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1.
Clinical and Experimental Rheumatology ; 40(10):84, 2022.
Article in English | EMBASE | ID: covidwho-2067776

ABSTRACT

Objectives. To investigate the safety and efficacy of SARS-Cov-2 vaccination in a large international cohort of patients with primary Sjogren syndrome due to scarcity of data in this population. Methods. By the first week of May 2021, all Big Data Sjogren Consortium centers had been contacted and asked for Registry patients to be included in the study if they had received at least one dose of any SARS-CoV-2 vaccine. The in-charge physician asked patients about local and systemic reactogenicity, using a pre-defined electronic questionnaire to collect epidemiologic data, COVID 19 vaccination data, and COVID 19 vaccination side effects. Adverse events were defined as those reported by the patient at the site of injection within 7 days from vaccination (reactogenicity) as local adverse events, systemic symptoms as systemic side effects, and postvaccination AEs of special interest related to SS as SS flares. Results. The vaccination data of 1237 patients (1170 women, with a mean age at diagnosis of primary SjS of 50.5 13.2) were received. A total of 835 patients (67 percent) reported any adverse event, including local (53 percent) and systemic (50 percent) AEs. Subjective symptoms (63%) were the most common local AEs, followed by objective signs at the injection site (16%) and general symptoms were the most commonly reported systemic AEs (46 percent), followed by musculoskeletal (25 percent), gastrointestinal (9 percent), cardiopulmonary (3 percent), and neurological (2 percent). People under 60 years old had a higher risk of developing AE after vaccination (OR 2.48, CI 95 1.89-3.27 percent), as did those with low systemic SS activity (OR 1.62, CI 95 1.22-2.15) and those who received mRNA vaccines, according to a multivariate analysis (OR 1.57, CI 95 percent 1.12- 2.18). The risk of developing systemic AEs was also higher in women (OR 2.85, CI 95 percent 1.60-5.2346), White people (OR 1.73, CI 95 1.14-2.65), and those who received a deficient vaccination regimen (OR 1.78, CI 95 1.12-2.88 percent). In addition to 141 (11%) patients who reported a significant worsening/exacerbation of their pre-vaccination sicca symptoms as a result of post-vaccination SS flares, 15 (1.2%) patients (13 women, mean age at vaccination 41.9 years) reported active involvement in the glandular (n=8), articular (n=7), cutaneous (n=6), pulmonary (n=2), and peripheral nervous system (n=1) domains as post-vaccination systemic flare. All side effects and flares subsided within 1-3 weeks, with no lasting effects or deaths. In terms of vaccination efficacy, breakthrough SARS-CoV-2 infection was confirmed after vaccination in three (0.24 percent) patients, all of whom recovered completely, and positive anti-SARS-Cov-2 antibodies were detected in approximately 95 percent of vaccinated SjS patients, according to data available. Conclusions. SARS-CoV-2 vaccination in patients with primary SjS, like other vaccines with adequate response and no safety signals, raised no concerns about the vaccine's efficacy or safety.

2.
Zh Nevrol Psikhiatr Im S S Korsakova ; 122(9): 132-136, 2022.
Article in Russian | MEDLINE | ID: covidwho-2056582

ABSTRACT

This paper reports two cases of Guillain-Barre syndrome associated with coronavirus infection COVID-19. The clinical symptoms and neurological status of patients, the data of the additional examination and the features of the prescribed therapy are described in detail. The issue of the tropicity of the SARS-CoV-2 virus to human nervous tissue and its possible ways of affecting the peripheral nervous system is discussed.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , COVID-19/complications , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Humans , SARS-CoV-2
3.
Zh Nevrol Psikhiatr Im S S Korsakova ; 122(9): 15-21, 2022.
Article in Russian | MEDLINE | ID: covidwho-2056579

ABSTRACT

Based on the available literature data, the article discusses the prevalence of various forms of damage of the peripheral nervous system in COVID-19 and in the post-COVID period. Information about the clinical features and the course of individual cranial neuropathies, chronic dysimmune neuropathies, Guillain-Barré syndrome, drug-induced neuropathies, fine fiber neuropathy, myasthenia gravis and polyneuropathy of critical conditions was systemized in the context of coronavirus infection. SARS-CoV-2 can trigger various stages of pathogenesis, including neuroimmune ones, which cause long-term consequences of COVID-19, including those associated with the damage of the peripheral nervous system. Awareness of COVID-19-associated pathological conditions will allow assessment of the possible risks of damage of the peripheral nervous system, recognize them at early stages and develop more effective approaches for treatment.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , Myasthenia Gravis , COVID-19/complications , Guillain-Barre Syndrome/complications , Guillain-Barre Syndrome/etiology , Humans , Myasthenia Gravis/complications , Peripheral Nervous System , SARS-CoV-2
4.
Cureus ; 14(8): e28309, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-2056305

ABSTRACT

The coronavirus can infect the upper respiratory tract, sinuses, and nose, and its severity manifests in its respiratory symptoms and neurological and psychological consequences. The majority of people who have COVID-19 present with moderate flu-like illness, and patients who are elderly with comorbid conditions, such as hypertension and diabetes, are more prone to experience severe illness and death. However, in the ongoing COVID-19 pandemic, neurological consequences have become a substantial source of morbidity and mortality. COVID-19 poses a global hazard to the nervous system because of its widespread dispersion and multiple pathogenic pathways. This review offers a critical assessment of the acute and long-term neurological effects of the COVID-19 virus. Some neurological problems include headache, dizziness, myalgia/fatigue, meningitis, ischemic/hemorrhagic stroke, and myelitis. Other people who have contracted COVID-19 also exhibit neurological features such as loss of taste and smell, reduced consciousness, and Guillain-Barré syndrome. This study seeks to help neurologists comprehend the wide range of neurologic aspects of COVID-19, as understanding neurological symptoms may help with the management and enhance the patient's outcomes.

5.
Drug Safety ; 45(10):1234-1235, 2022.
Article in English | ProQuest Central | ID: covidwho-2045563

ABSTRACT

Introduction: SFN is a relatively rare condition related to finer fibers of peripheral nervous system. A specific diagnostic procedure is necessary to reach a correct diagnosis.The most frequently reported symptoms are: pain (described as burning or a sensation of intense heat, as "aching cold", "pinpricks", "electric shocks),paraesthesia (spontaneous sensations of tingling,numbness,itching),dysesthesia and allodynia. Some published papers hypothesized a correlation between SFN and anticovid vaccine. Objective: Study target was to analyze the adverse events following immunization (AEFI) reported in our ASL (resident population 1,221,857, ¼ regional population) potentially linked to the SFN symptoms. Methods: Data relating to AEFI were extrapolated from the National Pharmacovigilance Network (NPN), while data referring to administered doses were extracted from the ASL QlinkView platform. Results: From 27 December 2020 to 26 April 2022, 624 reports, relating to vaccines anticovid AEFI, were received and recorded in the NPN. 2.109 AEFI were described in these reports. Administered vaccines: Comirnaty (346/624 sheets;1.164/2.109AEFI;2.092.042/ 3.028.781 total administered doses), the most reported AEFI were related to general pathologies: pain, wheal or erythema at the injection site, headache, fever, asthenia, nausea, malaise, tachycardia, muscle pain, fatigue, joint pain (25% of 1.164 AEFI). Other described symptoms: other pains, burning, itching, paraesthesia, tingling, numbness, allodynia, potentially linked to SFN (17.3% of 1.164 AEFI);Spikevax (112/624 sheets;392/2.109 AEFI;607.626/ 3.028.781 doses),the most reported AEFI, like Comirnaty, were related to the injection site (26% of 392 AEFI), while the potentially symptoms related to SFN were the 20.2% of 392 AEFI;Vaxzevria (146/624 sheets;512/2.109 AEFI;298.188/3.028.781 doses), the most reported AEFI, related to general pathologies, were the 33% of 512 AEFI, while potentially symptoms related to SFN were the 18.8%. Finally, as regards the Janssen vaccine (10/624 sheets;32/2.109 AEFI;30.702/3.028.781 doses), the most described events, related to general pathologies, are the 47% of the 32 AEFI, while 31% are potentially linked to the of SFN symptoms. No AEFI was reported related to the 223 doses about Novavax vaccine. The causality assessment was defined correlatable about 37 records (6% of 624 records). 12/37 records describe potentially linked to SFN symptoms (6 Vaxzevria (1%), 3 Comirnaty (0.5%) and 3 Spikevax (0.5%)). Conclusion: The analysis about AEFI reported in our ASL related to anticovid vaccines underlined the existence of symptoms potentially linked to SFN, although only in a few cases it was evaluated a causality assessment to vaccination. Just a specific diagnostic procedure can confirm the diagnosis and the correlation. Therefore, the correlation between SFN and vaccine needs larger-scale studies and insights for a correct evaluation.

6.
Profilakticheskaya Meditsina ; 25(8):98-104, 2022.
Article in Russian | EMBASE | ID: covidwho-2010548

ABSTRACT

The SARS-CoV-2 virus is the cause of the COVID-19 pandemic. It was first discovered in Wuhan, China, in December 2019. The COVID-19 pandemic has become a serious challenge for all humanity. Although most patients develop respiratory symptoms, the neurological manifestations due to central and peripheral nervous system involvement are quite common. Objective of the review. To analyze and systematize current data on the COVID-19 effect on the central and peripheral nervous system. Material and methods. The material for the study was more than 70 papers published between 2019—2022 and indexed in the international databases Scopus, Web of Science, and PubMed. Results. Analysis of the relevant literature on the pathogenesis of COVID-19 and some neurological complications was performed. It was observed that in addition to the respiratory system, SARS-CoV-2 affects the central nervous system, the peripheral nervous system, and the muscular system, resulting in neurological disorders. Understanding the pathogenesis of nervous system damage contributes to improved diagnosis of neurological complications. In general, according to the literature, patients with severe new coronavirus infection are prone to neurological complications. Conclusion. Since most studies currently focus on respiratory symptoms, the prevalence of neurological effects of COVID-19 may be underestimated. A detailed analysis of the mechanisms of both central and peripheral nervous system damage is needed.

7.
Journal of Pediatric Neurology ; 2022.
Article in English | Web of Science | ID: covidwho-2004826

ABSTRACT

Coronavirus disease (COVID-19) is caused by a novel severe acute respiratory syndrome coronavirus 2 virus which primarily targets the lungs. However, the central nervous system (CNS) and peripheral nervous system involvement due to COVID-19, however, has been reported as early as the cases of respiratory system involvement. In addition, there have been many reports describing neuroimaging features of COVID-19, but data beyond case studies in the pediatric population are still limited, indicating limited CNS involvement. The CNS involvement and complications include, but are not limited to, encephalopathy, meningoencephalitis, ischemic stroke, venous sinus thrombosis, acute necrotizing encephalopathy, acute disseminated encephalomyelitis, posterior reversible encephalopathy syndrome, acute cerebellitis, acute hemorrhagic myelitis, and Guillain-Barre syndrome. In this manuscript, we will discuss the imaging characteristics of some of these entities with a known diagnosis of COVID-19.

8.
Frontiers in Neurology ; 13, 2022.
Article in English | EMBASE | ID: covidwho-1979051
9.
J Neurol Sci ; 440: 120330, 2022 09 15.
Article in English | MEDLINE | ID: covidwho-1977545

ABSTRACT

BACKGROUND AND PURPOSE: Guillain-Barré-Syndrome (GBS) can follow COVID-19 vaccination, with clinical and paraclinical features still to be precisely assessed. We describe a cohort of patients who developed GBS after vaccination with different types of COVID-19 vaccines. METHODS: Patients with post-COVID-19 vaccination GBS, admitted to the six hospitals that cover the whole Liguria Region, Northwestern Italy, from February 1st to October 30th 2021, were included. Clinical, demographic, and paraclinical data were retrospectively collected. RESULTS: Among the 13 patients with post-COVID-19 vaccination GBS (9 males; mean age, 64 year), 5 were vaccinated with Oxford-AstraZeneca, 7 with Pfizer-BioNTech, and one with Moderna. Mean time between vaccination and GBS onset was 11.5 days. Ten patients developed GBS after the first vaccination dose, 3 after the second dose. Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) was the predominant GBS variant, mainly characterized by sensory involvement. Bilateral seventh cranial nerve involvement followed AstraZeneca vaccination in two cases. Three patients presented treatment-related fluctuations, and 4 mild symptoms that delayed treatments and negatively affected prognosis. Prognosis was poor (GBS-disability score, ≥3) in 5/13 patients, with a disability rate of 3/13. CONCLUSIONS: Our findings confirm that most post-COVID-19 vaccination GBS belong to the AIDP subtype, and occur after the first vaccine dose. Treatment-related fluctuations, and diagnosis-delaying, mild symptoms at onset are clinical features that affect prognosis and deserve particular consideration.


Subject(s)
COVID-19 , Guillain-Barre Syndrome , COVID-19/prevention & control , COVID-19 Vaccines/adverse effects , Guillain-Barre Syndrome/diagnosis , Humans , Male , Middle Aged , Retrospective Studies , Vaccination
10.
Management & Education ; 18(5):96-99, 2022.
Article in Bulgarian | Academic Search Complete | ID: covidwho-1971055

ABSTRACT

The Covid 19 infection has become one of the most current problems in the world since the end of 2019 due to the high morbidity and death rates, affecting all age, sex and racial groups. The disease develops in various ways among different individuals and leads to different kinds of complications. A small part of these affect the nervous system - the central, as well as the peripheral nervous system. In the majority of cases, this involves the onset of cerebrovascular illnesses, neuro-infections, GuillainBarré syndrome, myopathies and others. The acute inflammatory demyelinating polyradiculoneuropathy is an immune-mediated disease and can occur in cases of acute infections, as well as in the post-infection phase in different periods of time. This can be considered as one of the rare complications of the "acute Covid-19" syndrome. We present 3 clinical cases of acute inflammatory demyelinating polyradiculoneuropathy induced by the SARS-CoV-2 infection for the period between February and April 2021 among men in different age groups, which develop with a diverse clinical picture, characteristic cerebrospinal fluid and EMG changes. Partial motor function deficit recovery is observed after a medical treatment cycle is completed. [ FROM AUTHOR] Copyright of Management & Education / Upravlenie i Obrazovanie is the property of Prof. Dr. Assen Zlatarov University and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

11.
J Clin Med ; 11(15)2022 Jul 31.
Article in English | MEDLINE | ID: covidwho-1969325

ABSTRACT

Cutaneous neurosensory symptoms have become increasingly reported findings in COVID-19; however, these virus-related manifestations are largely overlooked, and their pathology is poorly understood. Moreover, alterations of skin sensibility currently recognize no clear histopathology substrate. The purpose of this study was to provide pathology evidence of neurosensory skin system involvement in COVID-19 patients complaining of subjective neurological symptoms affecting the skin. Out of 142 patients, six long COVID-19 cases complaining of cutaneous subjective neurological symptoms assessed on an NTSS-6 questionnaire underwent histopathological and immunohistochemical analyses of skin areas affected by paroxysmal diffuse burning and itching sensations. Two patients also performed electroneurography examination. The histology investigation showed hypertrophic glomus vascular bodies with hypertrophic S100+ perineural sheath cells and adjacent hypertrophy of the nerve branches associated with increased basophil polysaccharide matrix. Electroneurography revealed disturbances of A-delta and C dermal neuronal fibers. The main limitation of this study consisted of a limited number of skin biopsy samples, requiring further investigation. Histopathology findings are consistent with hypertrophy of nerve endings, suggesting a condition such as "dermal hyperneury", a recently reported small nerve hypertrophy condition affecting sensory C fibers. Such a neuropathic basis could explain dysesthesia experienced by the patients, as previously described in postherpetic neuralgia.

12.
Romanian Journal of Neurology/ Revista Romana de Neurologie ; 21(2):162-168, 2022.
Article in English | EMBASE | ID: covidwho-1957674

ABSTRACT

Background/aim. Coronavirus Disease 2019 (COVID-19) is an infectious disease caused by SARS-CoV-2. Although the main symptoms of this virus are in the respiratory system, neurological clinical manifestations in the form of the central nervous system (CNS), peripheral nervous system (PNS) and musculoskeletal system are often found. This study aims for data on the characteristics of neurological manifestations in COVID-19 patients. Research methods. A retrospective cohort study with medical record from June 2020 to June 2021 which was analyzed descriptive, Chi-Square test and survival using SPSS program. Research result. There were 136 patients with PCR swab results (+), 80 (58.8%) male and 56 (41.2%) female, age > 50 years 92 (67.6%), 47 (34.6%) died. Neurological manifestations in the CNS that stroke 72 (52.9%) RR 4.8 (CI 95% 2.1-10.6;p<0.001), seizures 19 (14%) RR 14.7 (95% CI 4-54.3;p <0.001), headache 32 (23.5%) RR 5.7 (95% CI 2, 4-13.4;p<0.001), encephalopathy 35 (25.7%) RR 41.1 (95% CI 12.7-132.7;p<0.001), in the PNS myasthenic crisis 6 (4.4%) RR 10.4 (95% CI 1.2-92.5;p = 0.035) anosmia 73 (53.7%) RR 0.2 (95% CI 0.1-0.5;p<0.001) while musculoskeletal myalgia 25 (18.4%) and low back pain 18 (13.2%) was not significant. Conclusion. Most neurological clinical manifestations in the CNS (stroke, headache, seizures and encephalopathy) followed by the PNS (myasthenia crisis and anosmia). Neuroinvasive complications are thought to play a role as one of the causes of respiratory failure and death in patients with COVID-19.

13.
Journal of Rehabilitation Sciences and Research ; 9(2):93-96, 2022.
Article in English | Scopus | ID: covidwho-1955434

ABSTRACT

Covid-19 was reported in China for the first time. The most common manifestation of this novel infection is respiratory problems. However, it can also invade both central and peripheral nervous systems. The usual central nervous system complications were dizziness (16.8%) and headache (13.1%). The most common reported symptoms in patients with peripheral nervous system problems were taste impairment (5.6%) and smelling impairment (5.1%) due to olfactory nerve involvement. In this study, we present a 46-year-old male who was referred to our clinic in Shiraz for electrodiagnosis and better evaluation due to paresthesia and numbness of the right 4th and 5th fingers accompanied by weakness and atrophy of the muscles in the ulnar nerve territory, which occurred during Covid-19 infection in this patient. Severe partial involvement of the right ulnar nerve at the elbow region was detected in the electrodiagnosis, and findings in the right elbow MRI favored ulnar neuritis. © The Authors. Published by JRSR.

14.
Journal of the Peripheral Nervous System ; 27, 2022.
Article in English | EMBASE | ID: covidwho-1935098

ABSTRACT

The proceedings contain 69 papers. The topics discussed include: chemotherapy induced peripheral neurotoxicy: why should we care?;studying the caudal nerve anatomy and physiology to refine detection of peripheral nerve damage in rodent models;anxiety and depression in Charcot-Marie-tooth disease: data from the Italian CMT National Registry;fatigue in CMT: a web based survey from the Italian CMT National Registry;early molecular diagnosis of mutations on the transthyretin gene as a strategy to improve the prognosis of hereditary transthyretin-mediated amyloidosis - an update of the GENILAM project;THR124MET myelin protein zero mutation mimicking motor neuron disease;torsional neuropathy in parsonage turner syndrome following anti-COVID19 vaccination. how to detect and manage with it?;isolated musculocutaneous involvement in parsonage-turner syndrome associated with SARS-COV2 vaccination;neonatal FC receptor expression in patients with chronic dysimmune neuropathy. a feasibility study;and peripheral neuropathies after common organ transplantations. literature review and the use of electrophysiological tests and ultrasound.

15.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925586

ABSTRACT

Objective: NA Background: Here we report a patient with COVID-19 associated inflammatory myopathy, presenting with facial, bulbar and proximal limb weakness. A 58-year-old woman presented with cough, dyspnea, and myalgia. Vital signs and her physical exam was unremarkable. Initial PCR testing for SARS-CoV-2 was negative and the patient was discharged home. She returned three weeks later with more severe dyspnea, cough, dysarthria, dysphagia, odynophagia and severe generalized weakness with inability to ambulate. She had no sensory symptoms or bowel or bladder dysfunction. Physical examination was significant for tachycardia and oxygen saturation of 88% on room air. She had bilateral ptosis, facial weakness, hypernasal dysarthria and profound symmetric proximal limb weakness. Reflexes were symmetrically diminished. Repeated SARS-CoV-2 PCR was positive. MRI of the entire neuroaxis showed no central or peripheral nervous system involvement, but demonstrated diffuse muscle edema and enhancement, with a region of myonecrosis Motor nerve conduction studies were unremarkable, needle electromyography revealed sparse fibrillation potentials;On admission, CK was elevated to 700 U/L. Anti-Sjögren's-syndrome-related antigen and anti-small ubiquitinlike modifier-1 activating enzyme antibodies were both strongly positive and Ku antibody was weakly positive. Muscle biopsy showed perivascular inflammatory infiltration with endomysial extension, regenerating fibers and upregulation of HLA Class ABC expression on non-necrotic fibers. Our presumptive diagnosis was COVID-19 associated myositis and a five-day course of 1000 mg intravenous methylprednisolone was administered. Over two weeks, her CK levels normalized and she recovered the ability to raise her arms and legs from the bed and showed slow improvement in bulbar function. Design/Methods: NA Results: Viral infection is a well-known cause of myositis. The severe immune activation known to occur in COVID-19 patients likely plays a major pathophysiologic role. The finding of multiple serologic autoimmune antibodies is intriguing suggesting an epiphenomenon rather than activation or unmasking of a specific immune response directed to the muscles. Conclusions: NA.

16.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925558

ABSTRACT

Objective: To explore triple overlap syndrome and immune effects of COVID-19 vaccination. Background: Neurologic immune related adverse events (nIRAE) are potential complications of Immune Checkpoint Inhibitors (ICI). nIRAE of the Peripheral Nervous System (PNS) can present fulminantly, especially myositis, myasthenia gravis (MG), and overlap syndrome of myositis, MG, and myocarditis. Design/Methods: NA Results: 77-year old male with metastatic melanoma presented to hospital with leg weakness, hoarseness, dyspnea, and ptosis 1 week after first cycle of ipilimumab and nivolumab and 3 days after COVID-19 vaccine. He had bradycardia with heart block, and hepatorenal failure. Exam was remarkable for dysarthria, right eye ptosis, hip flexion weakness 4+/5, without fatigability. Labs showed CK 21,325, Troponin-T 4,888, Aldolase 307, AChR antibody positive, and AntiStriated Muscle Antibody 1:3840. Vital Capacity (VC) was 1.9L and Negative Inspiratory Force (NIF) -20cmH2O. Patient received BiPAP, plasmapheresis, and methylprednisolone 1000mg. After this, he developed fatigability of ocular muscles, voice, and proximal arms;VC dropped to 1.3L. He was diagnosed with triple overlap syndrome, but MG manifested after receiving first dose of high-dose steroids. Heart biopsy showed lymphohystiocytic inflammation. Muscle biopsy showed focal and dispersed lymphomononuclear cell endomysial infiltration. Electromyography demonstrated patchy myositis in lower extremities. Patient completed 3 days of high-dose steroids, 5 days of plasmapheresis, abatacept, and rituximab, followed by slow steroid taper. He did not require intubation despite tenuous respiratory status. Conclusions: nIRAE of the PNS are rare potential complications of immunotherapy, usually presenting by 6 weeks, although overlap syndrome can present hyper-acutely after 1 dose. Our patient presented 1 week after first treatment, perhaps influenced by COVID vaccine. Management of nIRAE is consensus-based, as no standard evidence-based treatment exists. Our patient was successfully treated with plasmapheresis prior to high-dose steroids (obviating steroid-induced myasthenic crisis), abatacept and rituximab. The myasthenic crisis was successfully managed with BiPAP, avoiding intubation, and he ultimately improved.

17.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925501

ABSTRACT

Objective: Our study objective is to evaluate the electromyography and nerve conduction study (EMG/NCS) findings among COVID-19 patients and look for possible correlations. Background: Neurological manifestations in patients with coronavirus disease 2019 (COVID-19) have been reported from early features of anosmia and dysgeusia to widespread involvement of the central nervous system, peripheral nervous system, as well as the neuromuscular junction and muscle. Design/Methods: This is a hospital-based retrospective observational study. All COVID-19 patients between the period of 1st January 2020 to 31st December 2020 undergoing an EMG/NCS were included. Results: Eighteen patients (12 male and 6 female) were included. The mean age was 55 ±12 years. 11 patients required intubation for a mean period of 18.6 days (range: 3-37 days). Electrodiagnostic findings were consistent with a myopathy in a majority of these patients (82%). Five of them also had a concurrent axonal neuropathy. In the remaining patients who did not require intubation (n=7), three patients had myopathic EMG changes and one had Guillain Barre syndrome. Conclusions: Myopathic EMG changes are commonly seen in critically ill COVID-19 patients, especially with a prolonged hospital stay. At this time, there are no neuromuscular-specific recommendations for patients who contract COVID-19. Only time and additional data will unveil the varying nature and potential neurological sequelae of COVID-19.

18.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925495

ABSTRACT

Objective: To further define the potential long-term peripheral nervous system complications of SARS-CoV-2 and to prognosticate the average duration of clinical symptoms. Background: Many survivors of SARS-CoV-2 present to outpatient Neurology clinics with “long-haul” symptoms including myalgia, encephalopathy, headaches, paresthesia, anosmia, movement disorders, ataxia, dysphagia, and dysarthria. Given the novelty of this virus, accurate prognosis for neurologic recovery is currently unknown. Design/Methods: Using ICD-10 and CPT coding data, we identified a cohort of patients diagnosed with COVID-19 who then presented to the Indiana University Neuroscience Center from February 1, 2020 to June 18, 2021 for further workup of weakness or neuropathy of otherwise unexplained origin. Identified patients' workup and recovery were reviewed to establish a more definitive understanding of the underlying etiology of symptoms as well as a predicted time model for recovery. Results: Fifteen patients presented to our clinic fulfilling inclusion criteria. Four had complications resulting from critical illness neuropathy/myopathy, 4 had functional neurologic disorder, 4 were diagnosed with a post-viral neuropathy, 1 was diagnosed with Guillain-Barre Syndrome, 1 was diagnosed with a post-infectious radiculitis, and 1 was lost to follow up prior to further testing. Six (40%) of these 15 patients have recovered with an average time to return to neurologic baseline of 5.2 months. Conclusions: A subset of patients who have partially recovered from SARS-CoV-2 report ongoing neurologic symptoms. Peripheral nervous system complications from SARS-CoV-2 are rare, with only 15 patients reporting such symptoms in our study. The most common etiologies identified were critical illness neuropathy, post-infectious neuropathy and functional neurologic disorder;on average, recovered patients returned to neurologic baseline in 5.2 months.

19.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925410

ABSTRACT

Objective: Present a case of lupus myelitis occurring in a patient already receiving immunosuppression. Background: Neurologic complications of systemic lupus erythematosus span the central and peripheral nervous systems. We present a case of lupus myelitis in a patient previously well controlled with immunosuppression. Design/Methods: N/A Results: A 24-year-old woman with history of systemic lupus erythematosus presented with acute onset inability to walk due to bilateral leg weakness and numbness, associated with constipation and urinary retention. A week before, she experienced runny nose, sore throat, headache and neck pain radiating down her shoulders. Her medication regimen prior to admission included mycophenolate mofetil 1500 mg BID, hydroxychloroquine 200 mg daily, and prednisone 2.5 mg daily. Examination revealed bilateral lower limb weakness, more pronounced on right, hyperesthesia in the right leg, decreased proprioception bilaterally. She had intact pinprick, light touch, and vibration sense. Ankle reflexes were absent bilaterally. Laboratory testing showed pancytopenia, elevated anti-DsDNA (107 IU/mL), ESR of 69 mm/h, low serum C3/C4 and proteinuria. COVID-19 testing was negative. CSF analysis showed WBC of 890/mm3 , neutrophil predominance (93%), decreased glucose (32 mg/dL) and elevated protein (129 g/L). CSF cultures were negative. Aquaporin-4 receptor antibodies testing is pending. MRI of thoracic spine revealed patchy FLAIR hyperintensities at the level of T2, T4 and T10- T11 with mild enhancement at the level of the lesion T10-11, following intravenous gadolinium. The patient was treated IV methylprednisolone followed by cyclophosphamide and maintenance daily oral steroids with significant improvement of motor symptoms. She had mild residual right dorsiflexion weakness. Urinary and bowel function normalized. Conclusions: Lupus myelitis is a rare and potentially devastating complication of systemic lupus erythematosus. The timely recognition is crucial for proper management. CSF picture resembles an infection and may be misleading. While aquaporin-4 receptor antibodies report is pending, her very good recovery with methylprednisolone and cyclophosphamide strongly suggests lupus myelitis.

20.
Neurology ; 98(18 SUPPL), 2022.
Article in English | EMBASE | ID: covidwho-1925285

ABSTRACT

Objective: Determine neuromuscular manifestation incidence in COVID-19 patients from the longitudinal electronic health record database Optum. Background: Both central and peripheral nervous system (PNS) manifestations of COVID-19 have been reported. A Chinese retrospective case series, on 214 hospitalized COVID-19 patients, found that 8.9% presented with peripheral nerve disease and 7% had muscular injuries. Other studies looking at the prevalence of PNS manifestations are limited and have significantly lower numbers. Design/Methods: The COVID-19 data is sourced from more than 700 hospitals and 7000 clinics in the US. Patients with numerous neuromuscular diagnoses were identified based on ICD-10 coding. Examples include carpal tunnel syndrome, radial nerve lesion, sciatic nerve lesion, myasthenia gravis, acute transverse myelitis, Bell's palsy, and trigeminal neuralgia. Results: We reviewed a total of 598,847 patients with positive COVID-19 PCR and/or diagnosis coding. Neuromuscular complications must have been within 45 days of diagnosis to be included. Incidence of similar neuromuscular complaints was evaluated in 3,001,153 controls without COVID-19. Critical illness neuropathy was found in 35,782 COVID-positive patients and 6,281 of those without. Retrospective study limitations include temporal relationship to COVID-19 does not necessarily indicate causality and inability to confirm the coding by record review or EMG/NCS. Conclusions: Incidence of neuromuscular disorders is generally lower or equivalent in COVID19 patients than in the general population, except for critical illness neuropathy and myopathy. This finding may be explained by more COVID-19 patients being in the intensive care unit and bedbound for longer periods. It is worth noting that a small case series of COVID-related critical illness neuropathy and myopathy patients showed no histopathological or clinical differences compared to non-COVID patients. To our knowledge, this report includes an analysis of neuromuscular manifestations in one of the largest cohorts of COVID-19 patients. This can assist with risk-benefit discussions regarding treatment initiation, etiology of diagnoses, and counseling for COVID-19 questions.

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