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2.
Neurosci Lett ; 759: 136040, 2021 08 10.
Article in English | MEDLINE | ID: covidwho-1322284

ABSTRACT

Despite a likely underestimation due to the many obstacles of the highly infectious, intensive care setting, increasing clinical reports about COVID-19 patients developing acute paralysis for polyradiculoneuritis or myelitis determine additional impact on the disease course and outcome. Different pathogenic mechanisms have been postulated basing on clinical, laboratory and neuroimaging features, and response to treatments. Here we provide an overview with insights built on the available reports. Besides direct viral pathogenicity, a crucial role seems to be represented by immune-mediated mechanisms, supporting and further characterizing the already hypothesized neurotropic potential of SARS-CoV-2 and implying specific treatments. Proper clinical and instrumental depiction of symptomatic cases, as well as screening for their early recognition is advocated.


Subject(s)
COVID-19/complications , Guillain-Barre Syndrome/virology , Myelitis/epidemiology , Myelitis/virology , Guillain-Barre Syndrome/pathology , Humans , Myelitis/pathology , SARS-CoV-2
3.
Sci Transl Med ; 13(584)2021 03 10.
Article in English | MEDLINE | ID: covidwho-1127537

ABSTRACT

Acute flaccid myelitis (AFM) recently emerged in the United States as a rare but serious neurological condition since 2012. Enterovirus D68 (EV-D68) is thought to be a main causative agent, but limited surveillance of EV-D68 in the United States has hampered the ability to assess their causal relationship. Using surveillance data from the BioFire Syndromic Trends epidemiology network in the United States from January 2014 to September 2019, we characterized the epidemiological dynamics of EV-D68 and found latitudinal gradient in the mean timing of EV-D68 cases, which are likely climate driven. We also demonstrated a strong spatiotemporal association of EV-D68 with AFM. Mathematical modeling suggested that the recent dominant biennial cycles of EV-D68 dynamics may not be stable. Nonetheless, we predicted that a major EV-D68 outbreak, and hence an AFM outbreak, would have still been possible in 2020 under normal epidemiological conditions. Nonpharmaceutical intervention efforts due to the ongoing COVID-19 pandemic are likely to have reduced the sizes of EV-D68 and AFM outbreaks in 2020, illustrating the broader epidemiological impact of the pandemic.


Subject(s)
Central Nervous System Viral Diseases/epidemiology , Central Nervous System Viral Diseases/virology , Enterovirus D, Human/physiology , Myelitis/epidemiology , Myelitis/virology , Neuromuscular Diseases/epidemiology , Neuromuscular Diseases/virology , Disease Susceptibility , Epidemiological Monitoring , Humans , Models, Biological , Spatio-Temporal Analysis , United States/epidemiology
5.
Mult Scler Relat Disord ; 49: 102783, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1039505

ABSTRACT

BACKGROUND: Even though SARS-CoV-2 is a predominantly respiratory virus, several reports have described various neurological disorders, from the beginning of the pandemic. The first para-infectious myelitis case was described in Wuhan in February 2020. Nevertheless, data from registries and reviews are scarce. METHODS: A 40-year-old female with T5-T6 SARS-CoV-2 para-infectious myelitis is reported. A literature review of the published literature on the SARS-CoV-2 and para-infectious myelitis was done. Epidemiological, clinical, laboratory, image, treatment, and outcome data are described. RESULTS: Particular findings of our case are that Covid-19 was asymptomatic and anti-GD2/GD3 IgM was found. 18 para-infectious myelitis occurred over a wide age range (Beh et al., 2013-67), mean age 50.7±18.6 years, with 10/18 (55.6%) women. Covid-19 involvement was variable from asymptomatic cases to severe Covid-19 resulting in death. The mean time to establish myelitis from the onset of Covid-19 symptoms was 10.3 ±7.8 days (0-24). The most common clinical form was transverse myelitis (14/18 patients, 77.7%) and the most frequent radiological form was longitudinally extensive myelitis (11/17 patients, 64.7%). In CSF mild lymphocytosis (14/16, 87.5%) with low cellularity (40.9±49.7/µL) and elevated proteins (11/16, 77.8%, mean 145.0 mg±159.0/dL) were frequent. Oligoclonal bands were usually negative (7/9, 77.7%) and mirror pattern was found in 2/7 patients (33.3%). SARS-CoV-2 PCR in CSF was negative in 10/10 cases. CONCLUSION: SARS-CoV-2 can cause myelitis by immune-mediated mechanisms. Clinical-radiological characteristics of Covid-19 para-infectious myelitis were variable and non-specific.


Subject(s)
COVID-19/complications , Myelitis/virology , Nervous System Diseases/virology , Adult , Female , Humans , Immunoglobulin M , Pandemics
7.
West J Emerg Med ; 21(6): 45-51, 2020 Oct 06.
Article in English | MEDLINE | ID: covidwho-869246

ABSTRACT

Severe acute respiratory syndrome coronavirus 2, the source of COVID-19, causes numerous clinical findings including respiratory and gastrointestinal findings. Evidence is now growing for increasing neurological symptoms. This is thought to be from direct in-situ effects in the olfactory bulb caused by the virus. Angiotensin-converting enzyme 2 receptors likely serve as a key receptor for cell entry for most coronaviridae as they are present in multiple organ tissues in the body, notably neurons, and in type 2 alveolar cells in the lung. Hematogenous spread to the nervous system has been described, with viral transmission along neuronal synapses in a retrograde fashion. The penetration of the virus to the central nervous system (CNS) allows for the resulting intracranial cytokine storm, which can result in a myriad of CNS complications. There have been reported cases of associated cerebrovascular accidents with large vessel occlusions, cerebral venous sinus thrombosis, posterior reversible encephalopathy syndrome, meningoencephalitis, acute necrotizing encephalopathy, epilepsy, and myasthenia gravis. Peripheral nervous system effects such as hyposmia, hypogeusia, ophthalmoparesis, Guillain-Barré syndrome, and motor peripheral neuropathy have also been reported. In this review, we update the clinical manifestations of COVID-19 concentrating on the neurological associations that have been described, including broad ranges in both central and peripheral nervous systems.


Subject(s)
COVID-19/complications , SARS-CoV-2 , Bell Palsy/virology , Delirium/virology , Guillain-Barre Syndrome/virology , Humans , Leukoencephalitis, Acute Hemorrhagic/virology , Myelitis/virology , Parkinson Disease/complications , Sinus Thrombosis, Intracranial/virology , Stroke/virology
8.
J Clin Neurosci ; 80: 280-281, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-816712

ABSTRACT

The etiological agent of coronavirus disease-19 (COVID-19), SARS-coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and quickly spread worldwide leading the World Health Organization (WHO) to recognize it not only as a pandemic but also as an important thread to public health. Beyond respiratory symptoms, new neurological manifestations are being identified such as headache, ageusia, anosmia, encephalitis or acute cerebrovascular disease. Here we report the case of an acute transverse myelitis (TM) in a patient with SARS-CoV-2 infection detected by the nasopharyngeal swab technique but not in cerebrospinal fluid (CSF) analysis. Anti-herpes simplex virus (HSV) 1 and varicella-zoster IgM antibodies were not detected in serum samples and spinal and brain magnetic resonance imaging (MRI) showed no abnormal findings. This case remarks that COVID-19 nervous system damage could be caused by immune-mediated mechanisms.


Subject(s)
Coronavirus Infections/complications , Myelitis/virology , Pneumonia, Viral/complications , Antibodies, Viral/blood , Betacoronavirus/isolation & purification , COVID-19 , Coronavirus Infections/blood , Coronavirus Infections/cerebrospinal fluid , Coronavirus Infections/diagnostic imaging , Encephalitis/blood , Encephalitis/diagnostic imaging , Encephalitis/virology , Headache/virology , Humans , Magnetic Resonance Imaging , Male , Middle Aged , Myelitis/blood , Myelitis/diagnostic imaging , Nervous System Diseases/virology , Pandemics , Pneumonia, Viral/blood , Pneumonia, Viral/cerebrospinal fluid , Pneumonia, Viral/diagnostic imaging , SARS-CoV-2
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