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1.
Multiple Sclerosis and Related Disorders ; 70:104495, 2023.
Article in English | ScienceDirect | ID: covidwho-2165726

ABSTRACT

Objective To assess safety data of the inactivated COVID-19 vaccines in a real-world sample of people with autoimmune encephalitis (pwAE). Methods A cross-sectional study was performed between 1 March and 30 April 2022. We invited pwAE from our previous ONE-WC (Outcome of Autoimmune Encephalitis Study in Western China) registration study database, to attend neurological clinics, at West China Hospital to participate in a face-to-face survey using a custom-designed questionnaire for this study. The ONE-WC study began in October 2011 and prospectively enrolled pwAE from four large comprehensive neurological centers in Sichuan province, China. Results Of the 387 pwAE, 240 (62.0%) completed the questionnaire. Half the 240 participants (121, 50.4%) reported receiving at least one dose of COVID-19 vaccine, which in all but two patients received inactivated COVID-19 vaccine. Among vaccinated pwAE, the median age was 35 years (range 15-69) and 57.8% of them were women. The most frequent reasons that unvaccinated individuals reported for not receiving the COVID-19 vaccine were concern about vaccine-induced relapse of AE (50.4%) and advice from a physician to delay vaccination (21.0%). Small proportions of vaccinated individuals reported adverse events after the first dose (11.5%) or the second dose (10.2%), and none of the adverse events was serious. Across the entire sample, one individual reported relapsing within 30 days after the first dose and three individuals reported relapsing more than 120 days after the first dose. Conclusions This real-world survey indicates an overall favorable safety profile of the inactivated COVID-19 vaccine for pwAE.

3.
Experimental and Therapeutic Medicine ; 25(1) (no pagination), 2023.
Article in English | EMBASE | ID: covidwho-2163774

ABSTRACT

Outbreaks of zoonotic viral diseases pose a severe threat to public health and economies worldwide, with this currently being more prominent than it previously was human history. These emergency zoonotic diseases that originated and transmitted from vertebrates to humans have been estimated to account for approximately one billion cases of illness and have caused millions of deaths worldwide annually. The recent emergence of severe acute respiratory syndrome coronavirus-2 (coronavirus disease 2019) is an excellent example of the unpredictable public health threat causing a pandemic. The present review summarizes the literature data regarding the main vaccine developments in human clinical phase I, II and III trials against the zoonotic positive-sense single-stranded RNA viruses belonging to the Coronavirus and Alphavirus genera, including severe acute respiratory syndrome, Middle east respiratory syndrome, Venezuelan equine encephalitis virus, Semliki Forest virus, Ross River virus, Chikungunya virus and O'nyong-nyong virus. That there are neither vaccines nor effective antiviral drugs available against most of these viruses is undeniable. Therefore, new explosive outbreaks of these zoonotic viruses may surely be expected. The present comprehensive review provides an update on the status of vaccine development in different clinical trials against these viruses, as well as an overview of the present results of these trials. Copyright © 2023 Spandidos Publications. All rights reserved.

4.
Dubai Medical Journal ; : 1-4, 2022.
Article in English | Web of Science | ID: covidwho-2162088

ABSTRACT

Introduction: Since 2019, COVID-19 pneumonia caused by SARS-CoV-2 virus has led to a worldwide pandemic. Since then, various neurological manifestations of COVID-19 pneumonia have been reported. Neurological manifestations include headache, anosmia, seizures, and altered mental status. In some cases, it presents as stroke, encephalitis, and neuropathy. Artery of Percheron (AOP) is a variant in the posterior circulation. Here, a single artery arises from the posterior cerebral artery p1 segment. It supplies bilateral thalamus with or without midbrain. Thrombosis in this artery leads to clinical symptoms like reduced level of consciousness, altered mental status, and memory impairment. Case Report: Here, we present a case who presented with fever and altered sensorium without any focal neurological deficits and without known risk factors for stroke. His COVID-19 PCR was positive. He was initially diagnosed as COVID-19 pneumonia with encephalitis and was started on treatment for the same. His initial CT brain and lumbar puncture were normal. The next day, when MRI brain with and without contrast was done, the thalamic stroke due to AOP infarction was diagnosed and appropriate treatment for stroke was initiated. Discussion: Many patients miss the window for thrombolysis because of variable presentation in clinical symptoms with negative imaging. It is also difficult to assess the time of onset of stroke in this varied presentation. Our patient had fever and cough for 2 days and had altered mental status since the morning of admission. During hospital stay, he developed bilateral third nerve palsy. This case also highlights the importance of detailed evaluation in COVID-19 patients with neurological complaints. This helps to avoid delays in treatment and to improve clinical outcomes. As our knowledge of COVID-19 and its varied neurological manifestations evolve, we need to be prepared for more atypical presentation to facilitate timely interventions.

5.
BMJ Case Reports ; 15(12), 2022.
Article in English | ProQuest Central | ID: covidwho-2161824

ABSTRACT

A woman in her late 70s with a history of liver transplant presented with ophthalmoplegia, ataxia, areflexia, positive Babinski's sign and reduced consciousness. This followed an antecedent illness in the form of a herpes zoster infection. MRI of the brain/spinal cord, cerebrospinal fluid analysis with viral PCR and routine blood tests were normal, and tacrolimus neurotoxicity was ruled out. Serum anti-GQ1b antibodies were positive. A diagnosis of Bickerstaff's brainstem encephalitis was made, forming part of the continuum that involves Miller-Fisher syndrome, entitled the ‘anti-GQ1b syndrome'. Complete recovery ensued without intravenous immunoglobulins or plasma exchange. The role of monitoring anti-ganglioside pattern change to predict or confirm disease recurrence and disease severity is further discussed.

6.
Advances in Virus Research, Vol. 112 ; 112:1-29, 2022.
Article in English | Web of Science | ID: covidwho-2156882

ABSTRACT

Reverse genetics is the prospective analysis of how genotype determines phenotype. In a typical experiment, a researcher alters a viral genome, then observes the phenotypic outcome. Among RNA viruses, this approach was first applied to positive-strand RNA viruses in the mid-1970s and over nearly 50 years has become a powerful and widely used approach for dissecting the mechanisms of viral replication and pathogenesis. During this time the global health importance of two virus groups, flaviviruses (genus Flavivirus, family Flaviviridae) and betacoronaviruses (genus Betacoronavirus, subfamily Orthocoronavirinae, family Coronaviridae), have dramatically increased, yet these viruses have genomes that are technically challenging to manipulate. As a result, several new techniques have been developed to overcome these challenges. Here I briefly review key historical aspects of positive-strand RNA virus reverse genetics, describe some recent reverse genetic innovations, particularly as applied to flaviviruses and coronaviruses, and discuss their benefits and limitations within the larger context of rigorous genetic analysis.

7.
European Psychiatry ; 65(Supplement 1):S28, 2022.
Article in English | EMBASE | ID: covidwho-2153780

ABSTRACT

Introduction: The infection caused by the SARS-CoV-2 virus called COVID-19 may affect not only the respiratory system but also the central nervous system (CNS). Delirium is a frequent and serious condition in COVID-19 patients and may be caused by the direct invasion of the CNS or the induction of CNS inflammatory mediators or by indirect effects due to the systemic inflammatory status, other organ failure, prolonged mechanical ventilation time, immobilization but also social isolation. We aim to critically review literature reporting this syndrome in patients infected by the SARSCoV-2 virus with a particular emphasis on reported clinical, laboratorial and neuroimaging findings. Method(s): A state-of-the-art literature review was performed using PubMed, Embase and Web of Knowledge using the following keywords: delirium, COVID-19, SARS-Cov-2, neuroimaging, laboratorial findings. Result(s): More than 50% of patients with COVID-19 may present with delirium and in about 20% of the cases this is the primary presentation of the disorder. Previous data suggests that these patients may show a higher frequency of certain symptoms such as agitation, myoclonus, abulia, and alogia. Some distinct neuroinflammatory syndromes have been identified in patients presenting with delirium associated with the virus, namely, autoimmune encephalitis, Acute Disseminated Encephalomyelitis (ADEM) and stroke showing its potential for CNS involvement. Many of these patients present normal brain imaging, EEG and CSF findings but others have more specific laboratorial changes such as elevated creatinine kinase, elevated D-dimer levels, abnormal coagulation parameters and positive SARS-Cov-2 PCR in CSF or meningeal enhancement, ischemic stroke and perfusion changes in MRI imaging.

8.
Journal of the American Society of Nephrology ; 33:355, 2022.
Article in English | EMBASE | ID: covidwho-2124517

ABSTRACT

Introduction: Rhabdomyolysis is a serious clinical syndrome characterized by muscle breakdown and release of damaging proteins. Influenza infection has been increasingly reported as a causative disease. We are reporting an unusual case of severe rhabdomyolysis with acute renal failure leading to ESRD due to influenza A infection Case Description: A 70-year-old female with PMHx of hyperlipidemia and hypothyroidism, admitted with body aches along with flulike symptoms for 4 days duration, no history of seizure or trauma, only on levothyroxine at home. Physical exam with stable vital signs, clear lungs. Labs were pertinent for WBC 31.0x109, eosinophilia 20%, creatinine 1.4mg/dl (baseline 0.9) and AST/ALT 2590/530 mg/dl, hepatitis screen negative, urine analysis with +3 blood, 3 RBCs, +1 protein. CK 104,740 U/L, influenza A PCR positive, negative PCR for influenza B, COVID 19. Diagnosis of acute renal failure secondary to rhabdomyolysis secondary to influenza A was made, patient was started on oseltamivir and required renal replacement therapy, no recovery after 3 months and labeled ESRD Discussion: Influenza A is a negative-sense RNA virus, transmitted by large droplets and small particle aerosols, complication of influenza includes but not limited to pneumonia, encephalitis, myocarditis and Myositis which can be secondary to Direct invasion of muscle tissue by the viral agent, Myotoxic cytokines release and Immunologic processes induced by the viral infection. Rhabdomyolysis is a syndrome characterized by muscle necrosis and the release of intracellular muscle constituents into the circulation. It might occur due to trauma, drugs, bacterial or viral infections or others, Creatine kinase levels are typically elevated. The risk of AKI is higher with CK levels of more than 15 to 20,000 units/L, caused mainly by Volume depletion resulting in renal ischemia, tubular obstruction due to heme pigment casts, and tubular injury from free chelatable iron. Treatment is mainly by large volume administration of isotonic fluids, renal replacement therapy may be needed for sever cases. Conclusion(s): Influenza can be a serious disease leading to serious complications, extra caution should be considered in patients who develop acute renal failure after influenza infection;rhabdomyolysis should be suspected, investigated, and treated appropriately.

10.
Cureus ; 14(11): e31844, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2145125

ABSTRACT

Myelin oligodendrocyte glycoprotein (MOG) antibody has been associated with a wide range of neurological diseases, from neuromyelitis optica spectrum disorder to acute disseminated encephalomyelitis. However, MOG positivity with isolated encephalitis has been infrequently reported. MRI findings are usually of the demyelination type. In this case, we report on a patient with COVID-19 exposure who presented with altered mental status and multiple ring-enhancing lesions on MRI mimicking metastatic disease. Due to his unusual MRI findings and presentation, the correct diagnosis was not apparent until MOG antibody results came back positive.

11.
Multiple Sclerosis Journal ; 28(3 Supplement):848, 2022.
Article in English | EMBASE | ID: covidwho-2138828

ABSTRACT

Introduction: Several studies have reported attenuated humoral responses following SARS-CoV-2 mRNA vaccination in Multiple Sclerosis (MS) patients on anti-CD20 therapies and fingolimod. However, neutralising antibodies (NAbs) against the receptorbinding domain of the SARS-CoV-2 spike protein were quantified in only a few reports and there is limited data in neuromyelitis optica spectrum disorder (NMOSD) patients. Objectives and Aims: To measure serum NAbs levels prior to, and, at several time points after the first (V1) and second (V2) SARS-CoV-2 mRNA vaccination in patients with neuroimmunological conditions on various immunotherapies, and, to identify the factors associated with poor humoral responses. Method(s): This was a prospective observational study performed at the National Neuroscience Institute, Singapore. Patients with MS (n=77), NMOSD (n=33), myelin oligodendrocyte glycoprotein- antibody associated disease (n=6), autoimmune encephalitis (n=3), other CNS inflammatory diseases (n=5), myasthenia gravis (n=9) and healthy controls (HCs, n=42) were recruited. No subjects had COVID-19 infection prior to V1, V2 and the sampling time points. NAbs were measured using the Genscript cPassTM surrogate virus neutralisation test. Result(s): No patients or HCs had detectable NAbs prior to V1. Two to 4 weeks after V1, patients on anti-CD20 therapies had lower NAbs levels (p=0.010) compared to HCs and untreated patients. Two to 6 weeks post V2, patients on disease-modifying anti-rheumatic drugs (DMARDs) (p=0.010), fingolimod (p<0.0001) and anti-CD20 therapies (p<0.0001) showed decreased NAbs levels compared to HCs and untreated patients. This was also observed 8 to 16 weeks post V2 - DMARDs (p=0.046), fingolimod (p<0.0001) and anti-CD20 therapies (p<0.0001). NAbs levels decreased in both HCs and patients with increasing time interval following V2. There was no correlation between NAbs levels and the time interval from last anti-CD20 treatment to V1 (p=0.508). A multivariable logistic regression model adjusted for age, expanded disability status scale, gender, mRNA vaccine type, ethnicity and body mass index, revealed that fingolimod (p=0.026) and anti-CD20 therapies (p=0.003) were independent predictors of undetectable NAbs following V2. Conclusion(s): Fingolimod and anti-CD20 therapies are associated with attenuated NAbs levels post-vaccination. Future studies are needed to determine whether this translates to an increased risk of COVID-19 infection.

12.
Revue Neurologique ; 2022.
Article in English | ScienceDirect | ID: covidwho-2131968

ABSTRACT

Background and purpose: Mechanisms underlying acute brain injury in SARS-CoV-2 patients remain poorly understood. A better characterization of such mechanisms remains essential to preventing long-term neurological sequelae. Our present aim was to study a panel of biomarkers of neuroinflammation and neurodegeneration in the cerebrospinal fluid (CSF) of NeuroCOVID patients. Methods: We retrospectively collected clinical and CSF biomarkers data from 24 NeuroCOVID adults seen at the University Hospital of Guadeloupe between March and June 2021. Results: Among 24 NeuroCOVID patients, 71% had encephalopathy and 29% meningoencephalitis. A number of these patients also experienced de novo movement disorder (33%) or stroke (21%). The CSF analysis revealed intrathecal immunoglobulin synthesis in 54% of NeuroCOVID patients (two with a type 2 pattern and 11 with a type 3) and elevated neopterin levels in 75% of them (median 9.1 nM, IQR 5.6-22.1). CSF neurofilament light chain (NfL) was also increased compared to a control group of non-COVID-19 patients with psychiatric illnesses (2905 ng/l, IQR 1428-7124 versus 1222 ng/l, IQR 1049-1566). Total-tau was elevated in the CSF of 24% of patients, whereas protein 14-3-3, generally undetectable, reached intermediate levels in two patients. Finally, CSF Aß1-42 was reduced in 52.4% of patients (median 536 ng/l, IQR 432-904) with no change in the Aß1-42/Aß1-40 ratio (0.082, IQR 0.060-0.096). Conclusions: We showed an elevation of CSF biomarkers of neuroinflammation in NeuroCOVID patients and a rise of CSF NfL, evocative of neuronal damage. However, longitudinal studies are needed to determine whether NeuroCOVID could evolve into a chronic neurodegenerative condition.

13.
Annales Medico Psychologiques ; 180(10):1073-1078, 2022.
Article in English | Academic Search Complete | ID: covidwho-2129847

ABSTRACT

Voici un siècle, alors que se répandait l'épidémie de grippe dite espagnole, René Cruchet, en France, et Constantin von Economo, en Autriche, attiraient l'attention des médecins militaires et civils sur l'apparition d'une autre pandémie, l'encéphalite léthargique. Après une phase de somnolence irrépressible plus ou moins prolongée, ceux qui survivaient développaient, progressivement, des séquelles permanentes de type syndrome parkinsonien ou paroxystiques à type de dystonies variées. Les patients étaient souvent des enfants et de jeunes adultes. De 1920 à 1946, la Société Médico-Psychologique consacre vingt séances à l'étude des séquelles neuropsychiatriques de ces encéphalites. À côté des mouvements anormaux, les psychiatres prennent en charge des délires hallucinatoires, des comportements violents et agressifs avec désinhibition sexuelle, des épilepsies myocloniques, etc. Il ressort des présentations cliniques résumées ici que cette pandémie permet aux psychiatres de rapporter à des lésions diencéphaliques et mésencéphaliques des détériorations psychiatriques comme jamais ils ne l'avaient fait auparavant. L'hypothèse étiologique actuelle conclut cette présentation. A century ago, when the so-called Spanish flu epidemic was spreading, René Cruchet in France and Constantin von Economo in Austria drew the attention of military and civilian physicians to the existence of another pandemic, encephalitis lethargica. After a more or less prolonged phase of irrepressible drowsiness, those who survived progressively developed permanent sequelae, i.e. parkinson' syndrome, or various types of paroxysmal dystonia. The patients were often children and young adults. From 1920 to 1946, the Société Médico-Psychologique devoted twenty sessions to the study of the neuropsychiatric sequelae of these encephalitides. In addition to abnormal movements, psychiatrists treated hallucinatory delusions, violent and aggressive behaviors with sexual disinhibition, myoclonic epilepsy, etc. The clinical presentations summarized here seem to demonstrate that this pandemic allowed psychiatrists to relate psychiatric deterioration to diencephalic and mesencephalic lesions in a way that they had never done before. The current etiological hypothesis concludes this presentation. [ FROM AUTHOR]

14.
Neurobiology of Brain Disorders: Biological Basis of Neurological and Psychiatric Disorders, Second Edition ; : 481-500, 2022.
Article in English | Scopus | ID: covidwho-2129638

ABSTRACT

Spread of pathogens to the nervous system is a serious complication of infections. In addition to infections with well-known microbes and viruses in the Western world, and the World Health Organization priorities of HIV/AIDS, malaria, and tuberculosis, several neglected tropical infectious diseases target the nervous system and have high mortality rates. Infections can cause cognitive and behavioral disturbances as well as late-onset epilepsy in survivors. The specialized environment in the brain dampens immune responses to avoid harmful effects on the nonrenewable nervous tissue. Some pathogens can therefore evade efficient elimination, persist, and be involved in interactions with nervous tissue that create balances, which, if lost by the host, can result in long-term functional disturbances. Viruses also can be useful tools to study the structure and function of the nervous system. Neuroscience can disclose mechanisms of neurodegeneration and brain dysfunctions from studies of the interplay among pathogens, nervous tissues, and immune responses that could lead to better management of brain disorders. © 2023 Elsevier Inc. All rights reserved.

15.
PM and R ; 14(Supplement 1):S102-S103, 2022.
Article in English | EMBASE | ID: covidwho-2127991

ABSTRACT

Case Diagnosis: Guillain-Barre Syndrome secondary to COVID-19 pneumonia complicated by reactivation of Herpes Simplex and Epstein-Barr virus causing ventriculitis/ encephalitis Case Description or Program Description: 64 y/o male admitted to acute care hospital (ACH) with progressive bilateral lower extremity weakness associated with recent "flu-like" symptoms and positive COVID-19 test. ACH course was complicated by flaccid tetraplegia, hypoxemic respiratory failure and altered mental status. Initial CSF studies revealed elevated protein with albuminocytologic dissociation, negative cultures and negative viral panel, consistent with Guillain Barre Syndrome (GBS) in the setting of recent COVID-19 pneumonia. Patient was treated with plasmapheresis and IV corticosteroids with no neurological improvement. Setting(s): Inpatient rehab Assessment/Results: Patient then developed visual loss and was diagnosed with cortical blindness that could not be explained by his underlying GBS. MRI brain revealed findings consistent with ventriculitis/ encephalitis. Repeat CSF studies revealed positivity for Herpes Simplex Virus (HSV-2) as well as Epstein-Barr virus, both of which were previously undetected on admission. Patient was transferred to acute inpatient rehabilitation facility (IRF) with flaccid tetraplegia, cortical blindness, pressure ulcers, malnutrition at a total assist level of function. During IRF stay majority of rehab efforts were focused on training family to care for his various needs;tube feeds, medications, avoiding pressure ulcers. Discussion (relevance): The initial negative CSF studies and sequential development of this patient's symptoms are evidence to support that the COVID-19 virus can likely cause reactivation of other viruses. One study, "Investigation of Long COVID Prevalence and Its Relationship to Epstein-Barr Virus Reactivation", reported that up to 66.7% of COVID-19 patients were found to be positive for EBV reactivation. In our patient, the reactivation of HSV-2 and EBV causing ventriculitis/ encephalitis with cortical blindness had major implications on his rehabilitation outcomes. Conclusion(s): To date, there has been minimal published research on the potential of COVID-19 to cause reactivation of other viruses. This case report emphasizes the remarkable ability of the COVID-19 virus to reactivate other viruses and also provides an example of the clinical implications of this within acute rehabilitation.

16.
PM and R ; 14(Supplement 1):S95-S96, 2022.
Article in English | EMBASE | ID: covidwho-2127989

ABSTRACT

Case Diagnosis: Myelitis Case Description or Program Description: In two years, a rehabilitation unit had four distinct cases of viral myelitis. A 67-year-old male with T12 AIS C SCI due to West Nile virus (WNV);a 42-year-old male with L1 AIS C SCI due to Epstein-Barr virus (EBV);a 33-year-old male with L2 AIS D SCI due to varicella zoster virus (VZV);and a 35-year-old male with T10 AIS D SCI secondary to COVID-19. Setting(s): Tertiary Care Hospital Assessment/Results: Each case was notable for severe comorbid encephalitis and had a unique course and outcome. The cases of WNV and VZV acute transverse myelitis (ATM) greatly improved during their rehabilitation course and eventually achieved functional independence. The case of EBV myelitis had continuing functional decline to present. The patient with COVID-19 myelitis presented with paraplegia, initially improved to independent ambulation, then had progressive decline in his lower extremity strength. Discussion (relevance): Viral myelitis is an exceptionally rare cause of SCI, with an estimated incidence of 1-4 per 1 million. Myelitis as a consequence of WNV is exceedingly rare. Literature search revealed this is only the 4th case describing longitudinally extensive ATM from WNV. Myelitis due to EBV is also exceedingly rare, despite EBV being an often benign common viral infection. Among zoster patients, the incidence of myelitis has been reported to be only 0.3%. Incidence of COVID-19 associated myelitis is estimated to be 0.5 per million. Conclusion(s): These cases highlight four distinct etiologies of viral myelitis, with varying patterns of recovery. The patients with WNV and VZV improved significantly, while the patients with EBV and COVID continued to decline. This provides an opportunity to review the presentation of rare etiologies of SCI and promote awareness of WNV, EBV, VZV and COVID-19 as causes of myelitis. This knowledge may improve accuracy of diagnosis and prevent increased morbidity caused by inappropriate treatment.

17.
Journal of Clinical and Diagnostic Research ; 16(11):SR1-SR4, 2022.
Article in English | Web of Science | ID: covidwho-2124092

ABSTRACT

Apart from the regular respiratory symptoms, neurological manifestations like headache, encephalopathy, encephalitis, seizure, coma, demyelinating disorders, and aseptic meningitis has been seen in paediatric Coronavirus Disease-2019 (COVID-19) positive cases. The present case series is about three children, of age range 9 to 15 years, who presented with encephalitis between January 2022-February 2022. All the children tested positive for COVID-19, either by Rapid Antigen Test (RAT) or by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). One patient had necrotising encephalitis like changes in the MRI neuroimaging of the brain, but negative Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ribonucleic Acid (RNA) PCR in Cerebrospinal Fluid (CSF). The second patient's Magnetic Resonance Imaging (MRI) brain was suggestive of acute encephalopathy, but with normal CSF analysis. The third patient presented with clinical findings suggestive of encephalitis with normal CSF study and normal MRI. The children were managed with antipyretics, antiepileptics, antibiotics, and antiviral, injection mannitol, and steroids. After the completion of the treatment, all the children were alive and were discharged from the hospital.

18.
Neurology and Clinical Neuroscience ; 2022.
Article in English | Web of Science | ID: covidwho-2123216

ABSTRACT

Background: Neurological involvement associated with SARS-CoV-2 infection has been reported from different regions of the world. However, data from South East Asia are scarce. We described the neurological manifestations and their associated factors among the hospitalized COVID-19 patients from an academic tertiary hospital in Malaysia. Methods: A cross-sectional observational study of hospitalized COVID-19 patients was conducted. The neurological manifestations were divided into the self-reported central nervous system (CNS) symptoms, stroke associated symptoms, symptoms of encephalitis or encephalopathy and specific neurological complications. Multiple logistic regression was performed using demographic and clinical variables to determine the factors associated with outcome. Results: Of 156 hospitalized COVID-19 patients with mean age of 55.88 +/- 6.11 (SD) years, 23.7% developed neurological complications, which included stroke, encephalitis and encephalopathy. Patients with neurological complications were more likely to have diabetes mellitus (p = 0.033), symptoms of stroke [limb weakness (p < 0.001), slurred speech (p < 0.001)];and encephalitis or encephalopathy [confusion (p < 0.001), forgetfulness (p = 0.006) and seizure (p = 0.019)]. Unvaccinated patients had a 4.25-fold increased risk of having neurological complications (adjusted OR = 4.25;95% CI: 1.02, 17.71, p = 0.047). Anosmia and dysgeusia were less associated with neurological complications (adjusted OR = 0.22;95% CI: 0.05, 0.96, p = 0.044). The odds of neurological complications were increased by 18% in patients with leukocytosis (adjusted OR = 1.18, 95% CI: 1.003, p = 0.0460). Conclusions: Stroke, encephalitis and encephalopathy were the common neurological complications from our study. Diabetes mellitus, presence of symptoms of stroke, symptoms of encephalitis or encephalopathy, leukocytosis, and being unvaccinated against COVID-19 were the associated risk factors of developing neurological complications.

19.
Journal of Pediatric Neurology ; 2022.
Article in English | Web of Science | ID: covidwho-2122947

ABSTRACT

Coronavirus disease 2019 (COVID-19) results from infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Typical presentations include fever, shortness of breath, and cough though neurological manifestations have been rarely reported. Acute necrotizing encephalitis is a rare manifestation of COVID-19 and can be associated with devastating neurological outcomes. Difficulty in timely acquisition of neuroimaging and high rates of early mortality in these patients hinder timely diagnosis. In this clinicoradiological syndrome, patients suffer from rapidly worsening encephalopathy in first 2 weeks of illness and necrotizing parenchymal changes on neuroimaging. The pathophysiology is hypothesized to occur due to cytokine storm, blood-brain-barrier dysfunction, and viral-mediated immune dysregulation leading to endotheliopathy. Early immunomodulatory treatment with intravenous immunoglobulin and steroids is associated with a favorable outcome. Here, we report a one-and-half-year-old boy who presented with fever, seizures, and decreased activity since 3 days. He was noted to have hypertonia in all four limbs with exaggerated deep tendon reflexes. Nasopharyngeal reverse transcriptase polymerase chain reaction test for SARS-CoV-2 was positive. Magnetic resonance imaging brain was suggestive of acute necrotizing encephalopathy. Patient was treated with steroids.

20.
Journal of Neuroimmunology ; : 578007, 2022.
Article in English | ScienceDirect | ID: covidwho-2122627

ABSTRACT

Here, we describe the clinical phenotype of SARS-CoV-2-related CNS disease and evaluate the SARS-CoV-2 antibody index as a tool to differentiate between a direct (viral) and indirect etiology. Out of >4000 hospitalized patients with COVID-19, we included 13 patients with neurological symptoms with suspicion of neuroinflammation. On clinical grounds, eight were classified as having a possible/probable relationship between neurological symptoms and COVID-19. A clinically distinctive phenotype of brainstem and cerebellar symptoms was seen in 6/8 patients. As we found a positive SARS-CoV-2 antibody index in 3/5 patients, indicating specific intrathecal SARS-CoV-2 IgG production, a direct link with SARS-CoV-2 is likely.

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