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1.
PLoS One ; 16(11): e0260332, 2021.
Article in English | MEDLINE | ID: covidwho-1526704

ABSTRACT

INTRODUCTION: Traditional measures of muscular strength require in-person visits, making administration in large epidemiologic cohorts difficult. This has left gaps in the literature regarding relationships between strength and long-term health outcomes. The aim of this study was to test the feasibility and validity of a video-led, self-administered 30-second sit-to-stand (STS) test in a sub-cohort of the U.S.-based Cancer Prevention Study-3. METHODS: A video was created to guide participants through the STS test. Participants submitted self-reported scores (n = 1851), and optional video recordings of tests (n = 134). Two reviewers scored all video tests. Means and standard deviations (SD) were calculated for self-reported and video-observed scores. Mean differences (95% confidence intervals (CI)) and Spearman correlation coefficients between self-reported and observed scores were calculated, stratifying by demographic characteristics. RESULTS: Participants who uploaded a video reported 14.1 (SD = 3.5) stands, which was not significantly different from the number of stands achieved by the full cohort (13.9 (SD = 4.2), P-difference = 0.39). Self-reported and video-observed scores were highly correlated (ρ = 0.97, mean difference = 0.3, 95% CI = 0.1-0.5). There were no significant differences in correlations by sociodemographic factors (all P-differences ≥0.42). CONCLUSIONS: This study suggests that the self-administered, video-guided STS test may be appropriate for participants of varying ages, body sizes, and activity levels, and is feasible for implementation within large, longitudinal studies. This video-guided test would also be useful for remote adaptation of the STS test during the COVID-19 pandemic.


Subject(s)
Movement , Neurologic Examination/methods , Telemedicine/methods , Adult , Female , Humans , Male , Middle Aged , Physical Fitness , Sensitivity and Specificity , Sitting Position , Standing Position
3.
BMJ Case Rep ; 13(7)2020 Jul 08.
Article in English | MEDLINE | ID: covidwho-1291917
6.
BMJ Case Rep ; 14(3)2021 Mar 01.
Article in English | MEDLINE | ID: covidwho-1112321

ABSTRACT

COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.


Subject(s)
Bell Palsy , COVID-19 , Facial Paralysis , Guillain-Barre Syndrome/diagnosis , Prednisolone/administration & dosage , Pregnancy Complications, Infectious , Stroke/diagnosis , Valacyclovir/administration & dosage , Adult , Anti-Inflammatory Agents/administration & dosage , Antiviral Agents/administration & dosage , Bell Palsy/etiology , Bell Palsy/physiopathology , Bell Palsy/therapy , COVID-19/complications , COVID-19/physiopathology , COVID-19/therapy , Diagnosis, Differential , Facial Paralysis/diagnosis , Facial Paralysis/physiopathology , Facial Paralysis/therapy , Facial Paralysis/virology , Female , Humans , Neurologic Examination/methods , Physical Therapy Modalities , Pregnancy , Pregnancy Complications, Infectious/physiopathology , Pregnancy Complications, Infectious/therapy , Treatment Outcome
7.
GMS J Med Educ ; 38(1): Doc9, 2021.
Article in English | MEDLINE | ID: covidwho-1110230

ABSTRACT

Situation: The COVID-19 pandemic made the traditional bedside teaching inaccessible for medical students. Problem: Within a short period of time, established bedside teaching concepts had to be converted into online formats to meet the requirements of the health authorities. Approach: The Department of Neurology at the University Hospital Essen transformed the examination course in the 5th clinical semester into a live stream, taking into account data protection guidelines. This enabled students to participate from a distance, allowing them to take the medical history from a patient and to interact with the medical examiners. Thus, this concept goes beyond the video-based formats of the examination course. Optimization: During the course, we performed online evaluations to ensure an immediate feedback from the students. This enabled us to implement ongoing changes that had a positive impact on the course format, for example using better equipment to ensure a better video and audio quality. In the future, we hope to create a clinic's own online channel to further increase data security.


Subject(s)
COVID-19/epidemiology , Education, Distance/organization & administration , Education, Medical/organization & administration , Neurologic Examination/methods , Neurology/education , Humans , Pandemics , SARS-CoV-2
8.
Ann Otol Rhinol Laryngol ; 130(11): 1228-1235, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1079159

ABSTRACT

BACKGROUND: Acute neurological sequela in patients with COVID-19 infection include acute thromboembolic infarcts related to cytokine storm and post infectious immune activation resulting in a prothrombotic state. Radiologic imaging studies of the sinonasal tract and mastoid cavity in patients with COVID-19 infection are sparse and limited to case series. In this report, we investigate the radiologic involvement of nasal cavity, nasopharynx, paranasal sinuses, and mastoid cavity in patients with SARS-CoV-2 infection who presented with acute neurological symptoms. METHODS: Retrospective review of medical records and neuroradiologic imaging in patients diagnosed with acute COVID-19 infection who presented with acute neurological symptoms to assess radiologic prevalence of sinus and mastoid disease and its correlation to upper respiratory tract symptoms. RESULTS: Of the 55 patients, 23 (42%) had partial sinus opacification, with no evidence for complete sinus opacification. The ethmoid sinus was the most commonly affected (16/55 or 29%). An air fluid level was noted in 6/55 (11%) patients, most commonly in the maxillary sinus. Olfactory recess and mastoid opacification were uncommon. There was no evidence of bony destruction in any of the studies, Cough, nasal congestion, rhinorrhea, and sore throat were not significantly associated with any radiological findings. CONCLUSION: In patients who present with acute neurological symptoms, COVID-19 infection is characterized by limited and mild mucosal disease within the sinuses, nasopharynx and mastoid cavity. LEVEL OF EVIDENCE: 4.


Subject(s)
COVID-19 , Magnetic Resonance Imaging/methods , Mastoid/diagnostic imaging , Nasopharynx/diagnostic imaging , Paranasal Sinuses/diagnostic imaging , Tomography, X-Ray Computed/methods , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/physiopathology , Correlation of Data , Diagnostic Techniques, Neurological , Female , Humans , Male , Middle Aged , Neuroimaging/methods , Neurologic Examination/methods , New York/epidemiology , Prevalence , SARS-CoV-2/isolation & purification , Symptom Assessment/methods
9.
Cerebellum ; 20(1): 4-8, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1064615

ABSTRACT

The virtual practice has made major advances in the way that we care for patients in the modern era. The culture of virtual practice, consulting, and telemedicine, which had started several years ago, took an accelerated leap as humankind was challenged by the novel coronavirus pandemic (COVID19). The social distancing measures and lockdowns imposed in many countries left medical care providers with limited options in evaluating ambulatory patients, pushing the rapid transition to assessments via virtual platforms. In this novel arena of medical practice, which may form new norms beyond the current pandemic crisis, we found it critical to define guidelines on the recommended practice in neurotology, including remote methods in examining the vestibular and eye movement function. The proposed remote examination methods aim to reliably diagnose acute and subacute diseases of the inner-ear, brainstem, and the cerebellum. A key aim was to triage patients into those requiring urgent emergency room assessment versus non-urgent but expedited outpatient management. Physicians who had expertise in managing patients with vestibular disorders were invited to participate in the taskforce. The focus was on two topics: (1) an adequate eye movement and vestibular examination strategy using virtual platforms and (2) a decision pathway providing guidance about which patient should seek urgent medical care and which patient should have non-urgent but expedited outpatient management.


Subject(s)
COVID-19 , Neurologic Examination/methods , Telemedicine/methods , Triage/methods , Vestibular Diseases/diagnosis , Consensus , Humans , SARS-CoV-2
11.
BMJ Case Rep ; 13(11)2020 Nov 30.
Article in English | MEDLINE | ID: covidwho-975663

ABSTRACT

COVID-19 is a novel disease best known to cause a cough, fever and respiratory failure. Recently, it has been recognised that COVID-19 may present in multi-systemic ways which can cause diagnostic uncertainty or error.We present a patient who attended hospital with features of Guillain-Barré syndrome (GBS) before developing clinical and radiological findings of COVID-19. While the authors recognise that neurological complications have been reported following COVID-19 infection, to their knowledge this report describes a unique presentation of GBS without preceding COVID-19 symptoms.Since these conditions may have considerable overlapping features including respiratory failure and (following prolonged critical care admission) profound weakness, it is possible that one diagnosis may be overlooked. Raising awareness of a possible association between these conditions is important so both are considered allowing appropriate investigations to be arranged to optimise the chance of neurological recovery and survival, while also protecting staff from potentially unrecognised COVID-19.


Subject(s)
COVID-19 , Critical Illness , Guillain-Barre Syndrome , Infection Control/methods , Patient Care Management/methods , Respiratory Insufficiency , SARS-CoV-2/isolation & purification , COVID-19/diagnosis , COVID-19/physiopathology , COVID-19/prevention & control , COVID-19/therapy , Comorbidity , Critical Illness/rehabilitation , Critical Illness/therapy , Diagnostic Errors/prevention & control , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Male , Middle Aged , Neurologic Examination/methods , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/virology , Respiration, Artificial/methods , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/etiology , Tomography, X-Ray Computed/methods , Treatment Outcome
13.
BMJ Case Rep ; 13(10)2020 Oct 15.
Article in English | MEDLINE | ID: covidwho-873485

ABSTRACT

Early case series suggest that about one-third of patients with COVID-19 present with neurological manifestations, including cerebrovascular disease, reported in 2%-6% of hospitalised patients. These are generally older patients with severe infection and comorbidities. Here we discuss the case of a previously fit and well 39-year-old man who presented with fever and respiratory symptoms, evolving in pneumonia with hypoxia but only requiring continuous positive airway pressure. After resolution of the respiratory disease, the patient developed focal neurology and was found to have bilateral occipital, thalamic and cerebellar infarcts. A diagnosis of COVID-19 central nervous system vasculopathy was made. He developed a florid neuropsychiatric syndrome, including paranoia, irritability, aggression and disinhibition, requiring treatment with antipsychotics and transfer to neurorehabilitation. Neuropsychometry revealed a wide range of cognitive deficits. The rapid evolution of the illness was matched by fast resolution of the neuropsychiatric picture with mild residual cognitive impairment.


Subject(s)
Behavioral Symptoms , Brain Infarction , Brain Stem , Cerebellar Diseases , Cerebellum , Cognitive Dysfunction , Coronavirus Infections , Pandemics , Pneumonia, Viral , Adult , Behavioral Symptoms/diagnosis , Behavioral Symptoms/physiopathology , Behavioral Symptoms/rehabilitation , Betacoronavirus/isolation & purification , Brain Infarction/diagnosis , Brain Infarction/physiopathology , Brain Infarction/psychology , Brain Infarction/rehabilitation , Brain Stem/blood supply , Brain Stem/diagnostic imaging , COVID-19 , Cerebellar Diseases/physiopathology , Cerebellar Diseases/psychology , Cerebellar Diseases/rehabilitation , Cerebellar Diseases/virology , Cerebellum/blood supply , Cerebellum/diagnostic imaging , Cognitive Dysfunction/diagnosis , Cognitive Dysfunction/physiopathology , Cognitive Dysfunction/rehabilitation , Cognitive Dysfunction/virology , Coronavirus Infections/physiopathology , Coronavirus Infections/psychology , Coronavirus Infections/therapy , Humans , Male , Neurologic Examination/methods , Neuropsychological Tests , Pneumonia, Viral/physiopathology , Pneumonia, Viral/psychology , Pneumonia, Viral/therapy , Pneumonia, Viral/virology , Psychiatric Rehabilitation/methods , SARS-CoV-2 , Treatment Outcome
14.
BMJ Case Rep ; 13(6)2020 Jun 14.
Article in English | MEDLINE | ID: covidwho-832843

ABSTRACT

A 57-year-old man presented with a progressive flaccid symmetrical motor and sensory neuropathy following a 1-week history of cough and malaise. He was diagnosed with Guillain-Barré syndrome secondary to COVID-19 and started on intravenous immunoglobulin. He proceeded to have worsening respiratory function and needed intubation and mechanical ventilation. This is the first reported case of this rare neurological complication of COVID-19 in the UK, but it adds to a small but growing body of international evidence to suggest a significant association between these two conditions. Increasing appreciation of this by clinicians will ensure earlier diagnosis, monitoring and treatment of patients presenting with this.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections , Guillain-Barre Syndrome , Immunoglobulins, Intravenous/administration & dosage , Pandemics , Pneumonia, Viral , Respiration, Artificial/methods , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Coronavirus Infections/therapy , Early Diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/etiology , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Immunologic Factors/administration & dosage , Lung/diagnostic imaging , Male , Middle Aged , Neurologic Examination/methods , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/etiology , Pneumonia, Viral/physiopathology , Pneumonia, Viral/therapy , SARS-CoV-2 , Tomography, X-Ray Computed/methods , Treatment Outcome
15.
BMC Pregnancy Childbirth ; 20(1): 587, 2020 Oct 06.
Article in English | MEDLINE | ID: covidwho-818079

ABSTRACT

BACKGROUND: There are no published cases of tonic-clonic seizures and posterior bilateral blindness during pregnancy and Severe Acute Respiratory Syndrome (SARS) Coronavirus (COV) 2 (SARS-COV-2) infection. We do not just face new and unknown manifestations, but also how different patient groups are affected by SARS-COV-2 infection, such as pregnant women. Coronavirus Disease 2019 (COVID-19), preeclampsia, eclampsia and posterior reversible leukoencephalopathy share endothelium damage and similar pathophysiology. CASE PRESENTATION: A 35-year-old pregnant woman was admitted for tonic-clonic seizures and SARS-COV-2 infection. She had a normal pregnancy control and no other symptoms before tonic-clonic seizures development. After a Caesarean section (C-section) she developed high blood pressure, and we initiated antihypertensive treatment with labetalol, amlodipine and captopril. Few hours later she developed symptoms of cortical blindness that resolved in 72 h with normal brain computed tomography (CT) angiography. CONCLUSION: The authors conclude that SARS COV-2 infection could promote brain endothelial damage and facilitate neurological complications during pregnancy.


Subject(s)
Antihypertensive Agents/administration & dosage , Betacoronavirus/isolation & purification , Blindness, Cortical , Cesarean Section/methods , Coronavirus Infections , Eclampsia , Fibrinolytic Agents/administration & dosage , Pandemics , Pneumonia, Viral , Pregnancy Complications, Infectious , Seizures , Adult , Blindness, Cortical/diagnosis , Blindness, Cortical/virology , Brain/diagnostic imaging , COVID-19 , Computed Tomography Angiography/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Diagnosis, Differential , Eclampsia/diagnosis , Eclampsia/therapy , Eclampsia/virology , Female , Humans , Neurologic Examination/methods , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Pregnancy Complications, Infectious/etiology , Pregnancy Complications, Infectious/physiopathology , Pregnancy Outcome , SARS-CoV-2 , Seizures/diagnosis , Seizures/etiology , Seizures/therapy , Tomography, X-Ray Computed/methods , Treatment Outcome
17.
Pain Physician ; 23(4S): S205-S238, 2020 08.
Article in English | MEDLINE | ID: covidwho-777187

ABSTRACT

BACKGROUND: The COVID pandemic has impacted almost every aspect of human interaction, causing global changes in financial, health care, and social environments for the foreseeable future. More than 1.3 million of the 4 million cases of COVID-19 confirmed globally as of May 2020 have been identified in the United States, testing the capacity and resilience of our hospitals and health care workers. The impacts of the ongoing pandemic, caused by a novel strain of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have far-reaching implications for the future of our health care system and how we deliver routine care to patients. The adoption of social distancing during this pandemic has demonstrated efficacy in controlling the spread of this virus and has been the only proven means of infection control thus far. Social distancing has prompted hospital closures and the reduction of all non-COVID clinical visits, causing widespread financial despair to many outpatient centers. However, the need to treat patients for non-COVID problems remains important despite this pandemic, as care must continue to be delivered to patients despite their ability or desire to report to outpatient centers for their general care. Our national health care system has realized this need and has incentivized providers to adopt distance-based care in the form of telemedicine and video medicine visits. Many institutions have since incorporated these into their practices without financial penalty because of Medicare's 1135 waiver, which currently reimburses telemedicine at the same rate as evaluation and management codes (E/M Codes). Although the financial burden has been alleviated by this policy, the practitioner remains accountable for providing proper assessment with this new modality of health care delivery. This is a challenge for most physicians, so our team of national experts has created a reference guide for musculoskeletal and neurologic examination selection to retrofit into the telemedicine experience. OBJECTIVES: To describe and illustrate musculoskeletal and neurologic examination techniques that can be used effectively in telemedicine. STUDY DESIGN: Consensus-based multispecialty guidelines. SETTING: Tertiary care center. METHODS: Literature review of the neck, shoulder, elbow, wrist, hand, lumbar, hip, and knee physical examinations were performed. A multidisciplinary team comprised of physical medicine and rehabilitation, orthopedics, rheumatology, neurology, and anesthesia experts evaluated each examination and provided consensus opinion to select the examinations most appropriate for telemedicine evaluation. The team also provided consensus opinion on how to modify some examinations to incorporate into a nonhealth care office setting. RESULTS: Sixty-nine examinations were selected by the consensus team. Household objects were identified that modified standard and validated examinations, which could facilitate the examinations.The consensus review team did not believe that the modified tests altered the validity of the standardized tests. LIMITATIONS: Examinations selected are not validated for telemedicine. Qualitative and quantitative analyses were not performed. CONCLUSIONS: The physical examination is an essential component for sound clinical judgment and patient care planning. The physical examinations described in this manuscript provide a comprehensive framework for the musculoskeletal and neurologic examination, which has been vetted by a committee of national experts for incorporation into the telemedicine evaluation.


Subject(s)
Coronavirus Infections , Neurologic Examination/methods , Orthopedics/methods , Pain/diagnosis , Pandemics , Pneumonia, Viral , Telemedicine/methods , Betacoronavirus , COVID-19 , Humans , Neurologic Examination/trends , Orthopedics/trends , SARS-CoV-2 , Telemedicine/trends , United States
18.
Neurology ; 95(15): 693-694, 2020 10 13.
Article in English | MEDLINE | ID: covidwho-690840

ABSTRACT

Coronavirus disease 2019 (COVID-19) may pose unique challenges to clinicians attempting to diagnose brain death in patients infected with the SARS-CoV-2. Among these challenges is the risk of aerosol generation during the traditional apnea testing using the insufflation technique in addition to the risk of complications due to SARS-CoV-2-related lung disease. In this article, we discuss these challenges and provide further guidance to minimize such risks to ensure safety of healthcare professionals and other patients. We also emphasize the importance of maintaining the standards of brain death determination in this critical time.


Subject(s)
Brain Death/diagnosis , Coronavirus Infections/prevention & control , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Neurologic Examination/methods , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Betacoronavirus , COVID-19 , Coronavirus Infections/transmission , Humans , Insufflation/methods , Pneumonia, Viral/transmission , SARS-CoV-2
19.
R I Med J (2013) ; 103(6): 37-38, 2020 Jun 10.
Article in English | MEDLINE | ID: covidwho-604090

ABSTRACT

To date, there have been reports of neurologic manifestations in COVID-19 patients including ischemic strokes, Guillain-Barre Syndrome and anosmia. In this case report, we describe a patient who presented with dysosmia, dysgeusia, along with monocular peripheral vision loss after being diagnosed with COVID-19.


Subject(s)
Betacoronavirus/isolation & purification , Blindness , Diagnostic Techniques, Ophthalmological , Neurologic Examination/methods , Olfaction Disorders , Blindness/diagnosis , Blindness/etiology , Brain/diagnostic imaging , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Female , Humans , Magnetic Resonance Imaging/methods , Middle Aged , Olfaction Disorders/diagnosis , Olfaction Disorders/etiology , Optic Nerve/diagnostic imaging , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Remission, Spontaneous , SARS-CoV-2 , Treatment Outcome
20.
World Neurosurg ; 139: 549-557, 2020 07.
Article in English | MEDLINE | ID: covidwho-602202

ABSTRACT

Despite the substantial growth of telemedicine and the evidence of its advantages, the use of telemedicine in neurosurgery has been limited. Barriers have included medicolegal issues surrounding provider reimbursement, interstate licensure, and malpractice liability as well as technological challenges. Recently, the coronavirus disease 2019 (COVID-19) pandemic has limited typical evaluation of patients with neurologic issues and resulted in a surge in demand for virtual medical visits. Meanwhile, federal and state governments took action to facilitate the rapid implementation of telehealth programs, placing a temporary lift on medicolegal barriers that had previously limited its expansion. This created a unique opportunity for widespread telehealth use to meet the surge in demand for remote medical care. After initial hurdles and challenges, our experience with telemedicine in neurosurgery at Penn Medicine has been overall positive from both the provider and the patients' perspective. One of the unique challenges we face is guiding patients to appropriately set up devices in a way that enables an effective neuroexamination. However, we argue that an accurate and comprehensive neurologic examination can be conducted through a telemedicine platform, despite minor weaknesses inherent to absence of physical presence. In addition, certain neurosurgical visits such as postoperative checks, vascular pathology, and brain tumors inherently lend themselves to easier evaluation through telehealth visits. In the era of COVID-19 and beyond, telemedicine remains a promising and effective approach to continue neurologic patient care.


Subject(s)
Betacoronavirus , Coronavirus Infections/surgery , Neurologic Examination/methods , Neurosurgery/methods , Neurosurgical Procedures/methods , Pneumonia, Viral/surgery , Telemedicine/methods , COVID-19 , Coronavirus Infections/epidemiology , Humans , Neurologic Examination/trends , Neurosurgery/trends , Neurosurgical Procedures/trends , Pandemics , Pneumonia, Viral/epidemiology , SARS-CoV-2 , Telemedicine/trends
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