ABSTRACT
The new coronavirus 2019 epidemic declared in China on December 31, 2019 soon spread to the rest of the world, becoming the subject of an unprecedented health pandemic according to the World Health Organization's declaration of March 11, 2020. It is a disease that has the potential to cause multiple systemic infections. We report here the case of an acute polyradiculoneuritis of the Guillain-Barré type (GBS) indicative of a COVID-19 infection. This is a 41 year old patient seen for ascending, symmetrical and bilateral, progressive and acute tetraparesis with in a context of influenza syndrome and digestive infections treated 2 weeks earlier. During a COVID-19 infection, certain inflammatory cells stimulated by the virus produce inflammatory cytokines creating immune-mediated processes. The same mechanism is observed in GBS being also an immune-mediated disorder. The management of this disease in COVID-19 positive patients does not differ from that of patients who do not carry the virus. The risk of respiratory distress in COVID-19 positive patients becomes twice as great in patients with GBS who test positive for COVID-19 at the same time. Monitoring for hemodynamic disorders and respiratory distress in a neuro-intensive care unit may be fruitful.
Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/complications , Guillain-Barre Syndrome/etiology , Pneumonia, Viral/complications , Adult , Atrial Fibrillation/complications , Azithromycin/therapeutic use , Betacoronavirus/isolation & purification , COVID-19 , COVID-19 Testing , Chloroquine/adverse effects , Chloroquine/therapeutic use , Clinical Laboratory Techniques , Combined Modality Therapy , Contraindications, Drug , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Early Diagnosis , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/physiopathology , Guillain-Barre Syndrome/therapy , Humans , Male , Muscle Weakness/etiology , Nasopharynx/virology , Olfaction Disorders/etiology , Oxygen Inhalation Therapy , Pandemics , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Quadriplegia/etiology , Respiration, Artificial , SARS-CoV-2 , Urinary Incontinence/etiologyABSTRACT
Background: The diagnostic certainty of medullar tuberculosis (TB) without Pott disease is difficult to establish in a tropical environment with the large group of infectious, parasitic, and systemic myelopathies, despite the increasing availability of magnetic resonance imaging (MRI) data and improvement of biological exploration platforms. Methods: We retrospectively analyzed the files of 186 patients hospitalized in the Department of Neurology and Neurosurgery of the University Hospital Center of Conakry, Guinea, between 2008 and 2016 for the management of non-compressive and compressive myelopathy. Biological evidence of TB infection was demonstrated for 13 (6.9%) patients. Results: Infectious clinical picture prior to the development of neurological signs was reported in 11 patients (84.6%). The neurological signs were summed up by the existence of a sensitivo-motor semiology of progressive evolution (100% of cases) with sphincter disorders in 11 patients (84.6%) and a medullary compression symptomatology with a lesion and under lesion syndrome from the outset in 4 patients (30.8%). Medullary MRI revealed an extensive intramedullary hypersignal in 9 patients with non-compressive myelopathy and in 4 cases, the lesions appeared in T1 hypersignal and T2 isosignal were localized. Lumbar puncture (LP) revealed lymphocytic pleocytosis, hypoglucorrhage (0.3 to 0.5 g/l), and leukocytosis. Conclusion: This study reveals a classic clinical, biological, neuroradiological, and evolutionary profile of compressive and non-compressive myelopathies. These results are important for the therapeutic and evolutionary discussion of TB myelopathies for good management.
