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1.
BMJ Case Rep ; 15(4), 2022.
Article in English | PubMed | ID: covidwho-1807346

ABSTRACT

This case report describes an 84-year-old man who presented with 3 weeks of gradually worsening right arm weakness associated with a painful vesicular rash across his arm. This occurred 3 days after his first dose of the ChAdOx1 nCoV-19/AZD1222 (University of Oxford, AstraZeneca and the Serum Institute of India) vaccine. The diagnosis was complicated by the presence of right C5-C6 foraminal stenosis compressing on the C6 nerve root sheath on non-contrast MRI, leading to an initial diagnosis of cervical radiculopathy. However, a positive varicella zoster virus-PCR test and findings of abnormal contrast enhancement of his right C5-C7 nerve roots on gadolinium-enhanced MRI resulted in a revision of his diagnosis to zoster radiculopathy. He was subsequently commenced on oral valacilovir and made significant recovery. This report aims to highlight the diagnostic dilemma between cervical radiculopathy secondary to spondylosis and zoster radiculopathy and how an erroneous diagnosis could result in inappropriate, aggressive surgical intervention and delayed treatment with antiviral therapy.

2.
BMJ Case Rep ; 15(2)2022 Feb 08.
Article in English | MEDLINE | ID: covidwho-1685517

ABSTRACT

Vaccines for SARS-CoV-2 currently authorised by the European Medicine Agency are effective, safe and well tolerated in practice. Awareness of rare potential vaccine-related adverse effects (AEs) is important to improve their recognition, management and reporting. An 88-year-old man attended the emergency department with incomplete palsy of the right third cranial nerve 3 days after the first administration of Moderna mRNA-1273 SARS-CoV-2 vaccine. Imaging ruled out a vascular accident and a vaccine AE was hypothesised. Two weeks of oral steroids led to the patient's recovery, but without evidence of humoral immune response to vaccine. Thus, full immunisation with a dose of Pfizer mRNA-BNT162b2 SARS-CoV-2 vaccine in a different site was attempted. This was uneventful and followed by a robust antibody response. Empirical change of site and vaccine brand may represent a tailored option to obtain full immune protection in selected patients, after vaccine AEs.


Subject(s)
COVID-19 Vaccines , COVID-19 , Aged, 80 and over , Antibodies, Viral , Humans , Immunity, Humoral , Male , Oculomotor Nerve , Paralysis , RNA, Messenger , SARS-CoV-2 , Vaccination/adverse effects
3.
BMJ Case Rep ; 15(1)2022 Jan 04.
Article in English | MEDLINE | ID: covidwho-1605826

ABSTRACT

Prone positioning is a mainstay of management for those presenting to the intensive care unit with moderate-to-severe acute respiratory distress syndrome due to COVID-19. While this is a necessary and life-saving intervention in selected patients, careful positioning and meticulous care are required to prevent compression and traction of the brachial plexus, and resultant brachial plexopathy. We describe two patients who developed a brachial plexus injury while undergoing prone positioning for management of COVID-19 pneumonitis. Both patients were diabetic and underwent prolonged periods in the prone position during which the plexopathy affected arm was abducted for 19 and 55 hours, respectively. We discuss strategies to reduce the risk of this rare but potentially disabling complication of prone positioning.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Patient Positioning , Prone Position , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , SARS-CoV-2
4.
BMJ Case Rep ; 14(11)2021 Nov 30.
Article in English | MEDLINE | ID: covidwho-1546480

ABSTRACT

We describe a patient who developed bilateral oculomotor nerve palsy, ataxia, facial diplegia and lower limb weakness 2 weeks post-Oxford-AstraZeneca SARS-CoV2 vaccination, consistent with Miller-Fisher syndrome (MFS) and Guillain-Barre syndrome (GBS) overlap syndrome. Although some features of the patient's presentation were typical of recently reported cases of a rare GBS variant post-Oxford-AstraZeneca vaccination, including severe facial weakness and a lack of respiratory involvement, to our knowledge this is the first reported case of MFS associated with SARS-CoV2 vaccination. While postvaccination GBS remains rare, it appears to have a favourable prognosis, and recognising this entity is therefore important for patient counselling and monitoring for potential complications.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Miller Fisher Syndrome , COVID-19 Vaccines , Guillain-Barre Syndrome/chemically induced , Guillain-Barre Syndrome/diagnosis , Humans , Miller Fisher Syndrome/chemically induced , Miller Fisher Syndrome/diagnosis , RNA, Viral , SARS-CoV-2 , Vaccination
5.
BMJ Case Rep ; 14(11)2021 Nov 29.
Article in English | MEDLINE | ID: covidwho-1546474

ABSTRACT

Brachial plexus injury is a rare but potentially serious complication of laparoscopic surgery. Loss of motor and/or sensory innervation can have a significant impact on the patient's quality of life following otherwise successful surgery. A 38-year-old underwent elective laparoscopic management of severe endometriosis during which she was placed in steep head-down tilt Lloyd-Davies position for a prolonged period. On awakening from anaesthesia, the patient had no sensation or movement of her dominant right arm. A total plexus brachialis injury was suspected. As advised by a neurologist, an MRI brachial plexus, nerve conduction study and electromyography were requested. She was managed conservatively and made a gradual recovery with a degree of residual musculocutaneous nerve neuropathy. The incidence of brachial plexus injury following laparoscopy is unknown but the brachial plexus is particularly susceptible to injury as a result of patient positioning and prolonged operative time. Patient positioning in relation to applied clinical anatomy is explored and risk reduction strategies described.


Subject(s)
Brachial Plexus Neuropathies , Brachial Plexus , Endometriosis , Adult , Brachial Plexus Neuropathies/etiology , Endometriosis/surgery , Female , Humans , Musculocutaneous Nerve , Quality of Life
6.
BMJ Case Rep ; 14(10)2021 Oct 19.
Article in English | MEDLINE | ID: covidwho-1476414

ABSTRACT

Herpes zoster reactivation is a frequently encountered condition that can result in several uncommon complications. This case report highlights one such frequently overlooked complication, segmental zoster paresis. We discuss a case of prolonged fever and lower limb weakness in an immunocompromised patient with breast cancer on active chemotherapy after resolution of a herpetiform rash in the L2, L3 and L4 dermatomes. Early investigation with lumbar puncture, looking for cerebrospinal fluid pleocytosis, varicella zoster virus detection by PCR or molecular testing and immunoglobulins against varicella zoster virus, should be undertaken to support the diagnosis. Nerve conduction studies, electromyography and MRI of the spine can sometimes help with neurolocalisation. Intravenous acyclovir and a tapering course of steroids can help with resolution of symptoms. The variegate presentation can make diagnosis challenging. Awareness and a high index of suspicion can prevent delays in diagnosis and treatment and improve patient outcomes.


Subject(s)
Herpes Zoster , Acyclovir/therapeutic use , Herpes Zoster/complications , Herpes Zoster/diagnosis , Herpes Zoster/drug therapy , Herpesvirus 3, Human , Humans , Immunocompromised Host , Paresis/etiology
7.
BMJ Case Rep ; 14(10)2021 Oct 14.
Article in English | MEDLINE | ID: covidwho-1470501

ABSTRACT

In March 2020, the WHO declared COVID-19 to be a global pandemic and since December 2020, millions of vaccines have been administered. To date, cases of Guillain-Barré syndrome (GBS) following a COVID vaccine (Pfizer, Johnson & Johnson, Janssen, AstraZeneca) have been reported. A 61-year-old woman developed bilateral asymmetrical lower motor neuron (LMN) facial weakness followed by limb symptoms, 10 days after receiving the first dose of AstraZeneca COVID vaccine. The second patient was a 56-year-old man who, 9 days after receiving first dose of AstraZeneca COVID vaccine, developed bilateral asymmetrical LMN facial weakness with limb symptoms. Intravenous immunoglobulin was administered with rapid recovery. These cases of GBS following the AstraZeneca COVID vaccine add to cohort of patients reported. We flag up to raise awareness of this condition post-COVID-19 vaccine and highlight the prominent bifacial involvement. Early diagnosis and prompt treatment with intravenous immunoglobulin led to rapid recovery.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , COVID-19 Vaccines , Female , Guillain-Barre Syndrome/chemically induced , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/drug therapy , Humans , Male , Middle Aged , SARS-CoV-2 , Vaccination/adverse effects
8.
BMJ Case Rep ; 14(10)2021 Oct 04.
Article in English | MEDLINE | ID: covidwho-1450598

ABSTRACT

SARS-COV-2 predominantly results in a respiratory illness. However, it has also been associated with a wide range of neurological disorders including a broad range of immune neuropathies. These immune neuropathies associated with SARS-COV2 infection include Guillain-Barré syndrome (GBS), recurrent GBS and exacerbation of pre-existing chronic inflammatory demyelinating polyneuropathy (CIDP). We describe a case with acute-onset CIDP presenting with three relapses of demyelinating polyradiculoneuropathy, the third relapse occurring in the 8 week of illness following a previous COVID-19 infection and a recent COVID-19 vaccination with ChAdOx1 nCoV-19 and high COVID-19 antibody level. In our knowledge, this is the ever reported case of acute-onset CIDP associated with COVID-19 vaccine and high COVID-19 antibody level.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating , COVID-19 Vaccines , Guillain-Barre Syndrome/etiology , Humans , Polyradiculoneuropathy, Chronic Inflammatory Demyelinating/drug therapy , RNA, Viral , SARS-CoV-2 , Vaccination/adverse effects
9.
BMJ Case Rep ; 14(7)2021 Jul 30.
Article in English | MEDLINE | ID: covidwho-1334547

ABSTRACT

We report a case of Guillain-Barré syndrome (GBS) occurring soon after the first dose of Vaxzevria (previously known as COVID-19 vaccine AstraZeneca). Thus far, there has been no evidence of an increased risk of GBS resulting from either COVID-19 infection nor from COVID-19 vaccines; however, individual cases and population cohorts should be scrutinised, in order to ensure the constant evaluation of such risks. It is as yet not possible to draw conclusions about any significant association between COVID-19 vaccination and GBS. A temporal correlation does not imply, and should not be deemed to signify, causality. However, it is important to remain vigilant, so that any potential increased risk is properly evaluated. The specific presentation of bifacial weakness as the initial symptom may be a characteristic feature of GBS in the context of recent COVID-19 vaccination.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Influenza Vaccines , COVID-19 Vaccines , Guillain-Barre Syndrome/etiology , Humans , Influenza Vaccines/adverse effects , SARS-CoV-2 , Vaccination/adverse effects
10.
BMJ Case Rep ; 13(10)2020 Oct 29.
Article in English | MEDLINE | ID: covidwho-1304206

ABSTRACT

We report the first case of Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection in Japan. A 54-year-old woman developed neurological symptoms after SARS-CoV-2 infection. We tested for various antiganglioside antibodies, that had not been investigated in previous cases. The patient was diagnosed with GBS based on neurological and electrophysiological findings; no antiganglioside antibodies were detected. In previous reports, most patients with SARS-CoV-2-infection-related GBS had lower limb predominant symptoms, and antiganglioside antibody tests were negative. Our findings support the notion that non-immune abnormalities such as hyperinflammation following cytokine storms and microvascular disorders due to vascular endothelial damage may lead to neurological symptoms in patients with SARS-CoV-2 infection. Our case further highlights the need for careful diagnosis in suspected cases of GBS associated with SARS-CoV-2 infection.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , COVID-19 , Electromyography/methods , Female , Guillain-Barre Syndrome/therapy , Humans , Hypesthesia/diagnosis , Hypesthesia/etiology , Japan , Middle Aged , Muscle Weakness/diagnosis , Muscle Weakness/etiology , Pandemics/prevention & control , Pandemics/statistics & numerical data , Rare Diseases , Risk Assessment , Severity of Illness Index , Treatment Outcome
11.
BMJ Case Rep ; 13(9)2020 Sep 21.
Article in English | MEDLINE | ID: covidwho-1304172

ABSTRACT

Clinical manifestations of COVID-19 are known to be variable with growing evidence of nervous system involvement. In this case report, we describe the symptoms of a patient infected with SARS-CoV-2 whose clinical course was complicated with Guillain-Barré syndrome (GBS). We present a case of a 58-year-old woman who was initially diagnosed with COVID-19 pneumonia due to symptoms of fever and cough. Two weeks later, after the resolution of upper respiratory tract symptoms, she developed symmetric ascending quadriparesis and paresthesias. The diagnosis of GBS was made through cerebrospinal fluid analysis and she was successfully treated with intravenous immunoglobulin administration.


Subject(s)
Coronavirus Infections/complications , Guillain-Barre Syndrome/physiopathology , Low Back Pain/physiopathology , Muscle Weakness/physiopathology , Paresthesia/physiopathology , Pneumonia, Viral/complications , Analgesics/therapeutic use , Betacoronavirus , Brain/diagnostic imaging , COVID-19 , Coronavirus Infections/diagnosis , Diagnosis, Differential , Female , Gabapentin/therapeutic use , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Immunologic Factors/therapeutic use , Lumbar Vertebrae/diagnostic imaging , Magnetic Resonance Imaging , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Radiculopathy/diagnosis , SARS-CoV-2 , Spinal Cord/diagnostic imaging
12.
BMJ Case Rep ; 13(7)2020 Jul 08.
Article in English | MEDLINE | ID: covidwho-1291917
13.
BMJ Case Rep ; 14(6)2021 Jun 29.
Article in English | MEDLINE | ID: covidwho-1288366

ABSTRACT

Guillain-Barré syndrome (GBS) is a rare immune-mediated disorder of the peripheral nerves. Although its cause is not fully understood, the syndrome often follows infection with a virus or bacteria, although in rare occasions, vaccination may precede GBS. We describe a case of a 62-year-old woman who presented with paraesthesia and progressive weakness of both lower limbs over 3 days. Clinical examination and investigation findings including lumbar puncture and nerve conduction studies were consistent with the diagnosis of GBS. She had no history of either diarrhoea or respiratory tract infections preceding her presentation. However, she had her first intramuscular dose of the Oxford/AstraZeneca COVID-19 vaccine 11 days prior to her presentation. Although no direct link could be ascertained, the purpose of this report is to highlight the incidence and consider this issue while evaluating any case of GBS in the light of the current pandemic and vaccination programme.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , COVID-19 Vaccines , Female , Guillain-Barre Syndrome/etiology , Humans , Middle Aged , Pandemics , SARS-CoV-2
14.
BMJ Case Rep ; 14(5)2021 May 24.
Article in English | MEDLINE | ID: covidwho-1242197

ABSTRACT

A range of neurological manifestations associated with COVID-19 have been reported in the literature, but the pathogenesis of these have yet to be fully explained. The majority of cases of peripheral nervous system disease published thus far have shown a symmetrical pattern. In contrast, we describe the case of a patient with asymmetrical predominantly upper-limb sensorimotor polyneuropathy following COVID-19 infection, likely due to a multifactorial pathological process involving critical illness neuropathy, mechanical injury and inflammatory disease. His presentation, management and recovery contribute to the understanding of this complex condition and informs rehabilitation approaches.


Subject(s)
COVID-19 , Peripheral Nervous System Diseases , Polyneuropathies , Critical Illness , Humans , Polyneuropathies/etiology , SARS-CoV-2
15.
BMJ Case Rep ; 14(5)2021 May 11.
Article in English | MEDLINE | ID: covidwho-1225700

ABSTRACT

The COVID-19 pandemic has led to a rise in cases of Guillain-Barré syndrome (GBS). This autoimmune sequela is a manifestation of the neurotropism potential of the virus. At present, knowledge regarding the pathophysiology, clinical features, management and outcomes of the condition is still evolving. This paper presents the case of a 22-year-old pregnant patient who came in with a history of upper respiratory tract symptoms followed by acroparaesthesia and progressive ascending weakness. She was confirmed to have COVID-19 and GBS and was subsequently managed with intravenous immunoglobulin (IVIg) followed by supportive therapy. To the authors' knowledge and based on their literature search, this is the first reported case of GBS in a COVID-19 confirmed pregnant patient who received IVIg.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Immunoglobulins, Intravenous , Pregnancy Complications, Infectious , Adult , COVID-19/complications , COVID-19/drug therapy , Female , Guillain-Barre Syndrome/complications , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/drug therapy , Humans , Immunoglobulins, Intravenous/therapeutic use , Pandemics , Pregnancy , Pregnancy Complications, Infectious/drug therapy , SARS-CoV-2 , Young Adult
16.
BMJ Case Rep ; 13(9)2020 Sep 14.
Article in English | MEDLINE | ID: covidwho-1186219

ABSTRACT

A construction worker in his 30s presented three times in 4 days with progressive upper and then lower limb weakness. On the first two occasions he had no systemic symptoms, but on the third presentation he had fever and cough, starting from day 4 of weakness. Examination identified weakness in all four limbs and areflexia, suggesting a peripheral neuromuscular disorder. Investigations were consistent with Guillain-Barré syndrome and additional COVID-19 (SARS-CoV-2) infection. The patient improved after immunoglobulin treatment. At least four cases of Guillain-Barré syndrome have been reported in the literature with concurrent COVID-19 illness in whom respiratory signs appeared a few days after the onset of neurological signs. With the incubation period for COVID-19 respiratory symptoms believed to be up to 14 days, it is possible that neurological symptoms could develop before respiratory and other symptoms. During the current pandemic, presence of concurrent COVID-19 infection needs to be considered in patients presenting with Guillain-Barré syndrome.


Subject(s)
Coronavirus Infections/complications , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Adult , COVID-19 , Humans , Male , Pandemics
17.
BMJ Case Rep ; 14(3)2021 Mar 25.
Article in English | MEDLINE | ID: covidwho-1153656

ABSTRACT

COVID-19 affects a wide spectrum of organ systems. We report a 52-year-old man with hypertension and newly diagnosed diabetes mellitus who presented with hypoxic respiratory failure due to COVID-19 and developed severe brachial plexopathy. He was not treated with prone positioning respiratory therapy. Associated with the flaccid, painfully numb left upper extremity was a livedoid, purpuric rash on his left hand and forearm consistent with COVID-19-induced microangiopathy. Neuroimaging and electrophysiological data were consistent with near diffuse left brachial plexitis with selective sparing of axillary, suprascapular and pectoral fascicles. Given his microangiopathic rash, elevated D-dimers and paucifascicular plexopathy, we postulate a patchy microvascular thrombotic plexopathy. Providers should be aware of this significant and potentially under-recognised neurologic complication of COVID-19.


Subject(s)
Brachial Plexus Neuropathies/etiology , COVID-19/complications , Arm/pathology , Brachial Plexus Neuropathies/diagnosis , COVID-19/diagnosis , Diabetes Mellitus , Exanthema/complications , Fibrin Fibrinogen Degradation Products/analysis , Humans , Hypertension/complications , Magnetic Resonance Imaging , Male , Middle Aged , Neuralgia/complications , Patient Positioning/adverse effects , Respiratory Insufficiency/etiology , SARS-CoV-2/isolation & purification
18.
BMJ Case Rep ; 14(1)2021 Jan 28.
Article in English | MEDLINE | ID: covidwho-1054635

ABSTRACT

The COVID-19 pandemic has resulted in an incomparable disease burden worldwide. One of the main contributors stems from the multisystem inflammatory syndrome associated with SARS-CoV-2 infection. The numbers of those affected continue to rise with the increasing number of confirmed COVID-19 cases. However, we are yet to fully comprehend the risk factors, disease progression and prognosis for individuals affected. We describe a case of a previously healthy 17-year-old boy who tested positive for the SARS-CoV-2 virus. He presented with a 5-day history of mild influenza-like symptoms, however, quickly required ventilatory support in the intensive care unit. Two months postdischarge, he developed an isolated petechial rash on his palms and soles. His cutaneous presentation was in association with a mixed sensorimotor peripheral neuropathy, debilitating neuropathic pain and intermittent respiratory distress. We postulate that cutaneous manifestations post-COVID-19 could be indicatory of the newly identified multisystem inflammatory syndrome.


Subject(s)
COVID-19/complications , Exanthema/etiology , Adolescent , Humans , Male , Peripheral Nervous System Diseases/etiology , Respiratory Insufficiency/etiology , SARS-CoV-2 , Vasculitis/etiology
19.
BMJ Case Rep ; 13(8)2020 Aug 11.
Article in English | MEDLINE | ID: covidwho-713328

ABSTRACT

Acute facial nerve disease leading to peripheral facial paralysis is commonly associated with viral infections. COVID-19 may be a potential cause of peripheral facial paralysis and neurological symptoms could be the first and only manifestation of the disease. We report a case of a term pregnancy diagnosed with COVID-19 after presenting with isolated peripheral facial palsy.


Subject(s)
Betacoronavirus , Coronavirus Infections/complications , Facial Paralysis/etiology , Pneumonia, Viral/complications , Pregnancy Complications, Infectious/etiology , Adult , COVID-19 , Facial Paralysis/therapy , Female , Humans , Pandemics , Physical Therapy Modalities , Pregnancy , Pregnancy Complications, Infectious/therapy , SARS-CoV-2
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