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1.
Ital J Pediatr ; 47(1): 191, 2021 Sep 18.
Article in English | MEDLINE | ID: covidwho-2079518

ABSTRACT

BACKGROUND: Presently, it is known that, even if less frequently than in adults, children can develop a severe new coronavirus disease 2019 (COVID-19). Children with the SARS-CoV-2 infection can have neurological signs and symptoms of disease more frequently than previously thought, revealing the involvement of the central nervous system, the peripheral nervous system, or both. Aim of this manuscript is to highlight the neurologic complications associated with SARS-CoV-2 among pediatric patients with COVID-19, suggesting when to monitor carefully neurologic development. MAIN FINDINGS: Children with a severe chronic underlying disease, infants and toddlers and those who develop the so-called multisystem inflammatory syndrome (MIS-C) are those with the highest incidence of neurological complications. Fortunately, in most of the cases, neurological manifestations, mainly represented by headache and anosmia, are mild and transient and do not significantly complicate the COVID-19 course. However, in some cases, very severe clinical problems associated with relevant alterations of neuroimaging, electroencephalography, nerve conduction studies and electromyography findings can develop. Generally, almost all the children with COVID-19 and neurological manifestations till now described have made a complete recovery, although in some cases this has occurred after several weeks of treatment. Moreover, COVID-19 infection during pregnancy has been found associated with an increased risk of obstetric complications that can lead to neurological acute and long-term manifestations in neonates. CONCLUSIONS: Based on data showing the neurologic impact of COVID-19 in pediatric age, we suggest monitoring neurological development a few months after healing in pediatric patients who have presented MIS-C, seizures or other neurological manifestations and in children of pregnant women with COVID-19 in order to detect overt and subtle deficits.


Subject(s)
COVID-19/complications , Nervous System Diseases/virology , Pregnancy Complications, Infectious/virology , Systemic Inflammatory Response Syndrome/virology , COVID-19/diagnosis , COVID-19/virology , Child , Child, Preschool , Comorbidity , Female , Humans , Infant , Infant, Newborn , Male , Nervous System Diseases/diagnosis , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Risk Factors , SARS-CoV-2 , Seizures/virology , Systemic Inflammatory Response Syndrome/diagnosis
2.
Arq Neuropsiquiatr ; 80(5 Suppl 1): 1-6, 2022 05.
Article in English | MEDLINE | ID: covidwho-2065214

ABSTRACT

Training of neurologists for the near future is a challenge due to the likely advances in neuroscientific methods, which will change much of our knowledge on diagnosis and treatment of neurological diseases. OBJECTIVE: to comment on what may be more likely to be a constant in the very near future and to recommend how to prepare the neurologist for the 21st century. METHODS: through a critical review of recent articles on the teaching of Neurology, to present a personal view on the subject. RESULTS: Diagnostic methods and therapeutic resources in Neurology will be greatly improved, but the central core of teaching young neurologists will continue to be the clinical/anatomical correlation. The neurologist must be prepared to be the primary physician in the care of patients with neurological disorders, although the roles of consultant and clinical neuroscientist must also be considered. In addition to technical knowledge, the neurologist must be prepared to discuss not only distressing issues related to the specialty, such as the risks of genetic diseases for family members of their patients, the inexorable progression of some diseases and the need for palliative care, but also problems not directly related to Neurology that cause anxiety and depression in the patient or that are the main reason for the initial consultation. CONCLUSION: neurology will be an even more important area of medicine and the neurologist must be well prepared to be the primary doctor to diagnose, treat and follow the patient with neurological disorders. In addition to technical knowledge, training in doctor-patient relations should be highlighted.


Subject(s)
Nervous System Diseases , Neurology , Anxiety , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/therapy , Neurologists , Neurology/history
3.
Nurse Pract ; 47(10): 42-47, 2022 10 01.
Article in English | MEDLINE | ID: covidwho-2051568

ABSTRACT

ABSTRACT: Functional neurologic disorder is a complex disorder of truly experienced neurologic symptoms without evidence of underlying neurologic disease. This clinical review focuses on the pediatric population and includes the impacts of the COVID-19 pandemic. Clinician knowledge and early identification can substantially improve patient outcomes.


Subject(s)
COVID-19 , Conversion Disorder , Nervous System Diseases , Pediatrics , Child , Conversion Disorder/diagnosis , Humans , Nervous System Diseases/diagnosis , Pandemics
4.
Arq Neuropsiquiatr ; 80(5 Suppl 1): 281-289, 2022 05.
Article in English | MEDLINE | ID: covidwho-1993576

ABSTRACT

BACKGROUND: The COVID-19 pandemic has challenged neurologists since its early days. Neurology consultation services were then overloaded by emergency department and intensive-care patients with acute neurological syndromes. These complications are better explained today, but the growing number of patients with reported longstanding neurological symptoms constitute an emerging, complex, and still poorly understood phenomenon. OBJECTIVE: This review summarizes data on relevant neurological manifestations of acute SARS-CoV-2 infection and lasting post-infectious disease, also known as Long COVID. The complex history of Long COVID is examined to illustrate the upsides and challenges imposed by the active participation of patient communities in the production of medical knowledge. METHODS: Narrative review. RESULTS: Infection with the severe acute respiratory syndrome coronavirus 2 is associated with encephalopathy/delirium, cerebrovascular disease, headache, and peripheral nervous system involvement. Long COVID is a living concept jointly defined by patient communities, physicians and scientists, including neurologists. CONCLUSION: Co-production of Long COVID knowledge between scientists and patients has initiated an era of patient-led research and evidence-based activism that acts as a two-edged sword - putting patient's suffering in the spotlight, but with a tradeoff in methodological consistency.


Subject(s)
COVID-19 , Nervous System Diseases , COVID-19/complications , Humans , Nervous System Diseases/diagnosis , Pandemics , SARS-CoV-2
7.
Aging Clin Exp Res ; 34(7): 1635-1644, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1920347

ABSTRACT

BACKGROUND: Despite the relevance of telephone-based cognitive screening tests in clinical practice and research, no specific test assessing executive functioning is available. The present study aimed at standardizing and providing evidence of clinical usability for the Italian telephone-based Frontal Assessment Battery (t-FAB). METHODS: The t-FAB (ranging 0-12), comprising two subtests, has two versions: one requiring motor responses (t-FAB-M) and the other verbal responses (t-FAB-V). Three hundred and forty-six Italian healthy adults (HPs; 143 males; age range = 18-96 years; education range = 4-23 years) and 40 participants with neurological diseases were recruited. To HPs, the t-FAB was administered along with a set of telephone-based tests: MMSE, verbal fluency (VF), backward digit span (BDS). The in-person version of the FAB was administered to both HPs and clinical groups. Factorial structure, construct validity, inter-rater and test-retest reliability, t-FAB-M vs. t-FAB-V equivalence and diagnostic accuracy were assessed. Norms were derived via Equivalent Scores. RESULTS: In HPs, t-FAB measures yielded high inter-rater/test-retest reliability (ICC = .78-.94), were internally related (p ≤ .005) and underpinned by a single component, converging with the telephone-based MMSE, VF, BDS (p ≤ .0013). The two t-FAB versions were statistically equivalent in clinical groups (ps of both equivalence bounds < .001). Education predicted all t-FAB scores (p < .001), whereas age only the t-FAB-M score (p ≤ .004). t-FAB scores converge with the in-person FAB in HPs and clinical groups (rs = .43-.78). Both t-FAB versions were accurate in discriminating HPs from the clinical cohort (AUC = .73-.76). DISCUSSION: The t-FAB is a normed, valid, reliable and clinically usable telephone-based cognitive screening test to adopt in both clinical and research practice.


Subject(s)
Executive Function , Nervous System Diseases , Aged , Aged, 80 and over , Humans , Male , Nervous System Diseases/diagnosis , Neuropsychological Tests , Reference Standards , Reproducibility of Results , Telephone
8.
Ann Clin Transl Neurol ; 9(7): 995-1010, 2022 07.
Article in English | MEDLINE | ID: covidwho-1885373

ABSTRACT

OBJECTIVE: To assess the initial features and evolution of neurologic Postacute Sequelae of SARS-CoV-2 infection (neuro-PASC) in patients with and without prior neurologic disease. METHODS: Participants with neurologic symptoms following acute SARS-CoV-2 infection were recruited from October 9, 2020 to October 11, 2021. Clinical data included a SARS-CoV-2 infection history, neurologic review of systems, neurologic exam, Montreal cognitive assessment (MoCA), and symptom-based self-reported surveys at baseline (conducted after acute infection) and 6-month follow-up assessments. RESULTS: Fifty-six participants (69% female, mean age 50 years, 29% with prior neurologic disease such as multiple sclerosis) were enrolled, of which 27 had completed the 6-month follow-up visit in this ongoing study. SARS-CoV-2 infection severity was largely described as mild (39.3%) or moderate (42.9%). At baseline, following acute infection, the most common neurologic symptoms were fatigue (89.3%) and headaches (80.4%). At the 6-month follow-up, memory impairment (68.8%) and decreased concentration (61.5%) were the most prevalent, though on average all symptoms showed a reduction in reported severity score at the follow-up. Complete symptom resolution was reported in 33.3% of participants by 6 months. From baseline to 6 months, average MoCA scores improved overall though 26.3% of participants' scores decreased. A syndrome consisting of tremor, ataxia, and cognitive dysfunction (PASC-TAC) was observed in 7.1% of patients. INTERPRETATION: Early in the neuro-PASC syndrome, fatigue and headache are the most commonly reported symptoms. At 6 months, memory impairment and decreased concentration were most prominent. Only one-third of participants had completed resolution of neuro-PASC at 6 months, although persistent symptoms trended toward improvement at follow-up.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , SARS-CoV-2 , Disease Progression , Fatigue/etiology , Female , Headache/etiology , Humans , Longitudinal Studies , Male , Memory Disorders/etiology , Middle Aged , Nervous System Diseases/diagnosis
9.
Brain Behav ; 12(6): e2587, 2022 06.
Article in English | MEDLINE | ID: covidwho-1802075

ABSTRACT

BACKGROUND: Several investigations were carried out during the pandemic, demonstrating a number of neurological symptoms linked to coronavirus disease 2019 (COVID-19) infection. OBJECTIVES: The goal of this review is to discuss COVID-19 disease's neurological signs and squeals. METHODOLOGY: From December 2019 to May 2020, data were retrieved from PubMed, Scopus, and ScienceDirect, as well as a manual search using Google Scholar. COVID-19, neurological symptoms, cranial nerves, motor system were among the key phrases utilized in the search. RESULTS: The intensity of respiratory involvement increases the likelihood of neurological symptoms and consequences. According to some research, it might range from 34% to 80%. The central and peripheral neural systems are both affected, resulting in cranial nerve palsies and limb paralysis. CONCLUSION: COVID-19 neurologic complications are key drivers of patient severity and mortality. Headache, convulsions, mental and psychic disorders, delirium, and insomnia are just some of the symptoms that the virus can cause. The olfactory nerve is the most commonly damaged cranial nerve, resulting in anosmia. Stroke (mostly infarction), encephalitis, meningitis, Guillain-Barre syndrome, relapse of multiple sclerosis, and transverse myelitis are all symptoms and squeals.


Subject(s)
COVID-19 , Nervous System Diseases , COVID-19/complications , Humans , Neoplasm Recurrence, Local/complications , Nervous System Diseases/diagnosis , Pandemics , Prognosis , SARS-CoV-2
12.
J Infect Dis ; 225(6): 965-970, 2022 03 15.
Article in English | MEDLINE | ID: covidwho-1740882

ABSTRACT

Antibody responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in serum and cerebrospinal fluid (CSF) samples from 16 patients with coronavirus disease 2019 and neurological symptoms were assessed using 2 independent methods. Immunoglobulin G (IgG) specific for the virus spike protein was found in 81% of patients in serum and in 56% in CSF. SARS-CoV-2 IgG in CSF was observed in 2 patients with negative serological findings. Levels of IgG in both serum and CSF were associated with disease severity (P < .05). All patients with elevated markers of central nervous system damage in CSF also had CSF antibodies (P = .002), and CSF antibodies had the highest predictive value for neuronal damage markers of all tested clinical variables.


Subject(s)
Antibodies, Viral/blood , COVID-19/diagnosis , Immunoglobulin G/blood , Nervous System Diseases/blood , Nervous System Diseases/cerebrospinal fluid , SARS-CoV-2/isolation & purification , Aged , Antibodies, Neutralizing/blood , Antibody Formation , Biomarkers/blood , Biomarkers/cerebrospinal fluid , COVID-19/blood , COVID-19/cerebrospinal fluid , COVID-19/complications , Female , Humans , Male , Middle Aged , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , SARS-CoV-2/genetics , SARS-CoV-2/immunology , Spike Glycoprotein, Coronavirus
13.
Int Immunopharmacol ; 107: 108624, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1720132

ABSTRACT

Astrocytes are the most abundant cell type in the human central nervous system, and they play an important role in the regulation of neuronal physiology. In neurological disorders, astrocyte disintegration leads to the release of glial fibrillary acidic protein (GFAP) from tissue into the bloodstream. Elevated serum levels of GFAP can serve as blood biomarkers, and a useful prognostic tool to facilitate the early diagnosis of several neurological diseases ranging from stroke to neurodegenerative disorders. This systematic review synthesizes studies published between January 2012 and September 2021 that used GFAP as a potential blood biomarker to detect neurological disorders. The following electronic databases were accessed: MEDLINE, Scopus, and Web of Science. In all the databases, the following search strategy was used: ¨GFAP¨ OR ¨glial fibrillary acidic protein¨ AND ¨neurological¨ OR ¨neurodegenerative¨ AND ¨plasma¨ OR ¨serum¨. The initial search identified 1152 articles. After the exclusion criteria were applied, 48 publications that reported GFAP levels in neurological disorders were identified. A total of16 different neurological disorders that have plasmatic GFAP levels as a possible biomarker for the disease were described in the articles, being: multiple sclerosis, frontotemporal lobar degeneration, Alzheimer's disease, Parkinson disease, COVID-19, epileptic seizures, Wilson Disease, diabetic ketoacidosis, schizophrenia, autism spectrum disorders, major depressive disorder, glioblastoma, spinal cord injury, asthma, neuromyelitis optica spectrum disorder and Friedreich's ataxia. Our review shows an association between GFAP levels and the disease being studied, suggesting that elevated GFAP levels are a potentially valuable diagnostic biomarker in the evaluation of different neurological diseases.


Subject(s)
Body Fluids , COVID-19 , Depressive Disorder, Major , Nervous System Diseases , Biomarkers , Body Fluids/metabolism , Glial Fibrillary Acidic Protein/metabolism , Humans , Nervous System Diseases/diagnosis , Prognosis
14.
Dtsch Med Wochenschr ; 147(4): 173-177, 2022 02.
Article in German | MEDLINE | ID: covidwho-1713249

ABSTRACT

BACKGROUND: Persistent neurological late symptoms of SARS-CoV-2 infection are common and require regular follow-up treatment. In order to establish uniform therapy concepts, it is necessary to evaluate individual therapeutic approaches for long COVID and post-COVID-19 syndrome. ANAMNESE: A 62-year-old patient was admitted to our rehab clinic for follow-up treatment after severe SARS-CoV-2 infection with neurological symptoms. The initially extensive laboratory and imaging investigation did not reveal any organic cause for the sometimes apoplectiform, complex clinical picture, so that the patient was transferred directly to our rehabilitation clinic in the event of everyday restrictions and rollator dependency. EXAMINATION AND FINDINGS: Clinically, there was a reduced general condition and the mood was depressed. Neurological symptoms were gait ataxia, hand tremor, amnesic aphasia and reduced ability to concentrate. PET / CT showed no evidence of tumor or inflammation. THERAPY AND PROGRESS: A multimodal therapy program consisting of physiotherapy and occupational therapy as well as psychological support was carried out. In addition, off-label therapy with oral glucocorticoids and colchicine was initiated. In the course of the disease, there was a clear reduction in all symptoms with little residual hand tremor. CONCLUSIONS: Whole body and brain FDG PET can be helpful in long COVID and post-COVID-19 syndrome patients with neurological symptoms of unknown origin. These patients benefit from systematic rehabilitation. Glucocorticoids and colchicine appear to accelerate symptom reduction. The rehabilitative therapy should be continued on an outpatient basis.


Subject(s)
COVID-19/complications , Nervous System Diseases/etiology , Nervous System Diseases/rehabilitation , SARS-CoV-2 , Humans , Male , Middle Aged , Nervous System Diseases/diagnosis , Occupational Therapy/methods , Physical Therapy Modalities , Psychosocial Support Systems
15.
Neurologist ; 26(6): 237-243, 2021 Nov 04.
Article in English | MEDLINE | ID: covidwho-1501232

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease that affects many organs, especially the lung, and may lead to multiorgan failure. Studies describing neurological dysfunctions involving the central and peripheral nervous systems have emerged. In our study, we aimed to evaluate the neurological signs and symptoms in hospitalized patients with COVID-19. METHODS: The data of 290 patients admitted to our center (ward and intensive care unit) who received a diagnosis of COVID-19 were analyzed retrospectively. Patients' demographic, clinical and laboratory data, and their neurological diseases, symptoms, and complications were compared. RESULTS: Male sex, heart disease, chronic obstructive pulmonary disease and having a history of neurological disease were associated with increased mortality in patients with COVID-19. Seizures and altered consciousness were also found to be more common in patients who died. In addition, lower platelet counts (P=0.001), higher C-reactive protein levels (P<0.001) and higher D-dimer levels (P=0.003) were associated with increased risk of mortality. CONCLUSIONS: We believe that close monitoring of any possible neurological manifestations is mandatory in hospitalized patients at the onset of COVID-19 and during disease progression. Clinical findings such as neurological symptoms and acute phase reactants are important in the follow-up and treatment of the disease.


Subject(s)
COVID-19 , Nervous System Diseases , Hospitalization , Humans , Male , Nervous System Diseases/diagnosis , Retrospective Studies , SARS-CoV-2
16.
J Stroke Cerebrovasc Dis ; 31(1): 106163, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1482759

ABSTRACT

The SARS-CoV-2 virus, which causes Coronavirus disease 2019 (COVID-19), has resulted in millions of worldwide deaths. When the SARS-CoV-2 virus emerged from Wuhan, China in December 2019, reports of patients with COVID-19 revealed that hospitalized patients had acute changes in mental status, cognition, and encephalopathy. Neurologic complications can be a consequence from overall severity of the systemic infection, direct viral invasion of the SARS-CoV-2 virus in the central nervous system, and possible immune mediated mechanisms. We will examine the landscape regarding this topic in this review in addition to current understandings of COVID-19 and hemostasis, treatment, and prevention, as well as vaccination.


Subject(s)
COVID-19 , Central Nervous System/virology , Nervous System Diseases , Thrombophilia/prevention & control , Anticoagulants , Hemostasis , Humans , Nervous System Diseases/diagnosis , Nervous System Diseases/etiology , SARS-CoV-2 , Thrombophilia/diagnosis
17.
Clin Neurol Neurosurg ; 210: 106985, 2021 11.
Article in English | MEDLINE | ID: covidwho-1458745

ABSTRACT

BACKGROUND: Coronavirus disease 2019 (COVID-19), a global issue now, can have a variety of clinical manifestations. Hundreds of articles have discussed different aspects of this infectious disease, such as physiopathology, epidemiology, clinical manifestations and treatment protocols. Recently, neurological manifestations of the disease have been found to be pretty common among COVID-19 patients. Here, neurological symptoms of COVID-19 infection with a focus on non-cerebrovascular complications are discussed in a large study population. METHODS: Neurological symptoms of 891hospitalized COVID-19 patients from March to June 2020 in a major Hospital, Tehran, Iran, were reviewed. Demographic characteristics and neurological manifestations were analyzed. RESULTS: Among 891 hospitalized COVID-19 patients, the following symptoms were observed: headache (63.9%), sleeping problems (51.3%), hyposmia/anosmia (46%), dizziness (45.4%), hypogeusia (42.1%), memory issues (31.5%), auditory disturbances (17.5%), paralysis (3.7%) and seizures (1.7%). In 29.7% of the patients, a neurological symptom was the initiating symptoms of the infection. Females were more likely to show headache and dizziness compared to males (p value<0.05). Headache intensity was also higher in females compared to males (p value<0.05). Headache prevalence was lower in older patients (p value<0.05), while memory loss and impaired consciousness were higher by increasing age (p values=0.002 and 0.001, respectively). CONCLUSION: Neurological manifestations were common among COVID-19 patients under study. Headache, as the most common neurological symptom among COVID-19 patients, was the most prevalent and intense among the female population. Headache, dizziness, sleeping problems, hyposmia/anosmia and hypogeusia were common COVID-19 neurological manifestations, while memory issues, auditory disturbances, paralysis, and seizures were less common.


Subject(s)
COVID-19/epidemiology , COVID-19/therapy , Hospitalization/trends , Nervous System Diseases/epidemiology , Nervous System Diseases/therapy , Adolescent , Adult , Aged , Aged, 80 and over , COVID-19/diagnosis , Child , Cross-Sectional Studies , Dizziness/diagnosis , Dizziness/epidemiology , Dizziness/therapy , Female , Headache/diagnosis , Headache/epidemiology , Headache/therapy , Humans , Iran/epidemiology , Male , Middle Aged , Nervous System Diseases/diagnosis , Retrospective Studies , Seizures/diagnosis , Seizures/epidemiology , Seizures/therapy , Young Adult
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