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1.
J Neurovirol ; 27(1): 26-34, 2021 02.
Article in English | MEDLINE | ID: covidwho-1046668

ABSTRACT

Opsoclonus-myoclonus-ataxia syndrome is a heterogeneous constellation of symptoms ranging from full combination of these three neurological findings to varying degrees of isolated individual sign. Since the emergence of coronavirus disease 2019 (COVID-19), neurological symptoms, syndromes, and complications associated with this multi-organ viral infection have been reported and the various aspects of neurological involvement are increasingly uncovered. As a neuro-inflammatory disorder, one would expect to observe opsoclonus-myoclonus syndrome after a prevalent viral infection in a pandemic scale, as it has been the case for many other neuro-inflammatory syndromes. We report seven cases of opsoclonus-myoclonus syndrome presumably parainfectious in nature and discuss their phenomenology, their possible pathophysiological relationship to COVID-19, and diagnostic and treatment strategy in each case. Finally, we review the relevant data in the literature regarding the opsoclonus-myoclonus syndrome and possible similar cases associated with COVID-19 and its diagnostic importance for clinicians in various fields of medicine encountering COVID-19 patients and its complications.


Subject(s)
Ataxia/physiopathology , COVID-19/physiopathology , Cough/physiopathology , Fever/physiopathology , Myalgia/physiopathology , Opsoclonus-Myoclonus Syndrome/physiopathology , SARS-CoV-2/pathogenicity , Adult , Anticonvulsants/therapeutic use , Ataxia/diagnostic imaging , Ataxia/drug therapy , Ataxia/etiology , Azithromycin/therapeutic use , COVID-19/complications , COVID-19/diagnostic imaging , COVID-19/drug therapy , Clonazepam/therapeutic use , Cough/diagnostic imaging , Cough/drug therapy , Cough/etiology , Dyspnea/diagnostic imaging , Dyspnea/drug therapy , Dyspnea/etiology , Dyspnea/physiopathology , Female , Fever/diagnostic imaging , Fever/drug therapy , Fever/etiology , Humans , Hydroxychloroquine/therapeutic use , Levetiracetam/therapeutic use , Male , Middle Aged , Myalgia/diagnostic imaging , Myalgia/drug therapy , Myalgia/etiology , Opsoclonus-Myoclonus Syndrome/diagnostic imaging , Opsoclonus-Myoclonus Syndrome/drug therapy , Opsoclonus-Myoclonus Syndrome/etiology , Oseltamivir/therapeutic use , SARS-CoV-2/drug effects , Valproic Acid/therapeutic use
2.
Neurology ; 96(11): e1527-e1538, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1028513

ABSTRACT

OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. METHODS: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. RESULTS: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. CONCLUSIONS: The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.


Subject(s)
COVID-19/mortality , Confusion/physiopathology , Consciousness Disorders/physiopathology , Hospital Mortality , Stroke/physiopathology , Aged , Aged, 80 and over , Ageusia/epidemiology , Ageusia/physiopathology , Anosmia/epidemiology , Anosmia/physiopathology , Ataxia/epidemiology , Ataxia/physiopathology , COVID-19/physiopathology , Confusion/epidemiology , Consciousness Disorders/epidemiology , Cranial Nerve Diseases/epidemiology , Cranial Nerve Diseases/physiopathology , Delirium/epidemiology , Delirium/physiopathology , Female , Headache/epidemiology , Headache/physiopathology , Humans , Male , Middle Aged , Paresthesia/epidemiology , Paresthesia/physiopathology , Primary Dysautonomias/epidemiology , Primary Dysautonomias/physiopathology , Recurrence , SARS-CoV-2 , Seizures/epidemiology , Seizures/physiopathology , Stroke/epidemiology , Vertigo/epidemiology , Vertigo/physiopathology
3.
Ann Clin Transl Neurol ; 7(11): 2221-2230, 2020 11.
Article in English | MEDLINE | ID: covidwho-813302

ABSTRACT

OBJECTIVE: Covid-19 can involve multiple organs including the nervous system. We sought to characterize the neurologic manifestations, their risk factors, and associated outcomes in hospitalized patients with Covid-19. METHODS: We examined neurologic manifestations in 509 consecutive patients admitted with confirmed Covid-19 within a hospital network in Chicago, Illinois. We compared the severity of Covid-19 and outcomes in patients with and without neurologic manifestations. We also identified independent predictors of any neurologic manifestations, encephalopathy, and functional outcome using binary logistic regression. RESULTS: Neurologic manifestations were present at Covid-19 onset in 215 (42.2%), at hospitalization in 319 (62.7%), and at any time during the disease course in 419 patients (82.3%). The most frequent neurologic manifestations were myalgias (44.8%), headaches (37.7%), encephalopathy (31.8%), dizziness (29.7%), dysgeusia (15.9%), and anosmia (11.4%). Strokes, movement disorders, motor and sensory deficits, ataxia, and seizures were uncommon (0.2 to 1.4% of patients each). Severe respiratory disease requiring mechanical ventilation occurred in 134 patients (26.3%). Independent risk factors for developing any neurologic manifestation were severe Covid-19 (OR 4.02; 95% CI 2.04-8.89; P < 0.001) and younger age (OR 0.982; 95% CI 0.968-0.996; P = 0.014). Of all patients, 362 (71.1%) had a favorable functional outcome at discharge (modified Rankin Scale 0-2). However, encephalopathy was independently associated with worse functional outcome (OR 0.22; 95% CI 0.11-0.42; P < 0.001) and higher mortality within 30 days of hospitalization (35 [21.7%] vs. 11 [3.2%] patients; P < 0.001). INTERPRETATION: Neurologic manifestations occur in most hospitalized Covid-19 patients. Encephalopathy was associated with increased morbidity and mortality, independent of respiratory disease severity.


Subject(s)
Brain Diseases/physiopathology , Coronavirus Infections/physiopathology , Dizziness/physiopathology , Dysgeusia/physiopathology , Headache/physiopathology , Myalgia/physiopathology , Olfaction Disorders/physiopathology , Pneumonia, Viral/physiopathology , Adult , Aged , Aged, 80 and over , Ataxia/physiopathology , Betacoronavirus , COVID-19 , Chicago , Coronavirus Infections/mortality , Coronavirus Infections/therapy , Female , Humans , Male , Middle Aged , Mortality , Movement Disorders/physiopathology , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/therapy , Prognosis , Respiration, Artificial , Retrospective Studies , Risk Factors , SARS-CoV-2 , Seizures/physiopathology , Severity of Illness Index , Stroke/physiopathology
5.
Adv Biol Regul ; 77: 100745, 2020 08.
Article in English | MEDLINE | ID: covidwho-741319

ABSTRACT

Coronavirus disease 2019 caused by SARS-CoV-2 originated from China and spread across every corner of the world. The scientific interest on COVID-19 increased after WHO declared it a pandemic in the early February of 2020. In fact, this pandemic has had a worldwide impact on economy, health, and lifestyle like no other in the last 100 years. SARS-CoV-2 belongs to Coronaviridae family and causes the deadliest clinical manifestations when compared to other viruses in the family. COVID-19 is an emerging zoonotic disease that has resulted in over 383,000 deaths around the world. Scientists are scrambling for ideas to develop treatment and prevention strategies to thwart the disease condition. In this review, we have attempted to summarize the latest information on the virus, disease, prevention, and treatment strategies. The future looks promising.


Subject(s)
Betacoronavirus/pathogenicity , COVID-19/epidemiology , Communicable Disease Control/organization & administration , Coronavirus Infections/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Antiviral Agents/therapeutic use , Ataxia/diagnosis , Ataxia/physiopathology , Ataxia/virology , COVID-19/prevention & control , COVID-19/therapy , COVID-19/transmission , Communicable Disease Control/methods , Coronavirus Infections/prevention & control , Coronavirus Infections/therapy , Coronavirus Infections/transmission , Humans , Hydroxychloroquine/therapeutic use , Nausea/diagnosis , Nausea/physiopathology , Nausea/virology , Pandemics/prevention & control , Personal Protective Equipment/supply & distribution , Physical Distancing , Pneumonia, Viral/prevention & control , Pneumonia, Viral/therapy , Pneumonia, Viral/transmission , Quarantine/methods , Quarantine/organization & administration , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Vomiting/diagnosis , Vomiting/physiopathology , Vomiting/virology
6.
J Med Virol ; 92(7): 699-702, 2020 Jul.
Article in English | MEDLINE | ID: covidwho-96729

ABSTRACT

Neurologic sequelae can be devastating complications of respiratory viral infections. We report the presence of virus in neural and capillary endothelial cells in frontal lobe tissue obtained at postmortem examination from a patient infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Our observations of virus in neural tissue, in conjunction with clinical correlates of worsening neurologic symptoms, pave the way to a closer understanding of the pathogenic mechanisms underlying central nervous system involvement by SARS-CoV-2.


Subject(s)
Ageusia/diagnosis , Ataxia/diagnosis , Betacoronavirus/pathogenicity , Coronavirus Infections/diagnosis , Olfaction Disorders/diagnosis , Pneumonia, Viral/diagnosis , Seizures/diagnosis , Aged , Ageusia/complications , Ageusia/physiopathology , Ageusia/virology , Ataxia/complications , Ataxia/physiopathology , Ataxia/virology , Betacoronavirus/genetics , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Coronavirus Infections/virology , Endothelial Cells/pathology , Endothelial Cells/virology , Fatal Outcome , Frontal Lobe/blood supply , Frontal Lobe/pathology , Frontal Lobe/virology , Hospitalization , Humans , Lung/blood supply , Lung/pathology , Lung/virology , Male , Neurons/pathology , Neurons/virology , Olfaction Disorders/complications , Olfaction Disorders/physiopathology , Olfaction Disorders/virology , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia, Viral/virology , RNA, Viral/genetics , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2 , Seizures/complications , Seizures/physiopathology , Seizures/virology
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