Neuro-COVID-19.

Neuromuscular manifestations of new coronavirus disease 2019 (COVID-19) infection are frequent, and include dizziness, headache, myopathy, and olfactory and gustatory disturbances. Patients with acute central nervous system disorders, such as delirium, impaired consciousness, stroke and convulsive seizures, have a high mortality rate. The encephalitis/encephalopathy that causes consciousness disturbance and seizures can be classified into three conditions, including direct infection with the SARS-CoV-2 virus, encephalopathy caused by central nervous system damage secondary to systemic hypercytokinemia (cytokine storm) and autoimmune-mediated encephalitis that occurs after infection. The sequelae, called post-acute COVID-19 syndrome or long COVID, include neuromuscular manifestations, such as anxiety, depression, sleep disturbance, muscle weakness, brain fog and cognitive impairment. It is desirable to establish diagnostic criteria and treatment for these symptoms. Vaccine-induced thrombotic thrombocytopenia, Guillain-Barré syndrome, bilateral facial paralysis, encephalitis and opsoclonus-myoclonus syndrome have been reported as adverse reactions after the COVID-19 vaccine, although these are rare.

Neuromuscular complications of severe COVID-19 in paediatric patients: Medium-term follow-up.

Neuromuscular complications in paediatric patients with severe coronavirus disease 2019 (COVID-19) are poorly characterised. However, adult patients with severe COVID-19 reportedly present with frequent neuromuscular complications that mainly include critical illness polyneuropathy (CIP), critical illness myopathy (CIM), and focal neuropathies. We examined the records of all paediatric patients with severe COVID-19 who were mechanically ventilated and experienced neuromuscular complications from our single tertiary centre between March 2020 and August 2021. During this period, 4/36 (11%) patients admitted to the paediatric ICU who were mechanically ventilated experienced neuromuscular complications (one CIM, two focal neuropathies, and one CIP associated with plexopathy). In three of them, the gamma genetic variant of SARS-CoV-2 was identified. At the 4-5 month follow-up, three of our patients exhibited slight clinical improvement. We conclude that paediatric patients with severe COVID-19 may present neuromuscular complications similar to adults (11%), and their medium-term prognosis seems unfavourable.

[Neuromuscular complications of SARS-CoV-2 infection-Part 2: muscle disorders]. / Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion ­ Teil 2: Erkrankungen der Muskulatur.

Apart from disorders and diseases of the peripheral nerves, symptoms and disorders of the musculature and the neuromuscular transmission have also been described in association with coronavirus disease 2019 (COVID-19). In the second part of our review we provide an overview about frequently reported symptoms, such as myalgia as well as defined disorders, such as rhabdomyolysis, myositis, myasthenia and intensive care unit (ICU)-acquired weakness, which have been described during severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections or COVID-19.Furthermore, the criteria for a causality, such as association strength, plausibility, time course, and experimental evidence for a causal association that should be applied for the COVID-19-asssociated neuromuscular conditions described in the two parts of the review are discussed. At present, in addition to anosmia, which is also known in the lay press, myalgia in particular as a nonspecific symptom are frequent sequelae of a symptomatic SARS-CoV­2 infection. Other neuromuscular complications seem to be principally plausible (considering the pathogenesis) but apparently rare consequences of a SARS-CoV­2 infection. Prospective or cohort studies are necessary to confirm a causality and assess the risk.

[Neuromuscular complications of SARS-CoV-2 infections-Part 1: peripheral nerves]. / Neuromuskuläre Komplikationen einer SARS-CoV-2-Infektion ­ Teil 1: periphere Nerven.

In recent months various disorders and diseases of the peripheral nerves (including cranial nerves) and the musculature have been described in association with the pulmonary disease coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the first part of our review the current knowledge about a potential association of a SARS-CoV­2 infection with dysfunction and diseases of cranial and peripheral nerves is discussed. Anosmia, ageusia, motor cranial nerve involvement and Guillain-Barré syndrome (GBS) were described in a temporal association with a SARS-CoV­2 infection. Several studies could show that anosmia and ageusia were frequent symptoms of a SARS-CoV­2 infection. In contrast the failure of other cranial nerves has so far only been sporadically described. A number of case reports and case series indicate a causal association between a SARS-CoV­2 infection and GBS but epidemiological evidence is still lacking.

[COVID-19 neurologic manifestation]. / Manifestaciones neurológicas del COVID-19.

Dear Director: Reading your article "The pandemic due to the new covid-19 coronavirus", I would like to deepen the contributions of the symptoms of this disease. What has started as a pathology manifested by a respiratory syndrome such as atypical pneumonia, is currently associated with several non-respiratory manifestations (1). Guillain-Barré syndrome in a female traveler from Wuhan is one of the first reported neurological manifestations (2). The literature is rich in terms of headaches, seizures and strokes in seriously ill patients, although the first and last of these may be due to systemic complications of this novel coronavirus, a higher incidence of events has been reported in patients with a history of neurological manifestations. (3.4). One of the most recent manifestations reported is neuromuscular diseases. Guidon et al. criticize the lack of rigor in the reports on neuromuscular manifestations (4). If anything is certain, one manifestation of this pandemic is the large amount of information available in the scientific field, many of these without the same methodological rigor as before the pandemic, accentuating the responsibility of the reader to critically analyze all the information.

Estimado Director: Leyendo su artículo "La pandemia por el nuevo coronavirus covid-19", me gustaría profundizar los aportes de la sintomatología de esta enfermedad. Lo que ha comenzado como una patología manifestada por un síndrome respiratorio como neumonías atípicas, actualmente está asociada a varias manifestaciones no respiratorias(1). De las primeras manifestaciones neurológicas reportadas está el síndrome de Guillain-Barré en una viajera proveniente de Wuhan(2). La literatura es rica en cuanto a cefaleas, convulsiones e ictus en los pacientes graves, si bien la primera y última de estas pueden deberse a complicaciones sistémicas de este novel coronavirus, se ha reportado una mayor incidencia de eventos en pacientes con antecedentes de manifestaciones neurológicas(3,4). Una de las más recientes manifestaciones reportadas, son las enfermedades neuromusculares. Guidon et al. critican la falta de rigurosidad en los reportes sobre manifestaciones neuromusculares(4). Si algo es seguro, una manifestación de esta pandemia es la gran cantidad de información disponible en el ámbito científico, muchas veces de estas sin la misma rigurosidad metodológica anterior a la pandemia, acentuando la responsabilidad del lector de analizar críticamente toda la información.