barr syndrome associated with COVID-19 infection.

10.
J Neurovirol ; 27(2): 354-358, 2021 04.
Article in English | MEDLINE | ID: covidwho-1111383

ABSTRACT

A 63-year-old Caucasian male, known case of controlled type 2 diabetes, chronic renal failure, and ischemic heart disease, was presented with weakness and loss of movement in lower limbs, an absent sensation from the chest below, constipation, and urinary retention. About 4 days before these symptoms, he experienced a flu-like syndrome. Suspicious for COVID-19, his nasopharyngeal specimen's reverse transcription-polymerase chain reaction (RT-PCR) resulted positive. Chest X-ray and HRCT demonstrated severe pulmonary involvement. Immediately, he was admitted to the emergency ward, and the treatment was started according to the national COVID-19 treatment protocol. Subsequently, diagnostic measures were taken to investigate the patient's non-heterogeneous peripheral (spinal) neuromuscular manifestations. Brain CT scan and MRI were normal, but spinal MRI with gadolinium contrast showed extensive increased T2 signal involving central gray matter and dorsal columns, extended from C7 to T12 with linear enhancement in the sagittal plane, posteriorly within the mid and lower thoracic cord. The CSF specimen demonstrated pleocytosis, positive RT-PCR for SARS-CoV-2, and elevated IgG index. Clinical presentation, MRI, CSF, and laboratory findings prioritized the acute transverse myelitis (ATM) as a probable complication of COVID-19 infection over other differential diagnoses. Intravenous methylprednisolone and, subsequently, IV human immunoglobulin were added to the treatment regimen. In the end, the complete resolution of dysesthesia, urinary retention, and constipation were achieved. After continuous and extended respiratory and motor rehabilitation programs, he was discharged asymptomatic.


Subject(s)
COVID-19/complications , Myelitis, Transverse/virology , Paraplegia/virology , COVID-19/drug therapy , COVID-19/therapy , Diabetes Mellitus, Type 2/epidemiology , Humans , Kidney Failure, Chronic/epidemiology , Male , Middle Aged , Myelitis, Transverse/therapy , Myocardial Ischemia/epidemiology , SARS-CoV-2
11.
Air Med J ; 40(3): 179-181, 2021.
Article in English | MEDLINE | ID: covidwho-1108010

ABSTRACT

A 42-year-old man with coronavirus disease 2019 pneumonia was admitted to a small town hospital that did not have intensive care unit (ICU)-level resources available. Twelve hours later, the patient suddenly became agitated, and an extensive anterolateral ST-elevation myocardial infarction was detected by 12-lead electrocardiography and supported by a rise in serum cardiac enzymes. Low blood oxygen saturation (59%) and cardiac ejection fraction (ejection fraction = 20%) reflected criticality that could potentially require a catheterization laboratory, coronary artery bypass graft surgery, and ICU-level resources. After the coordination of physicians with the nearest equipped hospital and air medical crew, a Mil Mi-17 medical helicopter unit was dispatched. About 20 minutes before reaching the destination hospital, his clinical condition declined; his heart was 50 beats/min, his blood pressure was 75/40 mm Hg, and he had jugular vein distention. Muffled heart sounds, decreased electrocardiographic voltage, and the accumulation of pericardial effusion on a bedside ultrasound indicated cardiac tamponade. The air medical crew resuscitated the patient through the interventions of intubation, mechanical ventilation, administration of intravenous fluids, and initiation of an epinephrine infusion. Ultrasound-guided pericardiocentesis was performed in the helicopter, which kept him alive until pericardotomy could be performed at the destination hospital. Unfortunately, after pericardiotomy and coronary artery bypass graft surgery, the patient died 7 days later in the ICU due to severe cardiopulmonary failure.


Subject(s)
Air Ambulances , COVID-19/complications , COVID-19/mortality , Cardiac Tamponade/mortality , Cardiac Tamponade/surgery , ST Elevation Myocardial Infarction/mortality , ST Elevation Myocardial Infarction/surgery , Adult , Cardiac Tamponade/etiology , Coronary Artery Bypass/methods , Fatal Outcome , Humans , Intubation, Intratracheal/methods , Male , Pericardiectomy/methods , SARS-CoV-2 , ST Elevation Myocardial Infarction/etiology , Transportation of Patients
12.
Air Med J ; 39(4): 296-297, 2020.
Article in English | MEDLINE | ID: covidwho-655636

ABSTRACT

A 38-year-old emergency medical service Bell 214 male pilot with a dry cough, fever, anorexia, fatigue, and sweating for the past 3 days; an oral temperature of 38°C; blood pressure of 105/65 mm Hg; heart rate of 94 beats/min; respiratory rate of 21 breaths/min; and pulse oximetry of 93% on room air was suspicious for coronavirus disease 2019. Surprisingly, reverse transcription polymerase chain reaction was negative, but bilateral hilar adenopathy was reported in his chest radiography as a new challenge. The pathologic report of the adenopathy biopsy was noncaseating sarcoid-type granulomas. Serologic tests showed a serum angiotensin-converting enzyme level of 58 nmol/mL/min. The bronchoalveolar lavage fluid CD4/CD8 ratio was 3.68. The bronchoalveolar lavage findings provided an accurate sarcoidosis diagnosis, and a high-resolution computed tomographic scan revealed stage 1 pulmonary involvement. Because of the pulmonary involvement, clinical manifestations, use of inhaled fluticasone, and need for longer and accurate follow-up and to protect against coronavirus disease 2019, he has been temporarily suspended until the final assignment.


Subject(s)
Air Ambulances , Coronavirus Infections/diagnosis , Pilots , Pneumonia, Viral/diagnosis , Sarcoidosis, Pulmonary/diagnosis , Adult , Betacoronavirus , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques , Diagnosis, Differential , Emergency Medical Services , Humans , Lymphadenopathy/diagnostic imaging , Lymphadenopathy/pathology , Male , Mediastinum , Pandemics , SARS-CoV-2 , Sarcoidosis, Pulmonary/pathology
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