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Abstract
The primary target of severe acute respiratory syndrome coronavirus 2 is the respiratory system including the nose and lungs, however, it can also damage the kidneys, cardiovascular system and gastrointestinal system. Many recent reports suggested that severe acute respiratory syndrome coronavirus 2 infections can also affect the central nervous system as well as peripheral nervous system that lead to the several neurological complications. The virus can break the blood brain barrier and enters the brain via haematological route or directly by the angiotensin-converting enzyme 2 receptors present on endothelial cells of many cerebral tissues. The neurological complications are manifested by headache, dizziness, encephalopathy, encephalitis, cerebrovascular disease, anosmia, hypogeusia, muscle damage, etc. This review article described the possible routes and mechanism of nervous system infection and the range of neurological complications of COVID-19 that may help the medical practitioners and researchers to improve the clinical treatment and reduce the mortality rate among patients with viral diseases.
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Affiliation(s)
- Santosh Singh
- Biochemistry and Molecular Biology Laboratory, Department of Zoology, Guru Ghasidas Vishwavidyalaya (a Central University), Bilaspur, Chhattisgarh, India
| | - Nikita Meher
- Biochemistry and Molecular Biology Laboratory, Department of Zoology, Guru Ghasidas Vishwavidyalaya (a Central University), Bilaspur, Chhattisgarh, India
| | - Arifullah Mohammed
- Department of Agriculture Science, Faculty of Agro-Based Industry, Universiti Malaysia Kelantan, Jeli, Kelantan, Malaysia
| | | | - L.V.K.S. Bhaskar
- Biochemistry and Molecular Biology Laboratory, Department of Zoology, Guru Ghasidas Vishwavidyalaya (a Central University), Bilaspur, Chhattisgarh, India
| | - Norazlina Mat Nawi
- Department of Nuclear Medicine, Radiotherapy & Oncology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian, Kelantan, Malaysia
- * Correspondence: Norazlina Mat Nawi, Department of Nuclear Medicine, Radiotherapy & Oncology, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, Kubang Kerian 16150, Kelantan, Malaysia (e-mail: )
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Liampas A, Parperis K, Erotocritou MF, Nteveros A, Papadopoulou M, Moschovos C, Akil M, Coaccioli S, Hadjigeorgiou GM, Hadjivassiliou M, Zis P. Primary Sjögren syndrome-related peripheral neuropathy: A systematic review and meta-analysis. Eur J Neurol 2023; 30:255-265. [PMID: 36086910 PMCID: PMC10087501 DOI: 10.1111/ene.15555] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 08/24/2022] [Accepted: 08/31/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Primary Sjögren syndrome (pSS) is a chronic, systemic, autoimmune disorder characterized by lymphocytic infiltrates of the exocrine organs, leading to sicca symptoms and parotid enlargement. pSS has been linked to various neurological manifestations, including peripheral neuropathy (PN). We aimed to provide a comprehensive analysis of the currently available evidence regarding pSS-related PN. METHODS A literature search in the PubMed database was performed, and 49 papers were eligible to be included in this systematic review and meta-analysis. RESULTS The pooled prevalence of PN in pSS is estimated to be 15.0% (95% confidence interval = 10.7%-20.7%). The mean age of pSS patients at PN diagnosis is 59 years. Among the patients with pSS and PN, 83% are females. Neuropathic symptoms usually precede or lead to the pSS diagnosis at a 2:1 ratio in patients with pSS-related PN. The commonest type of pSS-related PN is distal axonal polyneuropathy (80% of patients with pSS-related PN), followed by sensory ganglionopathy. Peripheral and cranial mononeuropathies-particularly trigeminal-are also frequent. Risk factors for developing PN include increasing age and presence of vasculitis. Immune-mediated pathogenetic mechanisms are discussed. Glucocorticoids are the most commonly used treatment option for managing pSS-related PN, when associated with vasculitis, followed by the use of intravenous immunoglobulin. CONCLUSIONS PN is very common in pSS patients. Evidence on long-term prognosis of PN in pSS is limited, and further research is needed. Research into the use of immunosuppressive medication in nonvasculitic neuropathies in the context of pSS merits further consideration.
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Affiliation(s)
- Andreas Liampas
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | | | | | - Marianna Papadopoulou
- Department of Physiotherapy, Laboratory of Neuromuscular and Cardiovascular Study of Motion, University of West Attica, Egaleo, Greece
| | - Christos Moschovos
- Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Mohammed Akil
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - Stefano Coaccioli
- European League Against Pain, Zurich, Switzerland.,Department of Internal Medicine, Perugia University, Perugia, Italy
| | - Georgios M Hadjigeorgiou
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus
| | | | - Panagiotis Zis
- Medical School, University of Cyprus, Nicosia, Cyprus.,Department of Neurology, Nicosia General Hospital, Nicosia, Cyprus.,Second Department of Neurology, Attikon Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Medical School, University of Sheffield, Sheffield, UK
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53
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Shrestha DB, Shtembari J, Achhami E, Adhikari L, Rengarajan D. Posterior Reversible Encephalopathy Syndrome in a Male With Polysubstance Abuse: A Case Report. Cureus 2023; 15:e34477. [PMID: 36874686 PMCID: PMC9981862 DOI: 10.7759/cureus.34477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 01/31/2023] [Indexed: 02/04/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a neurologic disorder with multiple etiologies. The signs and symptoms of PRES are non-specific, making the differential diagnosis broad. Although PRES is suspected clinically, a diagnosis requires characteristic findings on imaging. In patients with undiagnosed PRES, the coexistence of substance abuse can divert the care provider from pursuing imaging studies, leading to a missed diagnosis. We describe the case of a 51-year-old male who presented with altered mental status and was diagnosed with PRES despite having a positive urine drug screen.
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Affiliation(s)
| | - Jurgen Shtembari
- Department of Internal Medicine, Mount Sinai Hospital, Chicago, USA
| | - Eliz Achhami
- Department of Internal Medicine, Sukraraj Tropical & Infectious Disease Hospital, Kathmandu, NPL
| | - Lukash Adhikari
- Department of Internal Medicine, Patan Academy of Health Sciences, Lalitpur, NPL
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54
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Tan HJ, Goh CH, Khoo CS, Ng CF, Tan JK, Wan Zaidi WA, Law ZK, Zulkifli MD, Md Rani SA, Wan Yahya WNN, Remli R, Mohamed Ibrahim N, Hod R, Mohamed Mukari SA, Mohd Mustapha AM, Kori N, Periyasamy P. Neurological manifestations in SARS-CoV-2 infection: A single-center cross-sectional study in Malaysia. Neurol Clin Neurosci 2023; 11:17-26. [PMID: 36714457 PMCID: PMC9874463 DOI: 10.1111/ncn3.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/23/2022] [Accepted: 10/18/2022] [Indexed: 11/07/2022]
Abstract
Background Neurological involvement associated with SARS-CoV-2 infection has been reported from different regions of the world. However, data from South East Asia are scarce. We described the neurological manifestations and their associated factors among the hospitalized COVID-19 patients from an academic tertiary hospital in Malaysia. Methods A cross-sectional observational study of hospitalized COVID-19 patients was conducted. The neurological manifestations were divided into the self-reported central nervous system (CNS) symptoms, stroke associated symptoms, symptoms of encephalitis or encephalopathy and specific neurological complications. Multiple logistic regression was performed using demographic and clinical variables to determine the factors associated with outcome. Results Of 156 hospitalized COVID-19 patients with mean age of 55.88 ± 6.11 (SD) years, 23.7% developed neurological complications, which included stroke, encephalitis and encephalopathy. Patients with neurological complications were more likely to have diabetes mellitus (p = 0.033), symptoms of stroke [limb weakness (p < 0.001), slurred speech (p < 0.001)]; and encephalitis or encephalopathy [confusion (p < 0.001), forgetfulness (p = 0.006) and seizure (p = 0.019)]. Unvaccinated patients had a 4.25-fold increased risk of having neurological complications (adjusted OR = 4.25; 95% CI: 1.02, 17.71, p = 0.047). Anosmia and dysgeusia were less associated with neurological complications (adjusted OR = 0.22; 95% CI: 0.05, 0.96, p = 0.044). The odds of neurological complications were increased by 18% in patients with leukocytosis (adjusted OR = 1.18, 95% CI: 1.003, p = 0.0460). Conclusions Stroke, encephalitis and encephalopathy were the common neurological complications from our study. Diabetes mellitus, presence of symptoms of stroke, symptoms of encephalitis or encephalopathy, leukocytosis, and being unvaccinated against COVID-19 were the associated risk factors of developing neurological complications.
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Affiliation(s)
- Hui Jan Tan
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Cheon Han Goh
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Ching Soong Khoo
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Chen Fei Ng
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Juen Kiem Tan
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Wan Asyraf Wan Zaidi
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Zhe Kang Law
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Muhamad Danial Zulkifli
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Shahrul Azmin Md Rani
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | | | - Rabani Remli
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Norlinah Mohamed Ibrahim
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Rozita Hod
- Department of Community Health, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | | | | | - Najma Kori
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
| | - Petrick Periyasamy
- Department of Medicine, Faculty of MedicineThe National University of MalaysiaKuala LumpurMalaysia
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55
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Dadu A, Satone V, Kaur R, Hashemi SH, Leonard H, Iwaki H, Makarious MB, Billingsley KJ, Bandres‐Ciga S, Sargent LJ, Noyce AJ, Daneshmand A, Blauwendraat C, Marek K, Scholz SW, Singleton AB, Nalls MA, Campbell RH, Faghri F. Identification and prediction of Parkinson's disease subtypes and progression using machine learning in two cohorts. NPJ Parkinsons Dis 2022; 8:172. [PMID: 36526647 PMCID: PMC9758217 DOI: 10.1038/s41531-022-00439-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
The clinical manifestations of Parkinson's disease (PD) are characterized by heterogeneity in age at onset, disease duration, rate of progression, and the constellation of motor versus non-motor features. There is an unmet need for the characterization of distinct disease subtypes as well as improved, individualized predictions of the disease course. We used unsupervised and supervised machine learning methods on comprehensive, longitudinal clinical data from the Parkinson's Disease Progression Marker Initiative (n = 294 cases) to identify patient subtypes and to predict disease progression. The resulting models were validated in an independent, clinically well-characterized cohort from the Parkinson's Disease Biomarker Program (n = 263 cases). Our analysis distinguished three distinct disease subtypes with highly predictable progression rates, corresponding to slow, moderate, and fast disease progression. We achieved highly accurate projections of disease progression 5 years after initial diagnosis with an average area under the curve (AUC) of 0.92 (95% CI: 0.95 ± 0.01) for the slower progressing group (PDvec1), 0.87 ± 0.03 for moderate progressors, and 0.95 ± 0.02 for the fast-progressing group (PDvec3). We identified serum neurofilament light as a significant indicator of fast disease progression among other key biomarkers of interest. We replicated these findings in an independent cohort, released the analytical code, and developed models in an open science manner. Our data-driven study provides insights to deconstruct PD heterogeneity. This approach could have immediate implications for clinical trials by improving the detection of significant clinical outcomes. We anticipate that machine learning models will improve patient counseling, clinical trial design, and ultimately individualized patient care.
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Affiliation(s)
- Anant Dadu
- grid.35403.310000 0004 1936 9991Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL 61820 USA ,grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.511118.dData Tecnica International, Washington, DC 20812 USA
| | - Vipul Satone
- grid.35403.310000 0004 1936 9991Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820 USA
| | - Rachneet Kaur
- grid.35403.310000 0004 1936 9991Department of Industrial and Enterprise Systems Engineering, University of Illinois at Urbana-Champaign, Champaign, IL 61820 USA
| | - Sayed Hadi Hashemi
- grid.35403.310000 0004 1936 9991Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL 61820 USA
| | - Hampton Leonard
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.511118.dData Tecnica International, Washington, DC 20812 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Hirotaka Iwaki
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.511118.dData Tecnica International, Washington, DC 20812 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Mary B. Makarious
- grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA ,grid.83440.3b0000000121901201Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, London, UK ,grid.83440.3b0000000121901201UCL Movement Disorders Centre, University College London, London, UK
| | - Kimberley J. Billingsley
- grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Sara Bandres‐Ciga
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Lana J. Sargent
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.224260.00000 0004 0458 8737School of Nursing, Virginia Commonwealth University, Richmond, VA 23298 USA
| | - Alastair J. Noyce
- grid.83440.3b0000000121901201UCL Movement Disorders Centre, University College London, London, UK ,grid.416041.60000 0001 0738 5466Preventive Neurology Unit, Wolfson Institute of Preventive Medicine, Queen Mary University of London and Department of Neurology, Royal London Hospital, London, UK
| | - Ali Daneshmand
- grid.189504.10000 0004 1936 7558Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118 USA
| | - Cornelis Blauwendraat
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Ken Marek
- grid.452597.8InviCRO LLC, Boston, MA USA ,grid.452597.8Molecular Neuroimaging, A Division of InviCRO, New Haven, CT USA
| | - Sonja W. Scholz
- grid.416870.c0000 0001 2177 357XNeurodegenerative Diseases Research Unit, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA ,grid.21107.350000 0001 2171 9311Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Andrew B. Singleton
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Mike A. Nalls
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.511118.dData Tecnica International, Washington, DC 20812 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
| | - Roy H. Campbell
- grid.35403.310000 0004 1936 9991Department of Computer Science, University of Illinois at Urbana-Champaign, Champaign, IL 61820 USA
| | - Faraz Faghri
- grid.94365.3d0000 0001 2297 5165Center for Alzheimer’s and Related Dementias (CARD), National Institute on Aging and National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD 20892 USA ,grid.511118.dData Tecnica International, Washington, DC 20812 USA ,grid.94365.3d0000 0001 2297 5165Laboratory of Neurogenetics, National Institute on Aging, National Institutes of Health, Bethesda, MD 20892 USA
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Pascarella A, Maglione M, Lenta S, Sciorio E, Mancusi R, Tucci C, Angrisani F, Acierno S, Calì C, Tipo V, Giannattasio A. Seizures in Children with SARS-CoV-2 Infection: Epidemiological, Clinical and Neurophysiological Characterization. Children (Basel) 2022; 9. [PMID: 36553366 DOI: 10.3390/children9121923] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/28/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may present with a wide variety of symptoms, including neurological manifestations. We investigated clinical, demographic, laboratory, neurophysiological and imaging characteristics of SARS-CoV-2-positive children with seizures and analyzed differences between children admitted during the periods with prevalent circulation of the Alpha/Delta and Omicron variants, respectively. Patients' characteristics were analyzed according to the presence or absence of seizures and then according to the SARS-CoV-2 variants. Five-hundred and four SARS-CoV-2-positive patients were included: 93 (18.4%) with seizures and 411 (81.6%) without. Patients with seizures were older, had more commonly an underlying epilepsy and had more frequently altered C-reactive protein than those without seizures. Electroencephalography was abnormal in 5/38 cases. According to the SARS-CoV-2 variant, seizures were recorded in 4.7% of the total number of hospitalized patients during the Alpha/Delta period, and in 16.9% of patients admitted during the Omicron period. During the Alpha/Delta variants, seizures were more commonly observed in patients with epilepsy compared to those observed during the Omicron period. Our findings suggest that although SARS-CoV-2 may potentially trigger seizures, they are generally not severe and do not require intensive care admission.
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Hegazi MA, Saeedi FA, Atwah AF, Sayed MH, Albeladi AA, Alyoubi SB, Aljudibi RA, Alyaslami SM, Alkathiry AT, Abdelgalil AA. Neurological Manifestations in Pediatric COVID-19 Patients Hospitalized at King Abdulaziz University Hospital, Jeddah, Saudi Arabia: A Retrospective Study. Children (Basel) 2022; 9. [PMID: 36553314 DOI: 10.3390/children9121870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 11/26/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
There are limited data about neurological manifestations in pediatric COVID-19 patients from all over the world, including Saudi Arabia. This study was performed to identify characteristics of pediatric COVID-19 cases with neurologic involvement hospitalized at King Abdulaziz University Hospital (KAUH), Saudi Arabia. This retrospective cross-sectional study included hospitalized patients aged 0-19 years with confirmed SARS-CoV-2 from April 2020 to February 2022. The required data were retrieved from patients' medical records. Ninety-four cases were included. The median ages of the studied group, those with neurological manifestations, and those without neurologic manifestations, were 6.5, 11.0, and 5.0 years, respectively. Neurological manifestations occurred in 29 COVID-19 patients (30.9%) with headache and decreased consciousness being the most common recorded manifestations in 8.5% and 6.4% of patients, respectively. Specific neurological manifestations were rare, as only two infants developed encephalopathy with fatal outcome. Most patients with and without neurological manifestations survived. Neuroimaging abnormalities were detected in 8 cases with neurological manifestations. Neurological manifestations were common in 31% of hospitalized pediatric COVID-19 cases. However, most of the neurological manifestations were mild and nonspecific, with headache being the most common one. Specific neurological manifestations were rare; however, pediatric COVID-19 patients, particularly young infants, were at risk of developing severe encephalopathy with fatal outcome.
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Topka M, Schneider M, Zrenner C, Belardinelli P, Ziemann U, Weiss D. Motor cortex excitability is reduced during freezing of upper limb movement in Parkinson's disease. NPJ Parkinsons Dis 2022; 8:161. [PMID: 36424411 DOI: 10.1038/s41531-022-00420-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
Whilst involvement of the motor cortex in the phenomenon of freezing in Parkinson's disease has been previously suggested, few empiric studies have been conducted to date. We investigated motor cortex (M1) excitability in eleven right-handed Parkinson's disease patients (aged 69.7 ± 9.6 years, disease duration 11.2 ± 3.9 years, akinesia-rigidity type) with verified gait freezing using a single-pulse transcranial magnetic stimulation (TMS) repetitive finger tapping paradigm. We delivered single TMS pulses at 120% of the active motor threshold at the 'ascending (contraction)' and 'descending (relaxation)' slope of the tap cycle during i) regular tapping, ii) the transition period of the three taps prior to a freeze and iii) during freezing of upper limb movement. M1 excitability was modulated along the tap cycle with greater motor evoked potentials (MEPs) during 'ascending' than 'descending'. Furthermore, MEPs during the 'ascending' phase of regular tapping, but not during the transition period, were greater compared to the MEPs recorded throughout a freeze. Neither force nor EMG activity 10-110 s before the stimulus predicted MEP size. This piloting study suggests that M1 excitability is reduced during freezing and the transition period preceding a freeze. This supports that M1 excitability is critical to freezing in Parkinson's disease.
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Gala D, Scharf S, Kudlak M, Green C, Khowaja F, Shah M, Kumar V, Ullal G. A Comprehensive Review of the Neurological Manifestations of Celiac Disease and Its Treatment. Diseases 2022; 10. [PMID: 36412605 DOI: 10.3390/diseases10040111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
Celiac disease (CD) is a common chronic inflammatory disorder occurring in genetically predisposed individuals secondary to gluten ingestion. CD usually presents with gastrointestinal symptoms such as pain, bloating, flatulence, and constipation or diarrhea. However, individuals can present in a nonclassical manner with only extraintestinal symptoms. The neurological manifestations of CD include ataxia, cognitive impairment, epilepsy, headache, and neuropathy. A lifelong gluten-free diet is the current recommended treatment for CD. This review discusses the relevant neurological manifestations associated with CD and the novel therapeutics. Further research is required to get a better understanding of the underlying pathophysiology of the neurological manifestations associated with CD. Clinicians should keep CD in the differential diagnosis in individuals presenting with neurological dysfunction of unknown cause.
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Lopez G, Eng C, Overman M, Ramirez D, Liu W, Beinhorn C, Sumler P, Prinsloo S, Li Y, Chen M, Bruera E, Cohen L. A randomized pilot study of oncology massage to treat chemotherapy-induced peripheral neuropathy. Sci Rep 2022; 12:19023. [PMID: 36348045 PMCID: PMC9643426 DOI: 10.1038/s41598-022-23372-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
This pilot randomized controlled trial investigated massage therapy for symptomatic relief of chemotherapy-induced peripheral neuropathy (CIPN) to determine the ideal weekly frequency and number of weeks of providing massage. We evaluated the feasibility and initial efficacy of a Swedish massage protocol to treat lower extremity (LE) CIPN. Inclusion criteria: LE neuropathy attributed to oxaliplatin, paclitaxel, or docetaxel, with no other attributable causes; ≥ 6 months since last chemotherapy; self-reported neuropathy score ≥ 3, 0-10 scale; age ≥ 18. Participant randomization (2:2:1:1) to one of four groups: LE (2) or head/neck/shoulder (control; 1) massage 3 times (3X) a week for 4 weeks; LE (2) or control (1) massage 2X/week for 6 weeks. Completion rate and the Pain Quality Assessment Scale (PQAS) was measured at baseline and 10 weeks later. 71 patients participated: 77.5% women; 57.7% (breast cancer), and 42.3% (GI cancer); mean age 60.3 y/o (range: 40-77); average > 3 years since last chemotherapy. Massage was deemed feasible: mean completion rates (max = 12) were 8.9 (SD 4.2) for 3X/week and 9.8 (SD 4.0) for 2X/week with no statistically significant differences. There were no statistically significant treatment group interactions in PQAS scores at 10-weeks follow-up. There was a statistically significant treatment schedule main effect for PQAS subscales (p < 0.05) at 10 weeks, with lower CIPN symptoms for 3X/week groups versus 2X/week groups. Improvements considered clinically significant favored the LE 3X/week group. Completion rates met pre-defined feasibility criteria. We seemed to observe better outcomes (CIPN symptom reduction) with the more intensive (3X/week for 4 weeks) massage intervention with no differences in adherence, regardless of whether the massage was directly to the CIPN-affected area or not. However, there was some suggestion that the massage program targeting the CIPN-affected area directly provided 3X a week for 4 weeks resulted in the best outcomes.
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Affiliation(s)
- Gabriel Lopez
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA
| | - Cathy Eng
- grid.412807.80000 0004 1936 9916Division of Hematology and Oncology, Vanderbilt-Ingram Cancer Center, Nashville, TN USA
| | - Michael Overman
- grid.240145.60000 0001 2291 4776Department of Gastrointestinal Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX USA
| | - David Ramirez
- grid.240145.60000 0001 2291 4776Department of Breast Medical Oncology, University of Texas, MD Anderson Cancer Center, Houston, TX USA
| | - Wenli Liu
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA
| | - Curtiss Beinhorn
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA
| | - Pamela Sumler
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA
| | - Sarah Prinsloo
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA ,grid.240145.60000 0001 2291 4776Department of Neurosurgery, University of Texas, MD Anderson Cancer Center, Houston, TX USA
| | - Yisheng Li
- grid.240145.60000 0001 2291 4776Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX USA
| | - Minxing Chen
- grid.240145.60000 0001 2291 4776Department of Biostatistics, University of Texas, MD Anderson Cancer Center, Houston, TX USA
| | - Eduardo Bruera
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA
| | - Lorenzo Cohen
- grid.240145.60000 0001 2291 4776Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas, MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1414, Houston, TX 77030 USA
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Teixeira-Vaz A, Rocha JA, Reis DAE, Oliveira M, Moreira TS, Silva AI, Monteiro-Soares M, Paiva JA. Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens. Rev Bras Ter Intensiva 2022; 34:342-350. [PMID: 36351066 PMCID: PMC9749094 DOI: 10.5935/0103-507x.20220229-en] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/07/2022] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVE To evaluate whether critical SARS-CoV-2 infection is more frequently associated with signs of corticospinal tract dysfunction and other neurological signs, symptoms, and syndromes, than other infectious pathogens. METHODS This was a prospective cohort study with consecutive inclusion of patients admitted to intensive care units due to primary infectious acute respiratory distress syndrome requiring invasive mechanical ventilation > 48 hours. Eligible patients were randomly assigned to three investigators for clinical evaluation, which encompassed the examination of signs of corticospinal tract dysfunction. Clinical data, including other neurological complications and possible predictors, were independently obtained from clinical records. RESULTS We consecutively included 54 patients with acute respiratory distress syndrome, 27 due to SARS-CoV-2 and 27 due to other infectious pathogens. The groups were comparable in most characteristics. COVID-19 patients presented a significantly higher risk of neurological complications (RR = 1.98; 95%CI 1.23 - 3.26). Signs of corticospinal tract dysfunction tended to be more prevalent in COVID-19 patients (RR = 1.62; 95%CI 0.72 - 3.44). CONCLUSION Our study is the first comparative analysis between SARS-CoV-2 and other infectious pathogens, in an intensive care unit setting, assessing neurological dysfunction. We report a significantly higher risk of neurological dysfunction among COVID-19 patients. As such, we suggest systematic screening for neurological complications in severe COVID-19 patients.
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Affiliation(s)
- Ana Teixeira-Vaz
- Physical Medicine and Rehabilitation Department, Centro Hospitalar
Universitário de São João, Faculdade de Medicina, Universidade do Porto - Porto,
Portugal
| | - José Afonso Rocha
- Physical Medicine and Rehabilitation Department, Centro Hospitalar
Universitário de São João, Faculdade de Medicina, Universidade do Porto - Porto,
Portugal
| | - David Almeida e Reis
- Physical Medicine and Rehabilitation Department, Centro Hospitalar
Universitário de São João, Faculdade de Medicina, Universidade do Porto - Porto,
Portugal
| | - Mafalda Oliveira
- Physical Medicine and Rehabilitation Department, Centro Hospitalar
Universitário de São João, Faculdade de Medicina, Universidade do Porto - Porto,
Portugal
| | - Tiago Simões Moreira
- Physical Medicine and Rehabilitation Department, Centro Hospitalar
Universitário de São João, Faculdade de Medicina, Universidade do Porto - Porto,
Portugal
| | - Ana Isabel Silva
- Physical Medicine and Rehabilitation Department, Centro Hospitalar
Universitário de São João, Faculdade de Medicina, Universidade do Porto - Porto,
Portugal
| | - Matilde Monteiro-Soares
- Rede de Investigação em Saúde, Centro de Investigação em
Tecnologias e Serviços de Saúde, Faculdade de Medicina, Universidade do Porto -
Porto, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário
de São João, Faculdade de Medicina, Universidade do Porto - Porto, Portugal
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Kulkarni R, Gupta D, Pujari S, Deshpande V, Naphade P, Deshpande R. Neurological Manifestations in COVID-19 in Three Waves of the Pandemic: An Inpatient Study from India. Ann Indian Acad Neurol 2022; 25:1047-1055. [PMID: 36911448 PMCID: PMC9996479 DOI: 10.4103/aian.aian_204_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/04/2022] Open
Abstract
Background Though severe acute respiratory syndrome coronavirus 2 (SARS CoV 2) virus primarily affects respiratory system, neurological involvement is well known. Aims To describe the neurological manifestations of coronavirus disease 2019 (COVID-19) during three waves of the pandemic. Methodology This was an ambispective observational single-centre study to describe the neurological manifestations of COVID-19 infection among inpatients from a tertiary care referral centre in Western India from March 2020 to January 2022. Results Out of 14,822 patients admitted with COVID-19, 307 (2.07%) had neurological manifestations. Neurological manifestations were seen in 1.87% in first wave (onset to 10 Feb 21); 2.37% in second wave (Feb 11, 2021 to Dec 31, 2021) and 6.26% in third wave (Jan 1, 2022 to Jan 31, 2022). The most common neurological manifestations were encephalopathy (34.5%), ischemic stroke (32.1%), and acute symptomatic seizures (8.8%). Encephalopathy (p = 0.028) was more common in first wave while seizures were more common in third wave (p = 0.001). In patients with encephalopathy, hypoxia (p = 0.0001), shock (p = 0.001), renal involvement (p = 0.002), and sepsis (p = 0.033) were associated with higher mortality; while those with no systemic involvement had better survival (p = 0.0001). Among patients with ischemic stroke, 32.1% did not have any traditional vascular risk factors. These patients were 9 years younger and required 6 days less hospitalization than patients of stroke with vascular risk factors. Conclusion SARS-CoV-2 produces many central and peripheral nervous system manifestations. Encephalopathy was more common in first wave while acute symptomatic seizures were more common in third wave. Encephalopathy was most common neurological manifestation with progressively higher mortality with increased number of systemic comorbidities. Ischemic stroke was seen in patients who had vascular risk factors as well as in patients without them.
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Affiliation(s)
- Rahul Kulkarni
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Dulari Gupta
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Shripad Pujari
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Vishal Deshpande
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Pravin Naphade
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
| | - Rushikesh Deshpande
- Department of Neurology, Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
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Wimmer C, Egger M, Bergmann J, Huge V, Müller F, Jahn K. Critical COVID-19 disease: Clinical course and rehabilitation of neurological deficits. Front Neurol 2022; 13:1012685. [PMID: 36388208 PMCID: PMC9649895 DOI: 10.3389/fneur.2022.1012685] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 10/06/2022] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND The COVID-19 disease frequently causes neurological symptoms. Critically ill patients often require neurorehabilitation for manifestations like intensive care unit (ICU) acquired weakness or encephalopathy. The outcome of these patients, however, is largely unknown. Here we report the clinical course of critical affected COVID-19 patients from hospital admission to discharge from inpatient neurorehabilitation. METHODS Prospective cohort study. COVID-19 patients admitted to neurorehabilitation were included based on a laboratory-confirmed SARS-CoV-2 infection. Assessments [modified Rankin Scale (mRS), Barthel-Index, Fatigue-Severity-Scale-7 and health-related quality of life (EQ-5D-5L)] were conducted at admission and before discharge from inpatient care. Data were compared to the preclinical health status. RESULTS Sixty-one patients (62 ± 13 years, 16 female) were included in the analysis. Most patients had been treated on ICU (n = 58; 57 ± 23 days) and had received invasive ventilation (n = 57; 46 ± 21 days). After discharge from ICU, patients spent on average 57 ± 26 days in neurorehabilitation. The most frequent neurological diagnoses were ICU-acquired weakness (n = 56) and encephalopathy (n = 23). During rehabilitation overall disability improved [mRS median (IQR) 4.0 (1.0) at inclusion and 2.0 (1.0) at discharge]. However, the preclinical health state [mRS 0.0 (0.0)] was not regained (p < 0.001). This was also reflected by the Barthel-Index [preclinical 100.0 (0.0), at inclusion 42.5 (35.0), at discharge 65.0 (7.5); p < 0.001]. Patients had only minor fatigue during inpatient care. Quality of life generally improved but was still low at discharge from hospital. CONCLUSION Patients with neurological sequelae after critical COVID-19 disease showed substantial deficits at discharge from inpatient care up to 4 months after the initial infection. They were restricted in activities of daily living and had reduced health-related quality of life. All patients needed continued medical support and physical treatment.
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Affiliation(s)
- Corinna Wimmer
- Department of Neurology and Intensive Care Medicine, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Marion Egger
- Department of Neurology and Intensive Care Medicine, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- Pettenkofer School of Public Health, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians University (LMU), Munich, Germany
| | - Jeannine Bergmann
- Department of Neurology and Intensive Care Medicine, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Volker Huge
- Department of Neurology and Intensive Care Medicine, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Friedemann Müller
- Department of Neurology and Intensive Care Medicine, Schoen Clinic Bad Aibling, Bad Aibling, Germany
| | - Klaus Jahn
- Department of Neurology and Intensive Care Medicine, Schoen Clinic Bad Aibling, Bad Aibling, Germany
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians University (LMU), Munich, Germany
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Szewczyk AK, Mitosek-Szewczyk K. COVID-19 Co-Infection May Promote Development of Sinusitis Complication in Children. Children (Basel) 2022; 9:children9111636. [PMID: 36360364 PMCID: PMC9688522 DOI: 10.3390/children9111636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/04/2022] [Accepted: 10/24/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The olfactory dysfunction that occurs during a COVID-19 infection has sparked much debate about its similarity to sinusitis. Up to 65% of COVID-19 pediatric patients may be asymptomatic; however, when symptoms are observed, fever and cough are the most common. Nasal congestion and discharge as well as headaches can also be seen, which makes both entities, i.e., COVID-19 and sinusitis, similar to each other. METHODS In this review, we present the clinical case of a teenager with a history of acute sinusitis and COVID-19 co-infection followed by purulent meningoencephalitis. We aim to summarize available findings on the association between COVID-19, sinusitis, and possible common complications of both diseases. RESULTS Differentiating between COVID-19 and sinusitis can be confusing because presented symptoms may overlap or mimic each other. Increased risk of complications, especially in patients with bacterial sinusitis co-infected with SARS-CoV-2, should prompt physicians to monitor young patients and inform parents about disturbing symptoms and possible complications. CONCLUSIONS Acute sinusitis and COVID-19 co-infection may lead to numerous complications and should be included among the factors predisposing to worse prognosis. It is especially related to patients with high risk factors and even more important in children as they often pass the infection asymptomatically and its complications can lead to loss of health or life.
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Affiliation(s)
- Anna K. Szewczyk
- Doctoral School, Medical University of Lublin, 7 Chodźki Street, 20-093 Lublin, Poland
- Department of Neurology, Medical University of Lublin, 7 Chodźki Street, 20-093 Lublin, Poland
- Correspondence:
| | - Krystyna Mitosek-Szewczyk
- Department of Child Neurology, Medical University of Lublin, 7 Chodźki Street, 20-093 Lublin, Poland
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Kopfer S, Iacobelli R, Wood S, Lindblad C, Thelin EP, Fletcher-Sandersjöö A, Broman LM. Incidence and predictors of brain infarction in neonatal patients on extracorporeal membrane oxygenation: an observational cohort study. Sci Rep 2022; 12:17932. [PMID: 36289242 DOI: 10.1038/s41598-022-21749-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/30/2022] [Indexed: 01/20/2023] Open
Abstract
To determine the incidence and identify predictors of brain infarctions (BI) in neonatal patients treated with extracorporeal membrane oxygenation (ECMO). We performed a retrospective cohort study at ECMO Centre Karolinska, Stockholm, Sweden. Logistic regression models were used to identify BI predictors. Neonates (age 0-28 days) treated with veno-arterial (VA) or veno-venous (VV) ECMO between 2010 and 2018. The primary outcome was a computed tomography (CT) verified BI diagnosed during ECMO treatment. In total, 223 patients were included, 102 patients (46%) underwent at least one brain CT and 27 patients (12%) were diagnosed with a BI. BI diagnosis was associated with increased 30-day mortality (48% vs. 18%). High pre-ECMO Pediatric Index of Mortality score, sepsis as the indication for ECMO treatment, VA ECMO, conversion between ECMO modes, use of continuous renal replacement therapy, and extracranial thrombosis were identified as independent predictors of BI development. The incidence of BI in neonatal ECMO patients may be higher than previously understood. Risk factor identification may help initiate steps to lower the risk or facilitate earlier diagnosis of BI in neonates undergoing ECMO treatment.
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Hazra S, Chaudhuri AG, Tiwary BK, Chakrabarti N. Integrated network-based multiple computational analyses for identification of co-expressed candidate genes associated with neurological manifestations of COVID-19. Sci Rep 2022; 12:17141. [PMID: 36229517 PMCID: PMC9558001 DOI: 10.1038/s41598-022-21109-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 09/22/2022] [Indexed: 01/04/2023] Open
Abstract
'Tripartite network' (TN) and 'combined gene network' (CGN) were constructed and their hub-bottleneck and driver nodes (44 genes) were evaluated as 'target genes' (TG) to identify 21 'candidate genes' (CG) and their relationship with neurological manifestations of COVID-19. TN was developed using neurological symptoms of COVID-19 found in literature. Under query genes (TG of TN), co-expressed genes were identified using pair-wise mutual information to genes available in RNA-Seq autopsy data of frontal cortex of COVID-19 victims. CGN was constructed with genes selected from TN and co-expressed in COVID-19. TG and their connecting genes of respective networks underwent functional analyses through findings of their enrichment terms and pair-wise 'semantic similarity scores' (SSS). A new integrated 'weighted harmonic mean score' was formulated assimilating values of SSS and STRING-based 'combined score' of the selected TG-pairs, which provided CG-pairs with properties of CGs as co-expressed and 'indispensable nodes' in CGN. Finally, six pairs sharing seven 'prevalent CGs' (ADAM10, ADAM17, AKT1, CTNNB1, ESR1, PIK3CA, FGFR1) showed linkages with the phenotypes (a) directly under neurodegeneration, neurodevelopmental diseases, tumour/cancer and cellular signalling, and (b) indirectly through other CGs under behavioural/cognitive and motor dysfunctions. The pathophysiology of 'prevalent CGs' has been discussed to interpret neurological phenotypes of COVID-19.
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Affiliation(s)
- Suvojit Hazra
- CPEPA-UGC Centre for "Electro-Physiological and Neuro-Imaging Studies Including Mathematical Modelling", University of Calcutta, Kolkata, West Bengal, India
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India
| | | | - Basant K Tiwary
- Department of Bioinformatics, School of Life Sciences, Pondicherry University, Pondicherry, India.
| | - Nilkanta Chakrabarti
- CPEPA-UGC Centre for "Electro-Physiological and Neuro-Imaging Studies Including Mathematical Modelling", University of Calcutta, Kolkata, West Bengal, India.
- Department of Physiology, University of Calcutta, Kolkata, West Bengal, India.
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Castillo RA, Castrillo JCM. [ NEUROLOGICAL MANIFESTATIONS ASSOCIATED WITH COVID-19 VACCINE]. Neurologia 2022:S0213-4853(22)00187-6. [PMID: 36245941 PMCID: PMC9554338 DOI: 10.1016/j.nrl.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) has spread rapidly, giving rise to a pandemic, causing significant morbidity and mortality. In this context, many vaccines have emerged to try to deal with this disease. OBJECTIVE To review the reported cases of neurological manifestations after the application of COVID-19 vaccines, describing clinical, analytical and neuroimaging findings and health outcomes. METHODS We carried out a review through bibliographic searches in PubMed. RESULTS We found 86 articles, including 13,809 patients with a wide spectrum of neurological manifestations temporally associated with COVID-19 vaccination. Most occurred in women (63.89%), with a median age of 50 years. The most frequently reported adverse events were Bell's palsy 4936/13809 (35.7%), headache (4067/13809), cerebrovascular events 2412/13809 (17.47%), Guillain-Barré syndrome 868/13809 (6.28%), central nervous system demyelination 258/13809 (1.86%) and functional neurological disorder 398/13809 (2.88%). Most of the published cases occurred in temporal association with the Pfizer vaccine (BNT162b2), followed by the AstraZeneca vaccine (ChAdOX1 nCoV-19). CONCLUSIONS It is not possible to establish a causal relationship between these adverse events and COVID-19 vaccines with the currently existing data, nor to calculate the frequency of appearance of these disorders. However, it is necessary for health professionals to be familiar with these events, facilitating their early diagnosis and treatment. Large controlled epidemiological studies are necessary to establish a possible causal relationship between vaccination against COVID-19 and neurological adverse events.
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Affiliation(s)
- Rocío Alonso Castillo
- Servicio de Neurología. Hospital Universitario Ramón y Cajal. Universidad de Alcalá, Spain
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Muacevic A, Adler JR. Pineal Gland Tumour With Drop Metastases: A Case Report. Cureus 2022; 14:e29855. [PMID: 36204259 PMCID: PMC9528170 DOI: 10.7759/cureus.29855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Pineal gland tumours are reported rarely in Malayasia and early diagnosis and intervention promise a better prognosis for patients. We report a rare case of pineal gland tumour with drop metastases in the fourth ventricle in a 20-year-old young male with Parinaud syndrome. The patient, who had no underlying medical illnesses, presented with neurological symptoms and limb weakness associated with tremors and blurring of vision which worsened over a span of four months. The patient was having difficulty in ambulating with reduced power over the lower limbs with tremors as well as Parinaud syndrome indicated through the limitation of upward gaze, light-near dissociation of the pupils and convergence nystagmus. An MRI showed the presence of a pineal gland tumour with drop metastases in the fourth ventricle with calcification. The patient underwent an endoscopic third ventriculostomy and tumour biopsy. The biopsy indicated a pineal gland tumour with a germinoma subset and the patient was subjected to radiotherapy. Latency of diagnosis is an important prognostic factor as it reduces the survival rate for these patients hence the following discussion on the pineal gland tumour and its diagnostic dilemma.
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69
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Muacevic A, Adler JR. A Study on the Correlations Between Comorbid Disease Conditions and Central and Peripheral Neurological Manifestations of COVID-19. Cureus 2022; 14:e29838. [PMID: 36337781 PMCID: PMC9625534 DOI: 10.7759/cureus.29838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2022] [Indexed: 11/26/2022] Open
Abstract
Background Medical comorbidities and neurological manifestations are commonly associated with COVID-19, though specific relationships remain unclear. Objective The aim of this study is to investigate the relationship between medical comorbidities and neurological manifestations in patients with COVID-19. Methods We reviewed medical comorbidities and COVID-19-related central nervous system (CNS) and peripheral nervous system (PNS) manifestations in 484 consecutive patients with COVID-19. Results Neurological manifestations were seen in 345 (71%) of 484 COVID-19 patients. CNS manifestations included headaches (22%), altered mental status (19%), dizziness (8%), gait imbalance (5%), strokes (four patients, <1%), and seizures (two patients, <1%). PNS manifestations included myalgia (31%), hypogeusia (8%), hyposmia (6%), critical illness myopathy (nine patients, 2%), visual disturbance (six patients, 1%), rhabdomyolysis (four patients, <1%), and nerve pain (one patient, <1%). There were 153 (32%) patients with CNS manifestations, 98 (20%) patients with PNS manifestations, and 94 (19%) patients with combined CNS and PNS manifestations. Comorbidities such as cardiac disease (22%), dementia (17%), hypertension (16%), and chronic obstructive pulmonary disease (COPD; 13%) were significantly associated with CNS manifestations. No comorbidities were associated with PNS manifestations. Conclusion Neurological manifestations were common in our sample of 484 COVID-19 patients, with headache and altered mental status being the most common CNS manifestations and myalgia being the most common PNS manifestation. Cardiac disease, dementia, hypertension, and COPD were more common in patients with CNS manifestations. Providers should be vigilant about the possible emergence of CNS manifestations in COVID-19 patients with these comorbid conditions.
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Usta NC, Bulut E. Evaluation of Intracranial Vascular and Non-Vascular Pathologies in Patients Hospitalized due to COVID-19 Infection. Acta Neurol Taiwan 2022; 31(3):121-130. [PMID: 35437742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Although Coronavirus disease 2019 (COVID-19) is a respiratory virus different clinical presentations may appear by affecting other organs and systems. Along with vascular diseases in COVID-19 disease, other conditions involving the central nervous system (CNS) such as meningocephalitis, cerebral edema, and lesions on corpus callosum. Neuroimaging has an extremely important place in the diagnosis when central nervus system involvement is clinically suspected in people infected with COVID-19. METHODS The study was monocentric, retrospectively designed between March 2020 and May 2021 in a tertiary healthcare facility. Among the patients who underwent neurological evaluation, patients with anomaly in brain MRI and CT were included in the study. RESULTS Among 5,430 patients who have been admitted due to COVID-19 between the dates mentioned above, 51 patients including 27 (52.9%) females and 24 (47.1%) males presented abnormal findings in cerebral radiological tests. Vascular abnormality was detected in 45 patients whereas 6 patients presented non-vascular abnormality. General demographic data and concomitant diseases of the patients were presented in Table 1and Table 2. CONCLUSION In line with the literature, this study which reviewed abnormalities of CNS involvement reflected on brain MRI and CT among neurological complications due to COVID-19 infection revealed that vascular abnormalities. Presence of concomitant diseases including advanced age and hypertension was detected as risk factors for development of vascular abnormality. It was documented that non-vascular brain anomalies which are less common and treated differently and these are at earlier ages when compared to patients with vascular anomalies with fewer co-morbidities and shorter duration of infection.
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Affiliation(s)
- Nuray Can Usta
- SBU Kanuni Training and Research Hospital, Department of Neurology, Trabzon, Turkey
| | - Eser Bulut
- SBU Kanuni Training and Research Hospital, Department of Radiology, Trabzon, Turkey
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Méndez-García LA, Escobedo G, Minguer-Uribe AG, Viurcos-Sanabria R, Aguayo-Guerrero JA, Carrillo-Ruiz JD, Solleiro-Villavicencio H. Role of the renin-angiotensin system in the development of COVID-19-associated neurological manifestations. Front Cell Neurosci 2022; 16:977039. [PMID: 36187294 PMCID: PMC9523599 DOI: 10.3389/fncel.2022.977039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 08/26/2022] [Indexed: 01/18/2023] Open
Abstract
SARS-CoV-2 causes COVID-19, which has claimed millions of lives. This virus can infect various cells and tissues, including the brain, for which numerous neurological symptoms have been reported, ranging from mild and non-life-threatening (e.g., headaches, anosmia, dysgeusia, and disorientation) to severe and life-threatening symptoms (e.g., meningitis, ischemic stroke, and cerebral thrombosis). The cellular receptor for SARS-CoV-2 is angiotensin-converting enzyme 2 (ACE2), an enzyme that belongs to the renin-angiotensin system (RAS). RAS is an endocrine system that has been classically associated with regulating blood pressure and fluid and electrolyte balance; however, it is also involved in promoting inflammation, proliferation, fibrogenesis, and lipogenesis. Two pathways constitute the RAS with counter-balancing effects, which is the key to its regulation. The first axis (classical) is composed of angiotensin-converting enzyme (ACE), angiotensin (Ang) II, and angiotensin type 1 receptor (AT1R) as the main effector, which -when activated- increases the production of aldosterone and antidiuretic hormone, sympathetic nervous system tone, blood pressure, vasoconstriction, fibrosis, inflammation, and reactive oxygen species (ROS) production. Both systemic and local classical RAS' within the brain are associated with cognitive impairment, cell death, and inflammation. The second axis (non-classical or alternative) includes ACE2, which converts Ang II to Ang-(1-7), a peptide molecule that activates Mas receptor (MasR) in charge of opposing Ang II/AT1R actions. Thus, the alternative RAS axis enhances cognition, synaptic remodeling, cell survival, cell signal transmission, and antioxidant/anti-inflammatory mechanisms in the brain. In a physiological state, both RAS axes remain balanced. However, some factors can dysregulate systemic and local RAS arms. The binding of SARS-CoV-2 to ACE2 causes the internalization and degradation of this enzyme, reducing its activity, and disrupting the balance of systemic and local RAS, which partially explain the appearance of some of the neurological symptoms associated with COVID-19. Therefore, this review aims to analyze the role of RAS in the development of the neurological effects due to SARS-CoV-2 infection. Moreover, we will discuss the RAS-molecular targets that could be used for therapeutic purposes to treat the short and long-term neurological COVID-19-related sequelae.
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Affiliation(s)
- Lucía A. Méndez-García
- Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga,”Mexico City, Mexico
| | - Galileo Escobedo
- Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga,”Mexico City, Mexico
| | - Alan Gerardo Minguer-Uribe
- Laboratory of Molecular Neuropathology, Cellular Physiology Institute, National Autonomous University of Mexico, Mexico City, Mexico
| | - Rebeca Viurcos-Sanabria
- Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga,”Mexico City, Mexico
- PECEM, School of Medicine, National Autonomous University of Mexico, Mexico City, Mexico
| | - José A. Aguayo-Guerrero
- Laboratory of Immunometabolism, Research Division, General Hospital of Mexico “Dr. Eduardo Liceaga,”Mexico City, Mexico
| | - José Damián Carrillo-Ruiz
- Research Directorate, General Hospital of Mexico “Dr. Eduardo Liceaga,”Mexico City, Mexico
- Department of Neurology and Neurosurgery, General Hospital of Mexico “Dr. Eduardo Liceaga,”Mexico City, Mexico
- Facultad de Ciencias de la Salud, Universidad Anáhuac, Huixquilucan, Mexico
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72
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Dias AL, Raghavendra BS, Ahmed S, Arunachalam R. Spectrum of Neurological Manifestations of COVID-19 Data from a Tertiary Care Hospital. Neurol India 2022; 70:1901-1904. [PMID: 36352585 DOI: 10.4103/0028-3886.359223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background Coronavirus is a novel virus which has disrupted life in the past year. While it involves the lungs in the majority and this has been extensively studied, it involves other organ systems. More number of studies need to be focused on the extrapulmonary manifestations of the disease. Objective To delineate the clinical manifestations of coronavirus disease 2019 (COVID-19) virus on the central and peripheral nervous systems and to assess the risk factors and the outcome of COVID-19 patients with neurological manifestations. Materials and Methods All patients who were SARS-CoV-2 RNA polymerase chain reaction (PCR) positive were assessed, and detailed clinical history and laboratory findings were collected. Data was analyzed using percentage, mean, and frequency. Results Out of 864 patients, 17 (N = 17, 1.96%) had neurological manifestations. Twelve out of 17 had comorbid conditions. Patients had diverse presentations ranging from acute cerebrovascular accident to paraplegia and encephalopathy. Ten (58.8%) patients presented with acute cerebrovascular accidents. Of the patients who developed stroke, five (50%) died. Conclusions COVID-19 usually presents as a respiratory disease. The neurological manifestations of COVID-19 are not uncommon. One should be aware of a wide spectrum of neurological signs and symptoms of COVID-19 for early diagnosis and treatment for preventing mortality and morbidity.
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Affiliation(s)
- Akshay Louis Dias
- Department of General Medicine, Fr Muller Medical College, Mangalore, Karnataka, India
| | - B S Raghavendra
- Department of Neurology, Fr Muller Medical College, Mangalore, Karnataka, India
| | - Safwan Ahmed
- Department of Neurology, Fr Muller Medical College, Mangalore, Karnataka, India
| | - R Arunachalam
- Department of General Medicine, Fr Muller Medical College, Mangalore, Karnataka, India
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Muhammad JS, Siddiqui R, Khan NA. COVID-19 and alcohol use disorder: putative differential gene expression patterns that might be associated with neurological complications. Hosp Pract (1995) 2022; 50:189-195. [PMID: 35686663 DOI: 10.1080/21548331.2022.2088183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Several lines of evidence suggest that SARS-CoV-2 invasion of the central nervous system leads to meningitis and encephalopathy syndromes. Additionally, chronic alcoholics were found to be at a higher risk of developing mental health problems and serious neurological manifestations, if exposed to SARS-CoV-2 infection. METHODS Herein, we studied RNA seq data from alcoholics' brain tissue and COVID-19 patient's brain tissue to identify the common differentially expressed genes. RESULTS Overlap analysis depicted the expression of seven genes (GHRL, SLN, VGF, IL1RL1, NPTX2, PDYN, and RPRML) that were significantly upregulated in both groups. Along with these, protein-protein interaction analysis revealed 10 other key molecules with strong interactions with the aforementioned genes. CONCLUSIONS Taken together with the functional effect of these genes, we suggest a strong molecular link between COVID-19-induced severities and neurological impairment in patients suffering from alcohol abuse disorder. These findings emphasize the importance of identifying chronic alcoholism as a risk factor for developing cognitive and memory impairment in COVID-19 patients.
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Affiliation(s)
- Jibran Sualeh Muhammad
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| | - Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, Sharjah, UAE
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
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Ahmed A Ibrahim E, Isam Farah Hassan R, Abbasher Hussien Mohamed Ahmed K, Taha Salah E, Eltahier Abdalla Omer M, S Haroun M. Neurological manifestations of COVID-19: A potential gate to the determinants of a poor prognosis. Brain Behav 2022; 12:e2587. [PMID: 35470588 PMCID: PMC9110897 DOI: 10.1002/brb3.2587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/26/2022] [Accepted: 04/10/2022] [Indexed: 12/14/2022] Open
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.
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Affiliation(s)
- Etedal Ahmed A Ibrahim
- Faculty of Medicine, Al Neelain University, Khartoum, Sudan.,The National Center for Neurological Sciences, Khartoum, Sudan.,Faculty of Medicine, Sudan University of Medical Science, Khartoum, Sudan
| | - Ramah Isam Farah Hassan
- The National Center for Neurological Sciences, Khartoum, Sudan.,Faculty of Medicine, International University of Africa, Khartoum, Sudan
| | | | | | | | - Mazin S Haroun
- Faculty of Medicine, University of Khartoum, Khartoum, Sudan
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Casanova I, Prada A, De Silanes CL, Gonzaga L, Barrio L, Eimil M, Oyanguren B, Alcántara P, Saíz MÁ, Díaz B, González M, González M. Neurological Complications in Systemic Inflammatory Diseases. Curr Rheumatol Rev 2022; 19:42-48. [PMID: 35593339 DOI: 10.2174/1573397118666220518094207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 12/08/2021] [Accepted: 12/23/2021] [Indexed: 02/08/2023]
Abstract
Systemic inflammatory diseases could produce neurologic complications, and they are frequently incorporated in the differential diagnosis of neurological symptoms. There are wellestablished criteria to meet the diagnosis of neurologic manifestations of these systemic diseases. Methods: However, the range of clinical presentations varies in each condition, and the prevalence of these complications differs between studies. Hence, in many cases, an etiological relationship is not clearly defined. Results and Conclusion: For these reasons, it is challenging to make an accurate diagnosis. We analyzed the spectrum of neurological manifestations in a cohort of patients with systemic lupus erythematosus, rheumatoid arthritis, Behçet disease and sarcoidosis in order to improve our current knowledge of these complications.
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Affiliation(s)
- Ignacio Casanova
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Alejandro Prada
- Department of Rheumatology, Hospital Universitario de Torrejón, Madrid, Spain
| | | | - Luis Gonzaga
- Department of Rheumatology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Laura Barrio
- Department of Rheumatology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Miriam Eimil
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Beatriz Oyanguren
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Pilar Alcántara
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Miguel Ángel Saíz
- Department of Neurophysiology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Blanca Díaz
- Department of Neurophysiology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Miriam González
- Department of Neurophysiology, Hospital Universitario de Torrejón, Madrid, Spain
| | - Marta González
- Department of Neurology, Hospital Universitario de Torrejón, Madrid, Spain
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Aamodt WW, Dubroff JG, Cheng G, Taylor B, Wood S, Duda JE, Morley JF. Gait abnormalities and non-motor symptoms predict abnormal dopaminergic imaging in presumed drug-induced Parkinsonism. NPJ Parkinsons Dis 2022; 8:53. [PMID: 35484281 DOI: 10.1038/s41531-022-00309-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 02/01/2022] [Indexed: 12/25/2022] Open
Abstract
Drug-induced parkinsonism (DIP) can be clinically indistinguishable from degenerative parkinsonism, and bedside assessments are needed to differentiate between these conditions. We examined 34 U.S. Veterans with DIP using 123I-FP-CIT (DAT-SPECT) to identify underlying nigrostriatal degeneration. Participants were 94% male with mean age of 64.5 ± 7.1 years. DAT-SPECT was abnormal in 12/34 (35%). Comparing normal and abnormal imaging groups, there were no differences in age, sex, race/ethnicity, psychiatric diagnosis, motor severity, or RBD Screening Questionnaire scores. Those with underlying neurodegeneration reported significantly more non-motor symptoms (NMS), worse olfactory function on the University of Pennsylvania Smell Identification Test, and greater turning duration/steps on the instrumented Timed Up and Go. Area under the curve (AUC) combining poor olfaction and total NMS burden was 0.84 (CI 0.71-0.97), while AUC for turn steps was 0.91 (CI 0.81-1.00). Gait impairment, hyposmia, and NMS may be useful alone and in combination to identify DIP patients with underlying dopaminergic degeneration.
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Mahdizade Ari M, Mohamadi MH, Shadab Mehr N, Abbasimoghaddam S, Shekartabar A, Heidary M, Khoshnood S. Neurological manifestations in patients with COVID-19: A systematic review and meta-analysis. J Clin Lab Anal 2022; 36:e24403. [PMID: 35385200 PMCID: PMC9102520 DOI: 10.1002/jcla.24403] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/19/2022] [Accepted: 03/24/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction The intensification of coronavirus disease 2019 (COVID‐19) complications, severe symptoms, and high mortality rate has led researchers to focus on this significant issue. While respiratory and cardiac complications have been described as high‐risk manifestations in patients with COVID‐19, neurological complications can also enhance mortality. This study aimed to evaluate the prevalence of neurological complications arises from SARS‐CoV‐2 and assess the mortality rate from neurological complications. Material and Methods Literature review was conducted by searching in PubMed/Medline, Web of Sciences, and Embase. After performing search strategies with relevant terms, a number of articles were excluded, including review articles, systematic review or meta‐analysis, duplicate publication of same researchers, congress abstracts, animal studies, case reports, case series, and articles reporting a history of neurological features prior to COVID‐19 infection. After retrieving the data, statistical analysis was performed using the STATA Version 14 software. Results From 4455 retrieved publications, 20 articles were selected for further analysis. Among 18,258 included patients, 2791 showed neurological symptoms, which were classified into different groups. Headache, confusion, and fatigue were reported as the most non‐specific neurological features in confirmed COVID‐19 patients. Psychiatric symptoms, CNS disorders, cerebrovascular disorders, CNS inflammatory disorders, PNS disorders, neuromuscular disorders, etc., were defined as specific neurological manifestations. The pooled prevalence of neurological manifestations and mortality rate of COVID‐19 patients with neurological features were estimated to be 23.0% (95% CI: 17.8–29.2) and 29.1% (95% CI: 20.3–39.8), respectively. Conclusion Neurological manifestations may commonly happen in patients with COVID‐19. This study reported a high prevalence of neurological complications and mortality rates in COVID‐19 patients. Therefore, patients with COVID‐19 who indicated neurological symptoms should be taken seriously and should receive early treatment to prevent undesirable events.
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Affiliation(s)
- Marzie Mahdizade Ari
- Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.,Microbial Biotechnology Research Centre, Iran University of Medical Sciences, Tehran, Iran
| | | | - Negar Shadab Mehr
- Student Research Committee, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | | | - Mohsen Heidary
- Department of Laboratory Sciences, School of Paramedical Sciences, Sabzevar University of Medical Sciences, Sabzevar, Iran.,Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Saeed Khoshnood
- Clinical Microbiology Research Center, Ilam University of Medical Sciences, Ilam, Iran
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Abstract
BACKGROUND The exact incidence of neurological complications from coronavirus disease 2019 (COVID-19) infection remains unknown. Neurological symptoms are more common with severe form of the disease. Through neuro-invasion, the virus can affect both neurons and glial cells and induce wide range of neurological pathologies. OBJECTIVES To systematically assess the neurological manifestations in patients diagnosed with COVID-19. METHODS A systematic literature search of the PubMed, Scopus, and Cochrane databases was performed. Randomized controlled trials, nonrandomized controlled trials, observational studies of neurological manifestations in patients diagnosed with COVID-19. RESULTS All three-database search identified 89 publications. A total of 22 full-text articles assessed for eligibility with 12 articles excluded. Altogether, the included studies reported 290 patients with neurological manifestations. Neurological manifestations were subdivided into central causes (CNS) and peripheral causes (PNS). CNS symptoms is commoner representing 91% of all neurological patients with 9% only with PNS. Headache represented the commonest neurological symptoms in regard to number of patients, meanwhile dizziness has the highest incidence with 11.9%. Neurological manifestations were divided according to COVID-19 severity into: (1) nonsevere and (2) severe; with all CNS manifestations were more in severe patients except headache were more in nonsevere patients. All included studies were on adult patients except one study in pediatric patients with limited number of participants. CONCLUSIONS From the descriptive analyses and available data of relatively small sample-sized studies, it can be concluded that in spite of the aforementioned limitations, that a wide spectrum of neurological manifestations including CNS and PNS can occur in COVID-19 patients.
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Affiliation(s)
- Wael Ibrahim
- Department of Neurology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
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79
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Unnithan AKA. A case of neurenteric cyst of spine mimicking an arachnoid cyst. Spinal Cord Ser Cases 2022; 8:31. [PMID: 35288542 DOI: 10.1038/s41394-022-00500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 02/19/2022] [Accepted: 02/22/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Intradural cysts of the spine are arachnoid cysts, neuroenteric cysts, and ependymal cysts. The usual finding in case of a neurenteric cyst is a ventrally located non-contrast-enhancing lesion that is isointense on T1-weighted sequence and hyperintense on T2-weighted imaging. An arachnoid cyst is hypointense in T1-weighted image and hyperintense in T2-weighted image, mimicking cerebrospinal fluid(CSF), and the location is dorsal to the cord. But a neurenteric cyst can mimic an arachnoid cyst in appearance. CASE A 48-yr old autorikshaw driver presented with weakness of fingers and lower limbs. All sensations were decreased below xiphisternum(T6). The gait was spastic. Magnetic Resonance Imaging(MRI) showed an extramedullary intradural cyst at C7-T1 level. It was hypointense on T1-weighted image and hyperintense on T2-weighted image. There was no enhancement with contrast. C7/T1 Laminectomy was done. On gentle retraction of the cord, a whitish cyst was seen. Some clear fluid was aspirated and cyst was excised en toto. Myelopathy improved over two weeks. Histopathological examination showed a cyst wall composed of fibrocollagenous tissue, and lined by pseudostratified epithelium containing many goblet cells and having focal ciliation. The findings were consistent with neurenteric cyst. Follow-up MRI after five years showed no recurrence. CONCLUSION To our knowledge, the peculiarities of the case are that the radiological features mimicked arachnoid cyst in having the intensity of CSF. But the ventral location was suggestive of a neurenteric cyst. Total excision could be done through the posterior approach after decompressing the cyst by aspiration.
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80
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Saceleanu V, Moreanu MS, Covache-Busuioc RA, Mohan AG, Ciurea AV. SARS-COV-2 - the pandemic of the XXI century, clinical manifestations - neurological implications. J Med Life 2022; 15:319-327. [PMID: 35450003 PMCID: PMC9015186 DOI: 10.25122/jml-2020-0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 03/02/2022] [Indexed: 11/21/2022] Open
Abstract
In December 2019, in Wuhan, China, the first cases of infection with SARS-CoV 2 responsible for COVID-19 disease were identified. SARS-CoV 2 was declared a pandemic on March 11, 2020, and since then has attracted the medical world's attention. The threat to humans' health that this emerging pandemic could leave raises awareness on the importance of understanding the mechanisms that underlie the developing conditions. The epidemiology, clinical picture, and pathogenesis of COVID-19 show that this virus presents new strategies to overcome the past defensive medicine. While all the current data has focused on the pulmonary and cardiovascular manifestations, little has been written about the neurological implications of the disease. This review updates new clinical aspects that SARS-CoV 2 expresses in humans by focusing primarily on neurological manifestations. The damage to the nervous system became more apparent - anosmia, ageusia, polyneuritis, meningitis, meningoencephalitis, stroke, acute necrotizing encephalopathy. Oxygen therapy is vital for those in critical health situations. Finally, prevention is the most important element in breaking the epidemiological chain.
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Affiliation(s)
- Vicentiu Saceleanu
- Department of Neurosurgery, Faculty of Medicine, Lucian Blaga University, Sibiu, Romania
- Department of Neurosurgery, County Emergency Hospital, Sibiu, Romania
| | - Mihai-Stelian Moreanu
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Aurel George Mohan
- Department of Neurosurgery, Faculty of Medicine and Pharmacy, University of Oradea, Oradea, Romania
- Department of Neurosurgery, County Emergency Hospital, Oradea, Romania
| | - Alexandru-Vlad Ciurea
- Department of Neurosurgery, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
- Department of Neurosurgery, Sanador Clinical Hospital, Bucharest, Romania
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81
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Vengalil S, Mahale R, Chakradhar N, Alluri S, Sagar Navanith PR, Ganaraja VH, Haripriya KR, Vikram HV, Asranna A, Mailankody P, Seshagiri DV, Cheerla HM, Maturu VN, Vaddepally CR, Kenchaiah R, Srijithesh PR, Chaudhuri JR, Netravathi M, Alladi S. The Spectrum of Neuro-COVID: A Study of a Comprehensively Investigated Large Cohort from India. Ann Indian Acad Neurol 2022; 25:194-202. [PMID: 35693675 PMCID: PMC9175391 DOI: 10.4103/aian.aian_310_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/05/2021] [Accepted: 08/06/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Though reports of neurological manifestations of COVID-19 have emerged from various parts of the world, the cohorts reported are from the West and mostly derived from electronic databases. Much remains unknown regarding neuro-COVID in developing countries. India is the second-worst affected country, and this study reports the neurological manifestations of COVID-19 in a comprehensively evaluated cohort. Objective: The aim of this study was to describe the range of neurological manifestations of COVID-19 in India with an emphasis on the risk factors, laboratory and imaging findings and short-term outcome. Methods: Retrospective review of hospital records of all confirmed COVID-19 patients with neurological manifestations, receiving inpatient care in two neurology referral hospitals were done. All demographic, clinical details, investigations, and treatment were analysed. Results: A total of 120 confirmed COVID-19 cases presenting with neurological symptoms were included. The mean age of illness and duration of illness was 48.03 ± 17.3 years and 10.9 ± 17.3 days respectively. New onset of neurological symptoms occurred in 100 cases while 20 patients had worsening of pre-existing neurological illness. Stroke was the commonest neurological disorder (43%), followed by encephalopathy (23%) and Guillain-Barre syndrome (10%). Other unusual neurological manifestations included new-onset headache (7%), seizures including denovo status epilepticus (5%) and meningo-encephalitis (5%). Nearly half of the patients had preceding COVID-19 symptoms. Poor outcome at discharge was seen in 40% and mortality occurred in 15%. Conclusion: Stroke and encephalopathy constitute the most common neurological manifestations. The absence of preceding COVID-19 symptoms in nearly half the cases is striking. Poor outcome was seen in nearly 50% despite early recognition and management.
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Affiliation(s)
- Seena Vengalil
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Rohan Mahale
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - N Chakradhar
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - Swathi Alluri
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - P R Sagar Navanith
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - V H Ganaraja
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - K R Haripriya
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Holla Venkappayya Vikram
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Ajay Asranna
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Pooja Mailankody
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Doniparthi V Seshagiri
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - H Manoj Cheerla
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - V N Maturu
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - C R Vaddepally
- Department of Pulmonary Medicine, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - Raghavendra Kenchaiah
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - P R Srijithesh
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Jaydip Ray Chaudhuri
- Department of Neurology, Yashoda Super Speciality Hospitals, Somajiguda, Hyderabad, Telangana, India
| | - M Netravathi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Verma V, Ifthekar S, Goyal N, Regmi A, Kandwal P, Azam Q, Sarkar B. Neglected floating cervical spine fracture with myelopathy and Anderson lesion of D2 D3: report of an unusual case. Spinal Cord Ser Cases 2022; 8:21. [PMID: 35145064 DOI: 10.1038/s41394-022-00487-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The cervical spine is the most commonly affected region in traumatic spine injuries of patients with Ankylosing Spondylitis (AS), accounting for 75% of cases, followed by the thoracic and lumbar spine. The fracture may not be detectable in plain radiographs alone due to pre-existing kyphotic deformity with distorted anatomy and high-riding shoulders. CASE PRESENTATION We present a case with a floating cervical spine following a trivial trauma injury and with cervical myelopathy symptoms. After posterior fixation of the cervico-thoracic spine, the patient improved with Nurick score and mJOA score improvement. After 6 months follow up the patient was walking without support, and myelopathy symptoms were negligible. DISCUSSION In this patient, a posterior approach was performed. We obtained a rigid construct so that we were able to mobilize a patient on the very next day and his myelopathy symptoms improved with minimal postoperative complications.
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83
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Liu EA, Salazar T, Chiu E, Fleming TK, Bagay L, Brown DP, Cuccurullo SJ. Focal Peripheral Neuropathies Observed in Patients Diagnosed With COVID-19: A Case Series. Am J Phys Med Rehabil 2022; 101:164-169. [PMID: 35026778 PMCID: PMC8745887 DOI: 10.1097/phm.0000000000001924] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A growing number of studies have documented a wide variety of neurological manifestations associated with the novel SARS-CoV-2 (COVID-19). Of the available literature, cranial neuropathies and central nervous system disorders, such as encephalopathy and ischemic strokes, remain the predominant discussion. Limited investigations exist examining peripheral neuropathies of those with COVID-19. This case series discusses eight patients who tested positive for COVID-19 and presented with localized weakness after a prolonged course of mechanical ventilation (>21 days). We retrospectively reviewed all patients' charts who received electrodiagnostic evaluation between March and November 2020 in the outpatient clinic or in the acute care hospital at the JFK Medical Center/JFK Johnson Rehabilitation Institute and Saint Peter's University Hospital of New Jersey. A total of eight COVID-19-positive patients were identified to have a clinical presentation of localized weakness after a prolonged course of mechanical ventilation. All patients were subsequently found to have a focal peripheral neuropathy of varying severity that was confirmed by electrodiagnostic testing. Patient demographics, clinical, and electrodiagnostic findings were documented. The findings of local weakness and focal peripheral neuropathies after diagnosis of COVID-19 raise significant questions regarding underlying pathophysiology and overall prognosis associated with COVID-19.
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84
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Usta NC, Kartal S, Gunay BO, Boz C. Neurological manifestations and etiological risk factors in patients hospitalized with COVID-19 in Turkey. ASIAN BIOMED 2022; 16:23-30. [PMID: 37551396 PMCID: PMC10321161 DOI: 10.2478/abm-2022-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) can affect the neurological as well as the respiratory system. Neurological manifestations may involve the central or peripheral nervous systems, or musculoskeletal system. Findings can range from mild presentations, such as headache and anosmia, to severe complications, such as stroke and seizure. Objectives To evaluate the neurological findings and to determine etiological risk factors for mortality in patients hospitalized for COVID-19. Methods Medical records of patients with COVID-19 who were hospitalized and sought neurological consultation between March 2020 and March 2021 at a reference pandemic hospital in Turkey were reviewed retrospectively in a cross-sectional study design. Result We included data from 150 (94 male) patients. Their mean age ± standard deviation was 68.56 ± 16.02 (range 21-97) years. The patients were categorized into 2 groups according to any acute neurological event or progression of neurological disease. Ischemic cerebrovascular events, seizures, and encephalopathy were the most common acute neurological events, while deterioration in consciousness, epileptic seizures, and Parkinson disease were observed in those with progression of neurological disease. Abnormal neurological findings were found at a mean of 7.8 ± 9.7 days following COVID-19 diagnosis and 50 (a third of) patients died. A logistic regression model found that advanced age, increased Modified Charlson Comorbidity Index (MCCI) score, and prolonged duration of hospitalization were factors significantly associated with increased mortality; however, sex and day of abnormal neurological findings after COVID-19 diagnosis were not. Common conditions accompanying neurological events were hypertension, coronary artery disease-heart failure, and diabetes mellitus. Conclusion COVID-19 may present with neurological symptoms in our Turkish patients and comorbidities are often present.
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Affiliation(s)
- Nuray Can Usta
- Department of Neurology, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon61250, Turkey
| | - Seyfi Kartal
- Department of Anaesthesiology and Reanimation, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon61250, Turkey
| | - Betul Onal Gunay
- Department of Ophthalmology, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon61250, Turkey
| | - Cavit Boz
- Department of Neurology, Karadeniz Technical University, School of Medicine, Trabzon, Turkey
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85
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George G, Murphy DC, Hogg HDJ, Boniface JB, Urasa S, Rwiza J, Uwemeye L, Bristow C, Hillsmith G, Rainey E, Walker R, Gray WK, Maria-Paddick S. Evaluation of a low-resource screening strategy for ophthalmic pathologies and associated neurological morbidity in an older Tanzanian HIV-positive population. Sci Rep 2022; 12:1434. [PMID: 35082308 PMCID: PMC8791939 DOI: 10.1038/s41598-022-04989-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 08/06/2021] [Indexed: 12/20/2022] Open
Abstract
Globally, 43 million people are living with HIV, 90% in developing countries. Increasing life expectancy with combination antiretroviral therapy (cART) results in chronic complications, including HIV-associated neurocognitive disorders (HAND) and eye diseases. HAND screening is currently challenging. Our aim was to evaluate clinical utility of retinopathy as a screening measure of HAND in older cART-treated individuals in Tanzania and feasibility of smartphone-based retinal screening in this low-resource setting. A cross-sectional systematic sample aged ≥ 50-years attending routine HIV follow-up in Tanzania were comprehensively assessed for HAND by American Academy of Neurology criteria and received ophthalmic assessment including smartphone-based retinal imaging. HAND and ophthalmic assessments were independent and blinded. Diagnostic accuracy was evaluated by AUROC curves. Of 129 individuals assessed, 69.8% were visually impaired. Thirteen had retinopathy. HAND prevalence was 66.7%. Retinopathy was significantly associated with HAND but HIV-disease factors (CD4, viral load) were not. Diagnostic accuracy of retinopathy for HAND was poor (AUROC 0.545-0.617) but specificity and positive predictive value were high. We conclude that ocular pathology and HAND appear highly prevalent in this low-resource setting. Although retinal screening cannot be used alone identify HAND, prioritization of individuals with abnormal retinal screening is a potential strategy in low-resource settings.
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Affiliation(s)
- Grace George
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Declan C Murphy
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - H D Jeffry Hogg
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Sarah Urasa
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Justus Rwiza
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Livin Uwemeye
- Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Clare Bristow
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Grace Hillsmith
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Emma Rainey
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Richard Walker
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - William K Gray
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, Tyne and Wear, UK
| | - Stella Maria-Paddick
- Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK.
- Department of Old Age Psychiatry, Gateshead Health NHS Foundation Trust, Bensham Hospital, Fontwell Drive, Gateshead, Tyne and Wear, UK.
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86
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Stefanou MI, Palaiodimou L, Bakola E, Smyrnis N, Papadopoulou M, Paraskevas GP, Rizos E, Boutati E, Grigoriadis N, Krogias C, Giannopoulos S, Tsiodras S, Gaga M, Tsivgoulis G. Neurological manifestations of long-COVID syndrome: a narrative review. Ther Adv Chronic Dis 2022; 13:20406223221076890. [PMID: 35198136 PMCID: PMC8859684 DOI: 10.1177/20406223221076890] [Citation(s) in RCA: 90] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/12/2022] [Indexed: 02/05/2023] Open
Abstract
Accumulating evidence points toward a very high prevalence of prolonged neurological symptoms among coronavirus disease 2019 (COVID-19) survivors. To date, there are no solidified criteria for 'long-COVID' diagnosis. Nevertheless, 'long-COVID' is conceptualized as a multi-organ disorder with a wide spectrum of clinical manifestations that may be indicative of underlying pulmonary, cardiovascular, endocrine, hematologic, renal, gastrointestinal, dermatologic, immunological, psychiatric, or neurological disease. Involvement of the central or peripheral nervous system is noted in more than one-third of patients with antecedent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, while an approximately threefold higher incidence of neurological symptoms is recorded in observational studies including patient-reported data. The most frequent neurological manifestations of 'long-COVID' encompass fatigue; 'brain fog'; headache; cognitive impairment; sleep, mood, smell, or taste disorders; myalgias; sensorimotor deficits; and dysautonomia. Although very limited evidence exists to date on the pathophysiological mechanisms implicated in the manifestation of 'long-COVID', neuroinflammatory and oxidative stress processes are thought to prevail in propagating neurological 'long-COVID' sequelae. In this narrative review, we sought to present a comprehensive overview of our current understanding of clinical features, risk factors, and pathophysiological processes of neurological 'long-COVID' sequelae. Moreover, we propose diagnostic and therapeutic algorithms that may aid in the prompt recognition and management of underlying causes of neurological symptoms that persist beyond the resolution of acute COVID-19. Furthermore, as causal treatments for 'long-COVID' are currently unavailable, we propose therapeutic approaches for symptom-oriented management of neurological 'long-COVID' symptoms. In addition, we emphasize that collaborative research initiatives are urgently needed to expedite the development of preventive and therapeutic strategies for neurological 'long-COVID' sequelae.
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Affiliation(s)
- Maria-Ioanna Stefanou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lina Palaiodimou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Bakola
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Smyrnis
- Second Department of Psychiatry, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marianna Papadopoulou
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece; Department of Physiotherapy, University of West Attica, Athens, Greece
| | - George P. Paraskevas
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Emmanouil Rizos
- Second Department of Psychiatry, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Eleni Boutati
- Second Propaedeutic Department of Internal Medicine and Research Institute, University General Hospital Attikon, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Grigoriadis
- Second Department of Neurology, ‘AHEPA’ University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sotirios Giannopoulos
- Second Department of Neurology, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Sotirios Tsiodras
- 4th Department of Internal Medicine, School of Medicine, ‘Attikon’ University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Mina Gaga
- 7th Respiratory Medicine Department and Asthma Center, Athens Chest Hospital ‘Sotiria’, Athens, Greece
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Wang H, Zhang Z, Zhou J, Han S, Kang Z, Chuang H, Fan H, Zhao H, Wang L, Ning Y, Sarapultsev A, Li WX, Li J, Lin Z, Luo S, Xiong N, Hu D. Next-Generation Sequencing and Proteomics of Cerebrospinal Fluid From COVID-19 Patients With Neurological Manifestations. Front Immunol 2021; 12:782731. [PMID: 34956212 PMCID: PMC8695435 DOI: 10.3389/fimmu.2021.782731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/23/2021] [Indexed: 01/03/2023] Open
Abstract
The SARS-CoV-2 and its variants are still hitting the world. Ever since the outbreak, neurological involvements as headache, ageusia, and anosmia in COVID-19 patients have been emphasized and reported. But the pathogenesis of these new-onset neurological manifestations in COVID-19 patients is still obscure and controversial. As difficulty always lay in the diagnosis of neurological infection, current reports to validate the presence of SARS-CoV-2 in cerebrospinal fluid (CSF) almost relied on the basic methods and warranted improvement. Here we reported a case series of 8 patients with prominent new-onset neurological manifestations, who were screened out from a patch of 304 COVID-19 confirmed patients. Next-generation sequencing (NGS) and proteomics were conducted in the simultaneously obtained CSF and serum samples of the selected patients, with three non-COVID-19 patients with matched demographic features used as the controls for proteomic analysis. SARS-CoV-2 RNA was detected in the CSF of four COVID-19 patients and was suspicious in the rest four remaining patients by NGS, but was negative in all serum samples. Proteomic analysis revealed that 185 and 59 proteins were differentially expressed in CSF and serum samples, respectively, and that only 20 proteins were shared, indicating that the proteomic changes in CSF were highly specific. Further proteomic annotation highlighted the involvement of complement system, PI3K-Akt signaling pathway, enhanced cellular interaction, and macrophages in the CSF proteomic alterations. This study, equipped with NGS and proteomics, reported a high detection rate of SARS-CoV-2 in the CSF of COVID-19 patients and the proteomic alteration of CSF, which would provide insights into understanding the pathological mechanism of SARS-CoV-2 CNS infection.
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Affiliation(s)
- Haijun Wang
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zili Zhang
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Junfen Zhou
- Department of Nuclear Medicine, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shuqing Han
- Department of Neurosurgery, Wuhan Red Cross Hospital, Wuhan, China
| | - Zhenyu Kang
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haoyu Chuang
- Department of Neurosurgery, Tainan Municipal An-Nan Hospital, Tainan, Taiwan
| | - Heng Fan
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongyang Zhao
- Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lin Wang
- Department of Clinical Laboratory, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yunjia Ning
- Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan, China
| | - Alexey Sarapultsev
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Science, Ekaterinburg, Russia
| | - Willis X Li
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Jinghong Li
- Department of Medicine, University of California San Diego, La Jolla, CA, United States
| | - Zhicheng Lin
- Laboratory of Psychiatric Neurogenomics, McLean Hospital, Harvard Medical School, Belmont, MA, United States
| | - Shanshan Luo
- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nian Xiong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.,Department of Neurology, Wuhan Red Cross Hospital, Wuhan, China
| | - Desheng Hu
- Department of Integrated Traditional Chinese and Western Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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88
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Diez-Cirarda M, Gabilondo I, Ibarretxe-Bilbao N, Gómez-Esteban JC, Kim J, Lucas-Jiménez O, Del Pino R, Peña J, Ojeda N, Mihaescu A, Valli M, Acera MA, Cabrera-Zubizarreta A, Gómez-Beldarrain MA, Strafella AP. Contributions of sex, depression, and cognition on brain connectivity dynamics in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:117. [PMID: 34916518 PMCID: PMC8677758 DOI: 10.1038/s41531-021-00257-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 11/19/2021] [Indexed: 01/09/2023] Open
Abstract
Alterations in time-varying functional connectivity (FC) have been found in Parkinson's disease (PD) patients. To date, very little is known about the influence of sex on brain FC in PD patients and how this could be related to disease severity. The first objective was to evaluate the influence of sex on dynamic FC characteristics in PD patients and healthy controls (HC), while the second aim was to investigate the temporal patterns of dynamic connectivity related to PD motor and non-motor symptoms. Ninety-nine PD patients and sixty-two HC underwent a neuropsychological and clinical assessment. Rs-fMRI and T1-weighted MRI were also acquired. Dynamic FC analyses were performed in the GIFT toolbox. Dynamic FC analyses identified two States: State I, characterized by within-network positive coupling; and State II that showed between-network connectivity, mostly involving somatomotor and visual networks. Sex differences were found in dynamic indexes in HC but these differences were not observed in PD. Hierarchical clustering analysis identified three phenotypically distinct PD subgroups: (1) Subgroup A was characterized by mild motor symptoms; (2) Subgroup B was characterized by depressive and motor symptoms; (3) Subgroup C was characterized by cognitive and motor symptoms. Results revealed that changes in the temporal properties of connectivity were related to the motor/non-motor outcomes of PD severity. Findings suggest that while in HC sex differences may play a certain role in dynamic connectivity patterns, in PD patients, these effects may be overcome by the neurodegenerative process. Changes in the temporal properties of connectivity in PD were mainly related to the clinical markers of PD severity.
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Affiliation(s)
- Maria Diez-Cirarda
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
- E.J. Safra Parkinson Disease Program & Movement Disorder Unit, Neurology Division; Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain.
| | - Iñigo Gabilondo
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- IKERBASQUE, The Basque Foundation for Science, Bilbao, Spain
| | - Naroa Ibarretxe-Bilbao
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Juan Carlos Gómez-Esteban
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
- Neurology Department, Cruces University Hospital, Barakaldo, Spain
| | - Jinhee Kim
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- E.J. Safra Parkinson Disease Program & Movement Disorder Unit, Neurology Division; Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Olaia Lucas-Jiménez
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Rocio Del Pino
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Javier Peña
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Natalia Ojeda
- Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Alexander Mihaescu
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- E.J. Safra Parkinson Disease Program & Movement Disorder Unit, Neurology Division; Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Mikaeel Valli
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada
- E.J. Safra Parkinson Disease Program & Movement Disorder Unit, Neurology Division; Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Maria Angeles Acera
- Neurodegenerative Diseases Group, Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | | | | | - Antonio P Strafella
- Brain Health Imaging Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, University of Toronto, Toronto, ON, Canada.
- E.J. Safra Parkinson Disease Program & Movement Disorder Unit, Neurology Division; Krembil Brain Institute, University Health Network, University of Toronto, Toronto, ON, Canada.
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Bagnato S, Ferraro M, Boccagni C, Battaglia G, D’Agostino T, Prestandrea C, Bellavia MA, Rubino F. COVID-19 Neuromuscular Involvement in Post-Acute Rehabilitation. Brain Sci 2021; 11:brainsci11121611. [PMID: 34942912 PMCID: PMC8699176 DOI: 10.3390/brainsci11121611] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with muscle and nerve injuries as a consequence of prolonged critical illness or the infection itself. In this study, we evaluated neuromuscular involvement in patients who underwent post-acute intensive rehabilitation after COVID-19. Methods: Clinical and neurophysiological evaluations, including nerve conduction studies and electromyography, were performed on 21 consecutive patients admitted for rehabilitation after COVID-19. Results: Clinical signs suggesting muscle or nerve involvement (weakness, reduced deep tendon reflexes, impaired sensitivity, abnormal gait) were found in 19 patients. Neurophysiological examinations confirmed neuromuscular involvement in 17 patients: a likely association of critical illness myopathy (CIM) and critical illness polyneuropathy (CIP) was found in 5 patients; CIM alone was found in 4 patients; axonal sensory-motor polyneuropathy was found in 4 patients (CIP in 2 patients, metabolic polyneuropathy in 2 patients); Guillain-Barré syndrome was found in 2 patients (classical demyelinating sensory-motor polyneuropathy and acute motor axonal neuropathy, respectively); peroneal nerve injury was found in 1 patient; and pre-existing L4 radiculopathy was found in 1 patient. Conclusions: Neuromuscular involvement is a very common finding among patients admitted for rehabilitation after COVID-19, and proper investigation should be conducted when muscle or nerve injury is suspected for adequate rehabilitative strategy planning.
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Affiliation(s)
- Sergio Bagnato
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
- Correspondence:
| | - Manfredi Ferraro
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Cristina Boccagni
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Gianluca Battaglia
- Unit of Cardiac and Pulmonary Rehabilitation, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy;
| | - Tiziana D’Agostino
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Caterina Prestandrea
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Marina Angela Bellavia
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
| | - Francesca Rubino
- Unit of Neurophysiology, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy; (M.F.); (C.B.); (T.D.); (C.P.); (M.A.B.); (F.R.)
- Unit of Cardiac and Pulmonary Rehabilitation, Rehabilitation Department, Giuseppe Giglio Foundation, 90015 Cefalù, Italy;
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Lhomme S, Abravanel F, Cintas P, Izopet J. Hepatitis E Virus Infection: Neurological Manifestations and Pathophysiology. Pathogens 2021; 10:pathogens10121582. [PMID: 34959537 PMCID: PMC8705630 DOI: 10.3390/pathogens10121582] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/30/2021] [Accepted: 12/01/2021] [Indexed: 02/06/2023] Open
Abstract
Hepatitis E virus (HEV) is the first cause of viral hepatitis in the world. While the water-borne HEV genotypes 1 and 2 are found in developing countries, HEV genotypes 3 and 4 are endemic in developed countries due to the existence of animal reservoirs, especially swine. An HEV infection produces many extra-hepatic manifestations in addition to liver symptoms, especially neurological disorders. The most common are neuralgic amyotrophy or Parsonage–Turner syndrome, Guillain–Barré syndrome, myelitis, and encephalitis. The pathophysiology of the neurological injuries due to HEV remains uncertain. The immune response to the virus probably plays a role, but direct virus neurotropism could also contribute to the pathophysiology. This review describes the main neurological manifestations and their possible pathogenic mechanisms.
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Affiliation(s)
- Sébastien Lhomme
- Infinity, Université Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France; (F.A.); (J.I.)
- Laboratoire de Virologie, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France
- Correspondence: ; Tel.: +33-(0)-5-67-69-04-24
| | - Florence Abravanel
- Infinity, Université Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France; (F.A.); (J.I.)
- Laboratoire de Virologie, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France
| | - Pascal Cintas
- Service de Neurologie, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France;
| | - Jacques Izopet
- Infinity, Université Toulouse, CNRS, INSERM, UPS, 31300 Toulouse, France; (F.A.); (J.I.)
- Laboratoire de Virologie, Hôpital Purpan, CHU Toulouse, 31300 Toulouse, France
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91
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Adams JL, Dinesh K, Snyder CW, Xiong M, Tarolli CG, Sharma S, Dorsey ER, Sharma G. A real-world study of wearable sensors in Parkinson's disease. NPJ Parkinsons Dis 2021; 7:106. [PMID: 34845224 PMCID: PMC8629990 DOI: 10.1038/s41531-021-00248-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 10/27/2021] [Indexed: 12/17/2022] Open
Abstract
Most wearable sensor studies in Parkinson's disease have been conducted in the clinic and thus may not be a true representation of everyday symptoms and symptom variation. Our goal was to measure activity, gait, and tremor using wearable sensors inside and outside the clinic. In this observational study, we assessed motor features using wearable sensors developed by MC10, Inc. Participants wore five sensors, one on each limb and on the trunk, during an in-person clinic visit and for two days thereafter. Using the accelerometer data from the sensors, activity states (lying, sitting, standing, walking) were determined and steps per day were also computed by aggregating over 2 s walking intervals. For non-walking periods, tremor durations were identified that had a characteristic frequency between 3 and 10 Hz. We analyzed data from 17 individuals with Parkinson's disease and 17 age-matched controls over an average 45.4 h of sensor wear. Individuals with Parkinson's walked significantly less (median [inter-quartile range]: 4980 [2835-7163] steps/day) than controls (7367 [5106-8928] steps/day; P = 0.04). Tremor was present for 1.6 [0.4-5.9] hours (median [range]) per day in most-affected hands (MDS-UPDRS 3.17a or 3.17b = 1-4) of individuals with Parkinson's, which was significantly higher than the 0.5 [0.3-2.3] hours per day in less-affected hands (MDS-UPDRS 3.17a or 3.17b = 0). These results, which require replication in larger cohorts, advance our understanding of the manifestations of Parkinson's in real-world settings.
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Affiliation(s)
- Jamie L Adams
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA.
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA.
| | - Karthik Dinesh
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | | | - Mulin Xiong
- Michigan State University College of Human Medicine, East Lansing, MI, USA
| | - Christopher G Tarolli
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Saloni Sharma
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - E Ray Dorsey
- Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA
- Center for Health + Technology, University of Rochester Medical Center, Rochester, NY, USA
| | - Gaurav Sharma
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
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92
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Kulkarni SS, Tayade DN, Parchandekar MK, Nayak PP, Kelkar VP, Pachore PJ. Major neurological complications following central neuraxial blockade - A multicentre pilot study in Aurangabad city (MGMA CNB Study). Indian J Anaesth 2021; 65:684-694. [PMID: 34764504 PMCID: PMC8577715 DOI: 10.4103/ija.ija_639_21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/21/2023] Open
Abstract
Background and Aims Incidence of major neurological complications following central neuraxial blockade (CNB) in India is not known. This information is essential for explaining risk preoperatively to patients and for medico-legal purposes. This study was undertaken to assess feasibility (recruitment process, protocol adherence, resources mobilisation, data management and evaluation of scientific outcome) for planning multicentric studies on major neurological complications following CNB at state/national level. Methods This was a hospital-based, multicentre pilot study, with cross-sectional and follow-up components. Patients receiving CNB either perioperatively or during acute/chronic pain management were included in the study. Thirty-six randomly selected tertiary and nontertiary care institutes were included. Details of demographic information, CNB procedure and major neurological complications were collected anonymously via online tools. Feedback about study feasibility was collected from participating anaesthesiologists and study team. Results Selected institutes continued participation throughout study period. About 99.98% of eligible patients were enroled. Complete data collection of 8053 patients and analysis was possible. Regular reminders from study coordinators helped to optimise data collection. Tertiary care institutes contributed to 74.50% of data. About 64.96% patients were females. Spinal anaesthesia was the most frequently used neuraxial block (93.41%). Bupivacaine and adjuvant were used in 95.53% and 16.5% patients, respectively. Two patients developed cardiac arrest and cause-effect relationship with CNB was established. Participants' recruitment, protocol adherence, resources mobilisation, data management and evaluation of scientific outcomes were feasible. Conclusion A multicentre state/nationwide study can be conducted based on this first-of-its-kind pilot study in India.
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Affiliation(s)
- Sadhana Sudhir Kulkarni
- Department of Emergency Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India
| | - Deepak Narayan Tayade
- Department of Community Medicine, MGM Medical College and Hospital, Aurangabad, Maharashtra, India
| | | | - Prabha Pandurang Nayak
- Department of Anaesthesiology, MGM Medical College and Hospital, Aurangabad, Maharashtra, India
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93
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Gürkaş E, Dünya B, Köken ÖY, Demirdağ TB, Yilmaz D, Özyürek H, Kurt ANÇ. Neurologic Manifestations of COVID 19 in Children: Prospective Study in a Single Center. Ann Indian Acad Neurol 2021; 24:891-895. [PMID: 35359557 PMCID: PMC8965935 DOI: 10.4103/aian.aian_225_21] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 03/31/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022] Open
Abstract
Background: The data related to the neurologic manifestations of coronavirus disease 2019 (COVID-19) in children are limited. The frequency of the neurologic manifestations and the risk factors in the development of these symptoms are not clear. Objectives: We aimed to determine the exact frequency of the neurological symptoms in pediatric patients with confirmed COVID-19 and to identify the risk factors for the development of neurological manifestations. Materials and Methods: We included pediatric Covid-19 patients admitted to the Children's Hospital of Ankara City Hospital between March 22 and June 1, 2020. Neurological findings were questioned by interviewing the patients and their families and detailed neurologic examinations were performed within protection measures. Results: A total of 312 pediatric patients with the diagnosis of COVID-19 were enrolled in the study. Sixty-six participants (21.15%) showed neurologic symptoms during COVID-19. Headache was the most common neurologic symptom and present in 14% (n: 44) of the cases. The other neurologic symptoms were myalgia (n: 30, 9.6%), anosmia/hyposmia (n: 6, 1.9%), ageusia (n: 2, 0.6%), and vertigo (n: 1, 0.3%). Neutrophil-to-lymphocyte ratio (NLR) (P = 0.002) and platelet-to-lymphocyte ratio (PLR) (P = 0.001) were significantly elevated in patients with neurological symptoms when compared to the patients without the symptoms. Conclusions: Physicians should be alert to the neurologic involvement of COVID-19 disease in children. NLR and PLR ratios could have a predictive value for the development of neurological manifestations.
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Affiliation(s)
- Esra Gürkaş
- Department of Pediatric Neurology, Ankara City Hospital, Children's' Hospital, Ankara, Turkey
| | - Betül Dünya
- Department of Pediatric Neurology, Ankara City Hospital, Children's' Hospital, Ankara, Turkey
| | - Özlem Y Köken
- Department of Pediatric Neurology, Ankara City Hospital, Children's' Hospital, Ankara, Turkey
| | - Tuğba B Demirdağ
- Department of Pediatric Infectious Disease, Gazi University, Ankara, Turkey
| | - Deniz Yilmaz
- Department of Pediatric Neurology, Ankara City Hospital, Children's' Hospital, Ankara, Turkey
| | - Hamit Özyürek
- Department of Pediatric Neurology, Ankara City Hospital, Children's' Hospital, Ankara, Turkey
| | - Ayşegül N Ç Kurt
- Department of Pediatric Neurology, Ankara City Hospital, Children's' Hospital, Ankara, Turkey
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94
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Mahapure KS, Prabhune AS, Chouvhan AV. COVID-19-Associated Acute Disseminated Encephalomyelitis: A Systematic Review. Asian J Neurosurg 2021; 16:457-469. [PMID: 34660355 PMCID: PMC8477843 DOI: 10.4103/ajns.ajns_406_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 01/29/2021] [Accepted: 05/19/2021] [Indexed: 11/06/2022] Open
Abstract
Objective: The objective of this study was to provide an overview of acute disseminating encephalomyelitis, a potential and serious complication of COVID-19. Methods: Three primary databases were used, PubMed, LitCovid, and WHO. The final review articles reported acute disseminated encephalomyelitis (ADEM) in COVID-19-positive patients and were full-text, peer-reviewed articles. Articles which did not have patient data such as in vitro studies and articles with unclear inference were excluded. Results: Out of 21 cases of ADEM, the diagnosis of severe acute respiratory syndrome-coronavirus 2 was confirmed in 18 and suspected in 3. Among the neurological symptoms, altered consciousness was most common (7/21), followed by anosmia (3), paraplegia (3/21), brain stem involvement (3/21), sphincter involvement (2/21), and quadriplegia (1/21). Raised inflammatory markers were most commonly seen in 9/17. Central nervous system imaging was abnormal in 19 cases and unavailable in 2 cases. Fifteen patients were treated with corticosteroids, 11 patients received intravenous immunoglobulin, while 3 patients received convalescent plasma. Two patients needed surgical intervention. Complications included seizures (1), acute kidney injury and septicemic shock (1), raised intracranial pressure (1), and supraventricular tachycardia secondary to hydroxychloroquine (1). One patient recovered completely and one had good recovery with mild deficits. Thirteen patients had incomplete recovery with residual neurological deficit while three patients died as the consequence of the disease. Conclusion: The physicians and neurosurgeons should be diligent while treating the COVID-19 patients with neurological manifestations and include ADEM as a differential diagnosis and stress on early diagnosis and treatment to reduce mortality and achieve satisfactory clinical outcome.
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Affiliation(s)
- Kiran Sunil Mahapure
- Department of Plastic Surgery, KAHER J N Medical College, Belgaum, Karnataka, India
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95
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Ziemele D, Ķauķe G, Skrējāne K, Jaunozoliņa L, Karelis G. A fatal case of COVID-19-associated acute necrotizing encephalopathy. Eur J Neurol 2021; 28:3870-3872. [PMID: 34655265 PMCID: PMC8653160 DOI: 10.1111/ene.14966] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/11/2021] [Accepted: 06/11/2021] [Indexed: 12/01/2022]
Abstract
Introduction An increasing number of published reports on SARS‐CoV‐2 neurological manifestations have revealed a wide spectrum of symptoms, diagnostic features, and outcomes. We report a fatal case of a COVID‐19‐associated acute necrotizing encephalopathy (ANE). Case report We report a 70‐year‐old man brought to the hospital after a generalized tonic‐clonic seizure. He was confused and disoriented. Nasopharyngeal swab testing for SARS‐CoV‐2 was positive. A head computed tomography (CT) scan and cerebrospinal fluid (CSF) analysis showed no signs of acute pathology. After recurrent seizures, he was sedated and intubated. Throughout the days that followed he remained in a therapeutic coma. After discontinuation of sedatives, he remained unconscious. A repeated head CT scan showed signs of pontine edema, and brain magnetic resonance imaging (MRI) revealed inhomogeneous hyperintensities with microhemorrhages and small autonecrotic cavities in both thalami, brain stem, and cerebellar peduncles. With a high suspicion of a COVID‐19‐associated ANE, the patient was started on high‐dose glucocorticoids; however, he died the next day. The CSF tested negative for SARS‐CoV‐2. Discussion A variety of COVID‐19 neurological manifestations have been reported to date, including various forms of encephalitis and encephalopathy. In our patient, encephalopathy with seizures was the presenting symptom of SARS‐CoV‐2 infection. The radiological findings on days 8 and 9 were consistent with an ANE. The precise pathogenesis of ANE remains unclear; however, an immune‐mediated mechanism is suspected. Early diagnostics with prompt administration of immunomodulators may be lifesaving. Suspicion of a COVID‐19‐related encephalopathy/encephalitis should be raised in all patients with altered mental status, seizures, and/or coma.
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Affiliation(s)
- Dace Ziemele
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia.,Rīga Stradiņš University, Riga, Latvia
| | - Gundega Ķauķe
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia.,Rīga Stradiņš University, Riga, Latvia
| | | | - Līga Jaunozoliņa
- Rīga Stradiņš University, Riga, Latvia.,Department of Radiology, Riga East University Hospital, Riga, Latvia
| | - Guntis Karelis
- Department of Neurology and Neurosurgery, Riga East University Hospital, Riga, Latvia.,Rīga Stradiņš University, Riga, Latvia
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96
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Müller J, Weiler M, Schneeweiss A, Haag GM, Steindorf K, Wick W, Wiskemann J. Preventive effect of sensorimotor exercise and resistance training on chemotherapy-induced peripheral neuropathy: a randomised-controlled trial. Br J Cancer 2021; 125:955-965. [PMID: 34226683 PMCID: PMC8476560 DOI: 10.1038/s41416-021-01471-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common, unpleasant and usually long-lasting side effect of neurotoxic chemotherapeutic agents. This study aimed to investigate the preventive potential of sensorimotor- (SMT) and resistance training (RT) on CIPN. METHODS Patients (N = 170) were randomised to SMT, RT or usual care (UC). Both exercise groups trained 3×/week for a total of 105 min/week during neurotoxic chemotherapy (mean length: 20 weeks). Before and 3 weeks after neurotoxic chemotherapy, CIPN signs/symptoms were assessed via Total Neuropathy Score (TNSr; primary endpoint) and EORTC QLQ-CIPN15 questionnaire. In addition, balance (centre of pressure), muscle strength (isokinetic), quality of life (QoL, EORTC QLQ-C30) and relative chemotherapy dose intensity (RDI) were investigated. The follow-up period covered 6 months after the end of chemotherapy. RESULTS Intention-to-treat analyses (N = 159) revealed no differences regarding CIPN signs/symptoms. Exploratory per-protocol analyses (minimum training attendance rate 67%; N = 89) indicated that subjectively perceived sensory symptoms in the feet increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) than in the UC group (-8.3 points (-16.1 to -0.4); P = 0.039, ES = 1.27). Furthermore, adherent exercisers received a higher RDI (96.6 ± 4.8 vs. 92.2 ± 9.4; P = 0.045), showed a better course of muscular strength (+20.8 Nm (11.2-30.4); P < 0.001, ES = 0.57) and QoL (+12.9 points (3.9-21.8); P = 0.005, ES = 0.64). During follow-up, CIPN signs/symptoms persisted in all groups. CONCLUSIONS This study demonstrates that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet and other clinically relevant cancer therapy-related outcomes, if an appropriate training stimulus is achieved. CLINICAL TRIAL REGISTRATION NCT02871284.
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Affiliation(s)
- Jana Müller
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Markus Weiler
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Division of Gynecological Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- grid.5253.10000 0001 0328 4908Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Karen Steindorf
- grid.7497.d0000 0004 0492 0584Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Wolfgang Wick
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Wiskemann
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
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97
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Kleineberg NN, Knauss S, Gülke E, Pinnschmidt HO, Jakob CEM, Lingor P, Hellwig K, Berthele A, Höglinger G, Fink GR, Endres M, Gerloff C, Klein C, Stecher M, Classen AY, Rieg S, Borgmann S, Hanses F, Rüthrich MM, Hower M, Tometten L, Haselberger M, Piepel C, Merle U, Dolff S, Degenhardt C, Jensen BEO, Vehreschild MJGT, Erber J, Franke C, Warnke C. Neurological symptoms and complications in predominantly hospitalized COVID-19 patients: Results of the European multinational Lean European Open Survey on SARS-Infected Patients (LEOSS). Eur J Neurol 2021; 28:3925-3937. [PMID: 34411383 PMCID: PMC8444823 DOI: 10.1111/ene.15072] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/07/2021] [Indexed: 12/30/2022]
Abstract
Background and purpose During acute coronavirus disease 2019 (COVID‐19) infection, neurological signs, symptoms and complications occur. We aimed to assess their clinical relevance by evaluating real‐world data from a multinational registry. Methods We analyzed COVID‐19 patients from 127 centers, diagnosed between January 2020 and February 2021, and registered in the European multinational LEOSS (Lean European Open Survey on SARS‐Infected Patients) registry. The effects of prior neurological diseases and the effect of neurological symptoms on outcome were studied using multivariate logistic regression. Results A total of 6537 COVID‐19 patients (97.7% PCR‐confirmed) were analyzed, of whom 92.1% were hospitalized and 14.7% died. Commonly, excessive tiredness (28.0%), headache (18.5%), nausea/emesis (16.6%), muscular weakness (17.0%), impaired sense of smell (9.0%) and taste (12.8%), and delirium (6.7%) were reported. In patients with a complicated or critical disease course (53%) the most frequent neurological complications were ischemic stroke (1.0%) and intracerebral bleeding (ICB; 2.2%). ICB peaked in the critical disease phase (5%) and was associated with the administration of anticoagulation and extracorporeal membrane oxygenation (ECMO). Excessive tiredness (odds ratio [OR] 1.42, 95% confidence interval [CI] 1.20–1.68) and prior neurodegenerative diseases (OR 1.32, 95% CI 1.07–1.63) were associated with an increased risk of an unfavorable outcome. Prior cerebrovascular and neuroimmunological diseases were not associated with an unfavorable short‐term outcome of COVID‐19. Conclusion Our data on mostly hospitalized COVID‐19 patients show that excessive tiredness or prior neurodegenerative disease at first presentation increase the risk of an unfavorable short‐term outcome. ICB in critical COVID‐19 was associated with therapeutic interventions, such as anticoagulation and ECMO, and thus may be an indirect complication of a life‐threatening systemic viral infection.
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Affiliation(s)
- Nina N Kleineberg
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Samuel Knauss
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Eileen Gülke
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans O Pinnschmidt
- Institute of Medical Biometry, Epidemiology University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Carolin E M Jakob
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Paul Lingor
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Kerstin Hellwig
- Department of Neurology, Katholisches Klinikum Bochum, Klinikum der Ruhr Universität, Bochum, Germany
| | - Achim Berthele
- Department of Neurology, Technical University of Munich, School of Medicine, Klinikum Rechts der Isar, Munich, Germany
| | - Günter Höglinger
- Department of Neurology with Clinical Neurophysiology, Hannover Medical School, Hannover, Germany.,German Center for Neurodegenerative Diseases (DZNE), Munich, Germany
| | - Gereon R Fink
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.,Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Jülich, Jülich, Germany
| | - Matthias Endres
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Berlin, Germany.,ExcellenceCluster NeuroCure, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner Site Berlin, Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christine Klein
- Institute of Neurogenetics, University of Luebeck and University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Melanie Stecher
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Annika Y Classen
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany.,German Center for Infection Research (DZIF), Partner-Site Cologne-Bonn, Cologne, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Stefan Borgmann
- Department of Infectious Diseases and Infection Control, Ingolstadt Hospital, Ingolstadt, Germany
| | - Frank Hanses
- Emergency Department, University Hospital Regensburg, Regensburg, Germany.,Department of Infectious Diseases and Infection Control, University Hospital Regensburg, Regensburg, Germany
| | - Maria M Rüthrich
- Department of Internal Medicine II, Hematology and Medical Oncology, University Hospital Jena, Jena, Germany.,Leibniz Institute for Natural Product Research and Infection Biology, Hans-Knöll Institute, Jena, Germany
| | - Martin Hower
- Department of Internal Medicine, Klinikum Dortmund, Dortmund, Germany
| | - Lukas Tometten
- Department I for Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | | | - Christiane Piepel
- Department of Internal Medicine I, Hospital Bremen Central, Bremen, Germany
| | - Uta Merle
- Department of Internal Medicine IV, University Hospital Heidelberg, Heidelberg, Germany
| | - Sebastian Dolff
- Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | | | - Björn-Erik O Jensen
- Department of Gastroenterology, Hepatology and Infectious Diseases, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Johanna Erber
- Department of Internal Medicine II, Technical University of Munich, School of Medicine, University Hospital Rechts der Isar, Munich, Germany
| | - Christiana Franke
- Department of Neurology with Experimental Neurology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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98
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Abstract
Movement disorders are rare compared to other neurological manifestations of COVID-19. Patients who have recovered from acute severe acute respiratory syndrome coronavirus-2 infection continue to have multiple debilitating symptoms months later. We report a case of 54-year-old man who presented with repetitive flexion movement of head which started 2 months after severe acute respiratory syndrome coronavirus-2 infection. Extensive work-up including neurological examination, neuroimaging, cerebrospinal fluid analysis, and electroencephalogram were normal. The self-reported questionnaires for depression and anxiety were suggestive of severe anxiety and depression. The patient continued to have the jerky movements besides cognitive impairment, frequent headaches, intermittent shortness of breath, sleeping difficulties, fatigue, and dizziness at 1-year follow-up. This case highlights the presentation of functional movement disorder as one of the manifestations of underlying neuropsychiatric condition. Our patient had significant effect on quality of life with high symptom burden which further highlights the struggle and unmet needs of the patients with multiple symptoms after severe acute respiratory syndrome coronavirus-2 infection.
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Affiliation(s)
- Alpana Garg
- Department of Internal Medicine, The University of Iowa, Iowa City, IA, USA
| | - Sachin Goyal
- Department of Medicine, Mercy Medical Center, Cedar Rapids, IA, USA
| | - Alejandro P Comellas
- Department of Internal Medicine-Pulmonary and Critical Care, The University of Iowa, Iowa City, IA, USA
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99
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Mabrouki FZ, Sekhsoukh R, Aziouaz F, Mebrouk Y. Acute Blindness as a Complication of Severe Acute Respiratory Syndrome Coronavirus-2. Cureus 2021; 13:e16857. [PMID: 34367838 PMCID: PMC8331174 DOI: 10.7759/cureus.16857] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/05/2022] Open
Abstract
Several neurological manifestations can occur in the acute phase or in post-infection severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In certain cases, they can even reveal the disease. Although some may be consequences of direct cellular viral invasion, many represent post-infectious inflammation mediated by autoimmune mechanisms. We report the case of a 60-year-old woman who was initially consulted for acute blindness without optic neuritis. Brain MRI revealed nonspecific demyelinating lesions without any radiological signs of optic neuritis. The patient underwent an exhaustive assessment and then the diagnosis of optic neuritis with a normal orbital MRI following a SARS-CoV-2 infection was reached.
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Affiliation(s)
- Fatima Zahra Mabrouki
- Ophthalmology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
| | - Rachid Sekhsoukh
- Ophthalmology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
| | - Faiza Aziouaz
- Neurology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
| | - Yassine Mebrouk
- Neurology, Faculty of Medicine and Pharmacy, Mohammed VI University Hospital, Oujda, MAR
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Abstract
Common symptoms such as dizziness, headache, olfactory dysfunction, nausea, vomiting, etc. in COVID-19 patients have indicated the involvement of the nervous system. However, the exact association of the nervous system with COVID-19 infection is still unclear. Thus, we have conducted a meta-analysis of clinical studies associated with neurological problems in COVID-19 patients. We have searched for electronic databases with MeSH terms, and the studies for analysis were selected based on inclusion and exclusion criteria and quality assessment. The Stats Direct (version 3) was used for the analysis. The pooled prevalence with 95% confidence interval of various neurological manifestations reported in the COVID-19 patients was found to be headache 14.6% (12.2-17.2), fatigue 33.6% (29.5-37.8), olfactory dysfunction 26.4% (21.8-31.3), gustatory dysfunction 27.2% (22.3-32.3), vomiting 6.7% (5.5-8.0), nausea 9.8% (8.1-11.7), dizziness 6.7% (4.7-9.1), myalgia 21.4% (18.8-24.1), seizure 4.05% (2.5-5.8), cerebrovascular diseases 9.9% (6.8-13.4), sleep disorders 14.9% (1.9-36.8), altered mental status 17.1% (12.3-22.5), neuralgia 2.4% (0.8-4.7), arthralgia 19.9% (15.3-25.0), encephalopathy 23.5% (14.3-34.1), encephalitis 0.6% (0.2-1.3), malaise 38.3% (24.7-52.9), confusion 14.2% (6.9-23.5), movement disorders 5.2% (1.7-10.4), and Guillain-Barre syndrome 6.9% (2.3-13.7). However, the heterogeneity among studies was found to be high. Various neurological manifestations related to the central nervous system (CNS) and peripheral nervous system (PNS) are associated with COVID-19 patients.
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Affiliation(s)
- Vitalakumar D
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
| | - Ankita Sharma
- Department of Biotechnology, National
Institute of Pharmaceutical Education and Research (NIPER)-Raeberali,
Lucknow 226002, India
| | - Anoop Kumar
- Department of Pharmacology and Clinical Research, Delhi
Institute of Pharmaceutical Sciences and Research (DIPSAR), Delhi
Pharmaceutical Sciences & Research University (DPSRU), New Delhi
110017, India
| | - S. J. S. Flora
- Department of Pharmacology and Toxicology,
National Institute of Pharmaceutical Education and Research
(NIPER)-Raeberali, Lucknow 226002, India
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