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Román GC, Gracia F, Torres A, Palacios A, Gracia K, Harris D. Acute Transverse Myelitis (ATM):Clinical Review of 43 Patients With COVID-19-Associated ATM and 3 Post-Vaccination ATM Serious Adverse Events With the ChAdOx1 nCoV-19 Vaccine (AZD1222). Front Immunol 2021; 12:653786. [PMID: 33981305 PMCID: PMC8107358 DOI: 10.3389/fimmu.2021.653786] [Citation(s) in RCA: 142] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 03/08/2021] [Indexed: 01/13/2023] Open
Abstract
Introduction Although acute transverse myelitis (ATM) is a rare neurological condition (1.34-4.6 cases per million/year) COVID-19-associated ATM cases have occurred during the pandemic. Case-finding methods We report a patient from Panama with SARS-CoV-2 infection complicated by ATM and present a comprehensive clinical review of 43 patients with COVID-19-associated ATM from 21 countries published from March 2020 to January 2021. In addition, 3 cases of ATM were reported as serious adverse events during the clinical trials of the COVID-19 vaccine ChAdOx1 nCoV-19 (AZD1222). Results All patients had typical features of ATM with acute onset of paralysis, sensory level and sphincter deficits due to spinal cord lesions demonstrated by imaging. There were 23 males (53%) and 20 females (47%) ranging from ages 21- to 73- years-old (mean age, 49 years), with two peaks at 29 and 58 years, excluding 3 pediatric cases. The main clinical manifestations were quadriplegia (58%) and paraplegia (42%). MRI reports were available in 40 patients; localized ATM lesions affected ≤3 cord segments (12 cases, 30%) at cervical (5 cases) and thoracic cord levels (7 cases); 28 cases (70%) had longitudinally-extensive ATM (LEATM) involving ≥4 spinal cord segments (cervicothoracic in 18 cases and thoracolumbar-sacral in 10 patients). Acute disseminated encephalomyelitis (ADEM) occurred in 8 patients, mainly women (67%) ranging from 27- to 64-years-old. Three ATM patients also had blindness from myeloneuritis optica (MNO) and two more also had acute motor axonal neuropathy (AMAN). Conclusions We found ATM to be an unexpectedly frequent neurological complication of COVID-19. Most cases (68%) had a latency of 10 days to 6 weeks that may indicate post-infectious neurological complications mediated by the host’s response to the virus. In 32% a brief latency (15 hours to 5 days) suggested a direct neurotropic effect of SARS-CoV-2. The occurrence of 3 reported ATM adverse effects among 11,636 participants in the AZD1222 vaccine trials is extremely high considering a worldwide incidence of 0.5/million COVID-19-associated ATM cases found in this report. The pathogenesis of ATM remains unknown, but it is conceivable that SARS-CoV-2 antigens –perhaps also present in the AZD1222 COVID-19 vaccine or its chimpanzee adenovirus adjuvant– may induce immune mechanisms leading to the myelitis.
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Affiliation(s)
- Gustavo C Román
- Department of Neurology, Neurological Institute, Houston Methodist Hospital, Houston, TX, United States.,Weill Cornell College of Medicine, Cornell University, New York, NY, United States.,Department of Neurology, Texas A&M University College of Medicine, Bryan, TX, United States
| | - Fernando Gracia
- Neurology Service, Hospital Paitilla, Panama City, Panama.,Faculty of Health Sciences, Interamerican University of Panama, Panama City, Panama.,Neurology Service, Hospital Santo Tomás, Panama City, Panama
| | - Antonio Torres
- Infectious Disease Service, Hospital Santo Tomás, Panama City, Panama
| | - Alexis Palacios
- Neuroradiology Service, Complejo Hospitalario Metropolitano, CSS (Caja de Seguro Social), Panama City, Panama
| | - Karla Gracia
- Interamerican University of Panama, Panama City, Panama
| | - Diógenes Harris
- Neurosurgery Service, Complejo Hospitalario Metropolitano, CSS, Panama City, Panama
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Al-Mufti F, Amuluru K, Sahni R, Bekelis K, Karimi R, Ogulnick J, Cooper J, Overby P, Nuoman R, Tiwari A, Berekashvili K, Dangayach N, Liang J, Gupta G, Khandelwal P, Dominguez JF, Sursal T, Kamal H, Dakay K, Taylor B, Gulko E, El-Ghanem M, Mayer SA, Gandhi C. Cerebral Venous Thrombosis in COVID-19: A New York Metropolitan Cohort Study. AJNR Am J Neuroradiol 2021; 42:1196-1200. [PMID: 33888450 DOI: 10.3174/ajnr.a7134] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/23/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) infection is associated with hypercoagulability. We sought to evaluate the demographic and clinical characteristics of cerebral venous thrombosis among patients hospitalized for coronavirus disease 2019 (COVID-19) at 6 tertiary care centers in the New York City metropolitan area. MATERIALS AND METHODS We conducted a retrospective multicenter cohort study of 13,500 consecutive patients with COVID-19 who were hospitalized between March 1 and May 30, 2020. RESULTS Of 13,500 patients with COVID-19, twelve had imaging-proved cerebral venous thrombosis with an incidence of 8.8 per 10,000 during 3 months, which is considerably higher than the reported incidence of cerebral venous thrombosis in the general population of 5 per million annually. There was a male preponderance (8 men, 4 women) and an average age of 49 years (95% CI, 36-62 years; range, 17-95 years). Only 1 patient (8%) had a history of thromboembolic disease. Neurologic symptoms secondary to cerebral venous thrombosis occurred within 24 hours of the onset of the respiratory and constitutional symptoms in 58% of cases, and 75% had venous infarction, hemorrhage, or both on brain imaging. Management consisted of anticoagulation, endovascular thrombectomy, and surgical hematoma evacuation. The mortality rate was 25%. CONCLUSIONS Early evidence suggests a higher-than-expected frequency of cerebral venous thrombosis among patients hospitalized for COVID-19. Cerebral venous thrombosis should be included in the differential diagnosis of neurologic syndromes associated with SARS-CoV-2 infection.
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Affiliation(s)
- F Al-Mufti
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.) .,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Amuluru
- Department of Radiology (K.A.), Goodman Campbell Brain and Spine, Indianapolis, Indiana
| | - R Sahni
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Bekelis
- Department of Neurosurgery (K. Bekelis), Catholic Health Services and Good Samaritan Hospital, West Islip, New York
| | - R Karimi
- Department of Neurosurgery (R.K.), Hackensack University Medical Center, Hackensack, New Jersey
| | - J Ogulnick
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - J Cooper
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - P Overby
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - R Nuoman
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - A Tiwari
- Department of Neurosurgery (A.T., K. Berekashvili), New York University, New York, New York
| | - K Berekashvili
- Department of Neurosurgery (A.T., K. Berekashvili), New York University, New York, New York
| | - N Dangayach
- Department of Neurosurgery (N.D., J.L.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - J Liang
- Department of Neurosurgery (N.D., J.L.), Icahn School of Medicine at Mount Sinai, New York, New York
| | - G Gupta
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - P Khandelwal
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - J F Dominguez
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - T Sursal
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.)
| | - H Kamal
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - K Dakay
- Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - B Taylor
- Department of Neurological Surgery (G.G., P.K., B.T.), Rutgers University, New Brunswick, New Jersey
| | - E Gulko
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - M El-Ghanem
- Department of Neurology (M.E.-G.), University of Arizona-Tuscon, Tuscon, Arizona
| | - S A Mayer
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
| | - C Gandhi
- From the Departments of Neurosurgery (F.A.-M., R.S., J.C., P.O., R.N., J.F.D., T.S., E.G., S.A.M., C.G.).,Neurology (F.A.-M., R.S., J.O., H.K., K.D., E.G., S.A.M., C.G.), Westchester Medical Center at New York Medical College, Valhalla, New York
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Oliveira V, Seabra M, Rodrigues R, Carvalho V, Mendes M, Pereira D, Caldeiras C, Martins B, Silva R, Azevedo A, Lima MJ, Monteiro C, Varela R, Malheiro S, Abreu M, Azevedo E, Leal Loureiro J, Tedim Cruz V, Silva MR, Magalhães R, Silva C, Maia LF, Correia M. Neuro-COVID frequency and short-term outcome in the Northern Portuguese population. Eur J Neurol 2021; 28:3360-3368. [PMID: 33884707 PMCID: PMC8250949 DOI: 10.1111/ene.14874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 04/07/2021] [Indexed: 01/26/2023]
Abstract
Background and purpose COVID‐19‐related acute neurological phenotypes are being increasingly recognised, with neurological complications reported in more than 30% of hospitalised patients. However, multicentric studies providing a population‐based perspective are lacking. Methods We conducted a retrospective multicentric study at five hospitals in Northern Portugal, representing 45.1% of all hospitalised patients in this region, between 1 March and 30 June 2020. Results Among 1261 hospitalised COVID‐19 patients, 457 (36.2%) presented neurological manifestations, corresponding to a rate of 357 per 1000 in the North Region. Patients with neurologic manifestations were younger (68.0 vs. 71.2 years, p = 0.002), and the most frequent neurological symptoms were headache (13.4%), delirium (10.1%), and impairment of consciousness (9.7%). Acute well‐defined central nervous system (CNS) involvement was found in 19.1% of patients, corresponding to a rate of 217 per 1000 hospitalised patients in the whole region. Assuming that all patients with severe neurological events were hospitalised, we extrapolated our results to all COVID‐19 patients in the region, estimating that 116 will have a severe neurological event, corresponding to a rate of nine per 1000 (95% CI = 7–11). Overall case fatality in patients presenting neurological manifestations was 19.8%, increasing to 32.6% among those with acute well‐defined CNS involvement. Conclusions We characterised the population of hospitalised COVID‐19 patients in Northern Portugal and found that neurological symptoms are common and associated with a high degree of disability at discharge. CNS involvement with criteria for in‐hospital admission was observed in a significant proportion of patients. This knowledge provides the tools for adequate health planning and for improving COVID‐19 multidisciplinary patient care.
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Affiliation(s)
- Vanessa Oliveira
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Mafalda Seabra
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Rita Rodrigues
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Vanessa Carvalho
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Michel Mendes
- Neurology Department, Centro Hospitalar Trás-os-Montes e Alto-douro, Vila Real, Portugal
| | - Diogo Pereira
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Catarina Caldeiras
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Bárbara Martins
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - Renata Silva
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Ana Azevedo
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Maria João Lima
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal
| | - Catarina Monteiro
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Ricardo Varela
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Sofia Malheiro
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Miguel Abreu
- Infectious Diseases Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal
| | - Elsa Azevedo
- Neurology Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
| | - José Leal Loureiro
- Neurology Department, Centro Hospitalar Entre-Douro e Vouga, Santa Maria da Feira, Portugal
| | - Vítor Tedim Cruz
- Neurology Department, Unidade Local de Saúde de Matosinhos, Matosinhos, Portugal.,Epidemiological Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
| | - Mário Rui Silva
- Neurology Department, Centro Hospitalar Trás-os-Montes e Alto-douro, Vila Real, Portugal
| | - Rui Magalhães
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Carolina Silva
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Luís F Maia
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal.,Institute of Innovation and Research in Health, University of Porto, Porto, Portugal
| | - Manuel Correia
- Neurology Department, Centro Hospitalar Universitário do Porto-Hospital de Santo António, Porto, Portugal.,Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
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Pajo AT, Espiritu AI, Apor ADAO, Jamora RDG. Neuropathologic findings of patients with COVID-19: a systematic review. Neurol Sci 2021; 42:1255-1266. [PMID: 33483885 PMCID: PMC7822400 DOI: 10.1007/s10072-021-05068-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 01/16/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite the expanding literature that discusses insights into the clinical picture and mechanisms by which the SARS-CoV-2 virus invades the nervous system, data on the neuropathologic findings of patients who died following SARS-CoV-2 infection is limited. METHODS A broad literature search was done for published articles that reported on histopathological findings of the brain in patients with COVID-19 in PubMed by MEDLINE, Embase, CENTRAL by the Cochrane Library, and SCOPUS from December 31, 2019 to October 31, 2020. RESULTS The systematic literature search strategy used resulted in a total of 1608 articles of which 14 were included in the analysis (PROSPERO registration number: CRD42020221022). There were ten case series, two case reports, one retrospective cohort, and one prospective cohort. The age of the patients ranged between 38 and 90 years old, most of them older than 65 years old (n=66, 45.2%) and males (n=79, 54.1%). Most tested negative in SARS-CoV-2 immunohistochemistry (n=70, 47.9%). The striking pathologic changes included diffuse edema (n=25, 17.1%), gliosis with diffuse activation of microglia and astrocytes (n=52, 35.6%), infarctions involving cortical and subcortical areas of the brain (n=4, 2.7%), intracranial bleed (subarachnoid hemorrhage and punctate hemorrhages) (n=18, 12.4%), arteriosclerosis (n=43, 29.5%), hypoxic-ischemic injury (n=41, 28.1%), and signs of inflammation (n=52, 35.6%). The cause of death was attributed to the cardiorespiratory system (n=66, 45.2%). CONCLUSIONS The neuropathologic changes observed likely represent direct cytopathic effects and indirect effects secondary to host-specific inflammatory response induced by the viral infection. Further studies however are required to better elucidate the pathologic mechanism.
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Affiliation(s)
- Azalea T. Pajo
- Division of Adult Neurology, Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Adrian I. Espiritu
- Division of Adult Neurology, Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Department of Clinical Epidemiology, College of Medicine, University of the Philippines Manila, Manila, Philippines
| | - Almira Doreen Abigail O. Apor
- Division of Adult Neurology, Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Roland Dominic G. Jamora
- Division of Adult Neurology, Department of Neurosciences, College of Medicine-Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Section of Neurology, Institute for Neurosciences, St. Luke’s Medical Center Global City, Taguig, Philippines
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55
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Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol 2021; 268:1133-1170. [PMID: 32840686 PMCID: PMC7445716 DOI: 10.1007/s00415-020-10124-x] [Citation(s) in RCA: 229] [Impact Index Per Article: 76.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.
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Affiliation(s)
| | - Ahmed Abdelhak
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Department of Neurology and Stroke, University Hospital of Tübingen, 72076, Tübingen, Germany
- Hertie Institute of Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
| | - Matteo Foschi
- Neurology Unit, S. Maria delle Croci Hospital-AUSL Romagna, ambito di Ravenna, 48121, Ravenna, Italy
| | - Hayrettin Tumani
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Specialty Hospital of Neurology Dietenbronn, 88477, Schwendi, Germany
| | - Markus Otto
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany.
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Lehmann HC, Schoser B, Wunderlich G, Berlit P, Fink GR. [Neuromuscular complications of SARS-CoV-2 infections-Part 1: peripheral nerves]. DER NERVENARZT 2021; 92:540-547. [PMID: 33770191 PMCID: PMC7994351 DOI: 10.1007/s00115-021-01094-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/02/2021] [Indexed: 01/05/2023]
Abstract
In recent months various disorders and diseases of the peripheral nerves (including cranial nerves) and the musculature have been described in association with the pulmonary disease coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In the first part of our review the current knowledge about a potential association of a SARS-CoV‑2 infection with dysfunction and diseases of cranial and peripheral nerves is discussed. Anosmia, ageusia, motor cranial nerve involvement and Guillain-Barré syndrome (GBS) were described in a temporal association with a SARS-CoV‑2 infection. Several studies could show that anosmia and ageusia were frequent symptoms of a SARS-CoV‑2 infection. In contrast the failure of other cranial nerves has so far only been sporadically described. A number of case reports and case series indicate a causal association between a SARS-CoV‑2 infection and GBS but epidemiological evidence is still lacking.
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Affiliation(s)
- Helmar C Lehmann
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland.
| | - Benedikt Schoser
- LMU Klinikum, Friedrich-Baur-Institut, Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Deutschland
| | - Gilbert Wunderlich
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Zentrum für Seltene Erkrankungen, Universitätsklinikum Köln, Köln, Deutschland
| | - Peter Berlit
- Deutsche Gesellschaft für Neurologie (DGN), Reinhardtstr. 27C, 10117, Berlin, Deutschland
| | - Gereon R Fink
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Köln, Kerpener Straße 62, 50937, Köln, Deutschland
- Institut für Neurowissenschaften (INM-3), Forschungszentrum Jülich, Jülich, Deutschland
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Tang KT, Hsu BC, Chen DY. Autoimmune and Rheumatic Manifestations Associated With COVID-19 in Adults: An Updated Systematic Review. Front Immunol 2021; 12:645013. [PMID: 33777042 PMCID: PMC7994612 DOI: 10.3389/fimmu.2021.645013] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 02/17/2021] [Indexed: 12/18/2022] Open
Abstract
Background: Numerous cases of the coronavirus disease 2019 (COVID-19) with autoimmune and rheumatic manifestations have been reported. Despite the available reviews that summarized its autoimmune/rheumatic manifestations, a systematic approach is still lacking. Therefore, we conducted a comprehensive systematic review in order to give an overview upon these rare but clinically significant manifestations. Methods: We performed a literature search of PubMed and EMBASE as of October 9, 2020. All articles relevant to either systemic or organ-specific autoimmune and rheumatic manifestations potentially associated with COVID-19 were collected. The reviewed literature were limited to adults ≥18 years. Results: Although most of the existing evidence was based on case reports or case series without a long-term follow-up, a variety of autoimmune/rheumatic manifestations were associated with COVID-19. The manifestations that have a consistent association with COVID-19 include autoimmune cytopenia, cutaneous vasculitis, encephalitis, and Guillain-Barre syndrome. Such association is conflicting as regards to antiphospholipid syndrome, hemophagocytic lymphohistiocytosis, and myasthenia gravis. Conclusion: Our systematic review indicated the potential of the COVID-19 virus to trigger a myriad of autoimmune and rheumatic manifestations, which should be considered amid global efforts to combat COVID-19.
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Affiliation(s)
- Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Taichung Veterans General Hospital, Taichung, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,Ph.D. Program in Translational Medicine and Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Bo-Chueh Hsu
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital Puli Branch, Nantou, Taiwan
| | - Der-Yuan Chen
- Translational Medicine Laboratory, China Medical University Hospital, Taichung, Taiwan.,Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
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Abstract
CONTEXT Recent literature points towards myelitis, like encephalitis, as a common central nervous system complication of COVID-19. This review elaborates on disorders of the spinal cord caused by the SARS-CoV-2 virus. OBJECTIVES To review the published data about SARS-CoV-2-associated spinal cord disorders and assess their clinical, neuroimaging, treatment, and prognostic aspects. METHODS The PubMed and Google Scholar databases were searched for published cases using the search items "COVID-19 OR SARS-CoV-2 AND myelitis", "COVID-19 OR SARS-CoV-2 AND myelopathy", and "COVID-19 OR SARS-CoV-2 AND spinal cord". RESULTS Thirty-three isolated cases were included in the present review, of which 14 were aged 60 years and above (range: 3-70 years). Eighteen patients had lung abnormalities on chest imaging. Eight patients had developed either an areflexic paraparesis or quadriparesis. In 17 patients, neuroimaging demonstrated longitudinally extensive transverse myelitis, while 3 cases showed neuroimaging changes in the spinal cord as a part of acute disseminated encephalomyelitis syndrome. Cerebrospinal fluid (CSF) examinations revealed inflammatory changes in 18 patients. However, the SARS-CoV-2 virus in the CSF was discovered in 2 patients. In 2 patients, anti-SARS-CoV-2 antibodies were demonstrated in the CSF. Following treatment, 13 patients were able to walk. CONCLUSIONS A variety of COVID-19-related spinal cord manifestations, such as acute transverse myelitis, acute necrotizing myelitis, SARS-CoV-2 myelitis, acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorder, hypoxic myelopathy, MOG antibody-associated myelitis, spinal cord infarction, and spinal epidural abscess, have been reported. The possible mechanisms of this involvement being direct invasion, cytokine storm, coagulopathy, and an autoimmune response. However, response to treatment has been generally unsatisfactory, with many patients having residual weakness necessitating long-term rehabilitation.
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Affiliation(s)
- Ravindra Kumar Garg
- Department of Neurology, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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59
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Delirium in your house: a survey during General Practitioner-programmed home visits. Aging Clin Exp Res 2021; 33:2747-2751. [PMID: 33604822 PMCID: PMC7891467 DOI: 10.1007/s40520-021-01806-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/23/2021] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To assess the prevalence of delirium (DEL) among older patients living at home and periodically visited by their General Practitioners (GPs). DESIGN Observational study. SETTING In Italy, programmed home visits by the GPs are regularly scheduled for their vulnerable and frail patients who are often on poly-drug regimens and suffering from dementia. PARTICIPANTS N = 102 patients among those receiving programmed home visits by n = 6 GP based in the Brianza area (Lombardy). MEASUREMENTS Patients were screened for delirium with the Italian version of the 4AT, with a score ≥ 4 considered as a positive indicator for DEL. The Charlson Comorbidity Index (CCI), the Short Physical Performance Battery (SPPB), the presence of dementia, and benzodiazepine (BZD) use were recorded. RESULTS DEL+ was detected in almost half of the recruited sample (44.1%), and it was clearly associated with increased comorbidity and decreased motor abilities. Pre-existing dementia was documented in most of DEL+ patients (71.1%), while this was the case for only a minority of DEL- (5.2%, p < 0.00001). Analogously, BZD use was over-represented in the DEL+ group with respect to the DEL- one (73.3% vs. 22.8%, p < 0.00001). CONCLUSIONS DEL prevalence as detected by GP during programmed home visits is surprisingly high, and related to motor impairment, comorbidities (among which dementia), and BZD use. DEL prompt recognition should be one of the goals of GP-programmed home visits, since this treatable and preventable condition is associated to an elevated burden of frailty and risk of death.
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60
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Tan BH, Liu JM, Gui Y, Wu S, Suo JL, Li YC. Neurological involvement in the respiratory manifestations of COVID-19 patients. Aging (Albany NY) 2021; 13:4713-4730. [PMID: 33582654 PMCID: PMC7906194 DOI: 10.18632/aging.202665] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 02/03/2021] [Indexed: 02/06/2023]
Abstract
The peculiar features of coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), are challenging the current biological knowledge. Early in Feb, 2020, we suggested that SARS-CoV-2 may possess neuroinvasive potential similar to that of many other coronaviruses. Since then, a variety of neurological manifestations have been associated with SARS-CoV-2 infection, which was supported in some patients with neuroimaging and/or cerebrospinal fluid tests. To date, at least 27 autopsy studies on the brains of COVID-19 patients can be retrieved through PubMed/MEDLINE, among which neuropathological alterations were observed in the brainstem in 78 of 134 examined patients, and SARS-CoV-2 nucleic acid and viral proteins were detected in the brainstem in 16/49 (32.7%) and 18/71 (25.3%) cases, respectively. To shed some light on the peculiar respiratory manifestations of COVID-19 patients, this review assessed the existing evidence about the neurogenic mechanism underlying the respiratory failure induced by SARS-CoV-2 infection. Acknowledging the neurological involvement has important guiding significance for the prevention, treatment, and prognosis of SARS-CoV-2 infection.
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Affiliation(s)
- Bai-Hong Tan
- Laboratory Teaching Center of Basic Medicine, Norman Bethune Health Science Center of Jilin University, Jilin, China
| | - Jia-Mei Liu
- Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China
| | - Yue Gui
- Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China
| | - Shuang Wu
- Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China
| | - Jia-Le Suo
- Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China
| | - Yan-Chao Li
- Department of Histology and Embryology, College of Basic Medical Sciences, Norman Bethune College of Medicine, Jilin University, Changchun, Jilin, China
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61
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Syahrul S, Maliga HA, Ilmawan M, Fahriani M, Mamada SS, Fajar JK, Frediansyah A, Syahrul FN, Imran I, Haris S, Rambe AS, Emran TB, Rabaan AA, Tiwari R, Dhama K, Nainu F, Mutiawati E, Harapan H. Hemorrhagic and ischemic stroke in patients with coronavirus disease 2019: incidence, risk factors, and pathogenesis - a systematic review and meta-analysis. F1000Res 2021; 10:34. [PMID: 33708378 PMCID: PMC7934095 DOI: 10.12688/f1000research.42308.1] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2021] [Indexed: 12/17/2022] Open
Abstract
Background: In this study, we aimed to determine the global prevalence, chronological order of symptom appearance, and mortality rates with regard to hemorrhagic and ischemic stroke in patients with coronavirus disease 2019 (COVID-19) and to discuss possible pathogeneses of hemorrhagic and ischemic stroke in individuals with the disease. Methods: We searched the PubMed, Scopus, and Web of Science databases for relevant articles published up to November 8, 2020. Data regarding study characteristics, hemorrhagic stroke, ischemic stroke, and COVID-19 were retrieved in accordance with the PRISMA guidelines. The Newcastle-Ottawa scale was used to assess the quality of the eligible studies. The pooled prevalence and mortality rate of hemorrhagic and ischemic stroke were calculated. Results: The pooled estimate of prevalence of hemorrhagic stroke was 0.46% (95% CI 0.40%–0.53%;
I
2=89.81%) among 67,155 COVID-19 patients and that of ischemic stroke was 1.11% (95% CI 1.03%–1.22%;
I
2=94.07%) among 58,104 COVID-19 patients. Ischemic stroke was more predominant (incidence: 71.58%) than hemorrhagic stroke (incidence: 28.42%) in COVID-19 patients who experienced a stroke. In COVID-19 patients who experienced a stroke, hospital admission with respiratory symptoms was more commonly reported than that with neurological symptoms (20.83% for hemorrhagic stroke and 5.51% for ischemic stroke versus
6.94% for hemorrhagic stroke and 5.33% for ischemic stroke, respectively). The pooled mortality rate of COVID-19 patients who experienced a hemorrhagic and ischemic stroke was 44.72% (95% CI 36.73%–52.98%) and 36.23% (95% CI 30.63%–42.24%), respectively. Conclusions: Although the occurrence of hemorrhagic and ischemic stroke is low, the mortality rates of both stroke types in patients with COVID-19 are concerning, and therefore, despite several potential pathogeneses that have been proposed, studies aimed at definitively elucidating the mechanisms of hemorrhagic and ischemic stroke in individuals with COVID-19 are warranted. PROSPERO registration: CRD42020224470 (04/12/20)
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Affiliation(s)
- Syahrul Syahrul
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia.,Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23111, Indonesia
| | | | - Muhammad Ilmawan
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia
| | - Marhami Fahriani
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Sukamto S Mamada
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | - Jonny Karunia Fajar
- Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65117, Indonesia.,Brawijaya Internal Medicine Research Center, Department of Internal Medicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Andri Frediansyah
- Research Division for Natural Product Technology (BPTBA), Indonesian Institute of Sciences (LIPI), Wonosari, 55861, Indonesia
| | - Faza Nabila Syahrul
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
| | - Imran Imran
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia.,Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23111, Indonesia
| | - Salim Haris
- Department of Neurology, Faculty of Medicine, Universitas Indonesia, Jakarta, 10430, Indonesia
| | - Aldy Safruddin Rambe
- Department of Neurology, Faculty of Medicine, Universitas Sumatera Utara, Medan, North Sumatra, 20155, Indonesia
| | - Talha Bin Emran
- Department of Pharmacy, BGC Trust University Bangladesh, Chittagong-4381, Bangladesh
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
| | - Ruchi Tiwari
- Department of Veterinary Microbiology and Immunology, College of Veterinary Sciences, UP Pandit Deen Dayal Upadhayay Pashu Chikitsa Vigyan Vishwavidyalay Evum Go-Anusandhan Sansthan (DUVASU), Mathura, Uttar Pradesh, 281 001, India
| | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Izatnagar, Uttar Pradesh, 243122, India
| | - Firzan Nainu
- Faculty of Pharmacy, Hasanuddin University, Makassar, South Sulawesi, 90245, Indonesia
| | - Endang Mutiawati
- Department of Neurology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia.,Department of Neurology, Dr. Zainoel Abidin Hospital, Banda Aceh, Aceh, 23111, Indonesia
| | - Harapan Harapan
- Medical Research Unit, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia.,Department of Microbiology, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia.,Tropical Disease Centre, School of Medicine, Universitas Syiah Kuala, Banda Aceh, Aceh, 23111, Indonesia
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62
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Baldini T, Asioli GM, Romoli M, Carvalho Dias M, Schulte EC, Hauer L, Aguiar De Sousa D, Sellner J, Zini A. Cerebral venous thrombosis and severe acute respiratory syndrome coronavirus-2 infection: A systematic review and meta-analysis. Eur J Neurol 2021; 28:3478-3490. [PMID: 33426733 PMCID: PMC8014715 DOI: 10.1111/ene.14727] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/05/2021] [Accepted: 01/06/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND PURPOSE Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection predisposes patients to arterial and venous thrombosis. This study aimed to systematically review the available evidence in the literature for cerebral venous thrombosis (CVT) in association with coronavirus disease-2019 (COVID-19). METHODS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases to identify cases of COVID-19-associated CVT. The search period spanned 1 January 2020 to 1 December 2020, and the review protocol (PROSPERO-CRD42020214327) followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Identified studies were evaluated for bias using the Newcastle-Ottawa scale. A proportion meta-analysis was performed to estimate the frequency of CVT among hospitalized COVID-19 patients. RESULTS We identified 57 cases from 28 reports. Study quality was mostly classified as low. CVT symptoms developed after respiratory disease in 90%, and the mean interval was 13 days. CVT involved multiple sites in 67% of individuals, the deep venous system was affected in 37%, and parenchymal hemorrhage was found in 42%. Predisposing factors for CVT beyond SARS-CoV-2 infection were present in 31%. In-hospital mortality was 40%. Using data from 34,331 patients, the estimated frequency of CVT among patients hospitalized for SARS-CoV-2 infection was 0.08% (95% confidence interval [CI]: 0.01-0.5). In an inpatient setting, CVT accounted for 4.2% of cerebrovascular disorders in individuals with COVID-19 (cohort of 406 patients, 95% CI: 1.47-11.39). CONCLUSIONS Cerebral venous thrombosis in the context of SARS-CoV-2 infection is a rare, although there seems to be an increased relative risk. High suspicion is necessary, because the diagnosis of this potentially life-threatening condition in COVID-19 patients can be challenging. Evidence is still scarce on the pathophysiology and potential prevention of COVID-19-associated CVT.
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Affiliation(s)
- Tommaso Baldini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| | - Gian Maria Asioli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
| | - Michele Romoli
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy.,Neurology Clinic, University of Perugia-S. Maria della Misericordia Hospital, Perugia, Italy
| | - Mariana Carvalho Dias
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Eva C Schulte
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany.,Institute of Virology, Technical University of Munich, Munich, Germany
| | - Larissa Hauer
- Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria
| | - Diana Aguiar De Sousa
- Department of Neurosciences and Mental Health (Neurology), Hospital de Santa Maria/CHLN, University of Lisbon, Lisbon, Portugal
| | - Johann Sellner
- Department of Neurology, Landesklinikum Mistelbach-Gänserndorf, Mistelbach, Austria.,Department of Neurology, Christian Doppler Medical Center, Paracelsus Medical University, Salzburg, Austria.,Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Andrea Zini
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Neurology and Metropolitan Stroke Center, "C.A. Pizzardi" Maggiore Hospital, Bologna, Italy
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63
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Bidlack JM, Chang SL, Fitting S, Gendelman HE, Gorantla S, Kumar S, Marcondes MCG, Meigs DD, Melendez LM, Sariyer IK, Yelamanchili S. The COVID-19 Pandemic: Reflections of Science, Person, and Challenge in Academic Research Settings. J Neuroimmune Pharmacol 2021; 16:706-717. [PMID: 34826061 PMCID: PMC8616745 DOI: 10.1007/s11481-021-10035-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/11/2021] [Indexed: 12/16/2022]
Abstract
In spring of 2021, the Society on NeuroImmune Pharmacology (SNIP) organized a virtual workshop on the coronavirus disease 2019 (COVID-19). The daylong event's fourth and final symposium, "Well-being and reflections," offered a glimpse at the pandemic's impact on the lives of our scientists and educators. This manuscript includes a brief summary of the symposium, a transcription of our incoming president Dr. Santosh Kumar's lecture, titled "Intervention and improved well-being of basic science researchers during the COVID-19 era: a case study," and the panel discussion that followed, "Reflection and sharing," featuring Drs. Jean M. Bidlack, Sylvia Fitting, Santhi Gorantla, Maria Cecilia G. Marcondes, Loyda M. Melendez, and Ilker K. Sariyer. The conclusion of this manuscript includes comments from SNIP's president Dr. Sulie L. Chang and our Chief Editor, Dr. Howard E. Gendelman. Drs. Sowmya Yelamanchili and Jeymohan Joseph co-chaired the symposium.
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Affiliation(s)
- Jean M. Bidlack
- grid.412750.50000 0004 1936 9166Department of Pharmacology and Physiology, School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY USA
| | - Sulie L. Chang
- grid.263379.a0000 0001 2172 0072Department of Biological Sciences, Institute of Neuroimmune Pharmacology, Seton Hall University, South Orange, NJ USA
| | - Sylvia Fitting
- grid.10698.360000000122483208Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Howard E. Gendelman
- grid.266813.80000 0001 0666 4105Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Santhi Gorantla
- grid.266813.80000 0001 0666 4105Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Santosh Kumar
- grid.267301.10000 0004 0386 9246Department of Pharmaceutical Sciences, College of Pharmacy, University of Tennessee Health Science Center, Memphis, TN USA
| | | | - Douglas D. Meigs
- grid.266813.80000 0001 0666 4105Department of Pharmacology and Experimental Neuroscience, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
| | - Loyda M. Melendez
- grid.267034.40000 0001 0153 191XDepartment of Microbiology and Medical Zoology, University of Puerto Rico-Medical Sciences Campus, San Juan, Puerto Rico, USA
| | - Ilker K. Sariyer
- grid.264727.20000 0001 2248 3398Department of Neuroscience and Center for Neurovirology, Lewis Katz School of Medicine, Temple University, PA Philadelphia, USA
| | - Sowmya Yelamanchili
- grid.266813.80000 0001 0666 4105Department of Anesthesiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE USA
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64
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Harrison AG, Lin T, Wang P. Mechanisms of SARS-CoV-2 Transmission and Pathogenesis. Trends Immunol 2020; 41:1100-1115. [PMID: 33132005 PMCID: PMC7556779 DOI: 10.1016/j.it.2020.10.004] [Citation(s) in RCA: 681] [Impact Index Per Article: 170.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 10/08/2020] [Accepted: 10/10/2020] [Indexed: 02/07/2023]
Abstract
The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) marks the third highly pathogenic coronavirus to spill over into the human population. SARS-CoV-2 is highly transmissible with a broad tissue tropism that is likely perpetuating the pandemic. However, important questions remain regarding its transmissibility and pathogenesis. In this review, we summarize current SARS-CoV-2 research, with an emphasis on transmission, tissue tropism, viral pathogenesis, and immune antagonism. We further present advances in animal models that are important for understanding the pathogenesis of SARS-CoV-2, vaccine development, and therapeutic testing. When necessary, comparisons are made from studies with SARS to provide further perspectives on coronavirus infectious disease 2019 (COVID-19), as well as draw inferences for future investigations.
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Affiliation(s)
- Andrew G Harrison
- Department of Immunology, School of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Tao Lin
- Department of Immunology, School of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA
| | - Penghua Wang
- Department of Immunology, School of Medicine, University of Connecticut Health Center, Farmington, CT 06030, USA.
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65
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Andrabi MS, Andrabi SA. Neuronal and Cerebrovascular Complications in Coronavirus Disease 2019. Front Pharmacol 2020; 11:570031. [PMID: 33613275 PMCID: PMC7892192 DOI: 10.3389/fphar.2020.570031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 10/13/2020] [Indexed: 12/23/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is a pandemic disease resulting from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection, primarily in the respiratory tract. This pandemic disease has affected the entire world, and the pathobiology of this disease is not yet completely known. The Interactions of SARS-CoV-2 proteins with different cellular components in the host cell may be necessary for understanding the disease mechanism and identifying crucial pharmacological targets in COVID-19. Studies have suggested that the effect of SARS-CoV-2 on other organs, including the brain, maybe critical for understanding the pathobiology of COVID-19. Symptoms in COVID-19 patients, including impaired consciousness dizziness, headache, loss of taste and smell, vision problems, and neuromuscular pain, suggest that neuronal complications comprise a crucial component of COVID-19 pathobiology. A growing body of literature indicates that SARS-CoV-2 can enter the brain, leading to neuronal defects in COVID-19 patients. Other studies suggest that SARS-CoV-2 may aggravate neuronal complications due to its effects on the cerebrovascular system. Emerging pieces of evidence show that stroke can be one of the leading neurological complications in COVID-19. In this review, we describe the observations about neuronal complications of COVID-19 and how SARS-CoV-2 may invade the brain. We will also discuss the cerebrovascular problems and occurrence of stroke in COVID-19 patients. We will also present the observations and our views about the potential pharmacological strategies and targets in COVID-19. We hope this review will help comprehend the current knowledge of neuronal and cerebrovascular complications from SARS-CoV-2 infections and highlight the possible long-term consequences of SARS-CoV-2 on the human brain.
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Affiliation(s)
- Mudasir S Andrabi
- Capstone College of Nursing, University of Alabama, Tuscaloosa, AL, United States
| | - Shaida A Andrabi
- Department of Pharmacology and Toxicology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States.,Department of Neurology, University of Alabama at Birmingham School of Medicine, Birmingham, AL, United States
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Freire-Álvarez E, Guillén L, Lambert K, Baidez A, García-Quesada M, Andreo M, Alom J, Masiá M, Gutiérrez F. COVID-19-associated encephalitis successfully treated with combination therapy. CLINICAL INFECTION IN PRACTICE 2020; 7:100053. [PMID: 33163956 PMCID: PMC7604011 DOI: 10.1016/j.clinpr.2020.100053] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 10/20/2020] [Accepted: 10/20/2020] [Indexed: 12/21/2022] Open
Abstract
A case of COVID-19 with clinical features of acute demyelinating encephalomyelitis. The patient was successfully treated with immunoglobulins and cytokine blockade. Acute encephalitis amenable to immunomodulation could be a feature of COVID-19.
Background Acute encephalitis can occur in different viral diseases due to infection of the brain or by an immune mechanism. Severe novel coronavirus disease 2019 (COVID-19) is associated with a major immune inflammatory response with cytokine upregulation including interleukin 6 (IL-6). We report a case presenting with acute encephalitis that was diagnosed as having severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection with hyperinflammatory systemic response and recovered after therapy with immunoglobulins and cytokine blockade. Case report A 39-year-old-man was brought to the Emergency Department with drowsiness, mental disorientation, intermittent fever and headache. A brain magnetic resonance imaging showed extensive involvement of the brain including cortical and subcortical right frontal regions, right thalamus, bilateral temporal lobes and cerebral peduncles, with no leptomeningeal enhancement. Cerebrospinal fluid (CSF) showed a leukocyte count of 20/µL (90% lymphocytes), protein level of 198 mg/dL, and glucose of 48 mg/dL. SARS-CoV-2 was detected in nasopharyngeal swabs by reverse-transcriptase-PCR (RT-PCR) but it was negative in the CSF. Remarkable laboratory findings in blood tests included low lymphocyte count and elevated ferritin, IL-6 and D-dimer. He had a complicated clinical course requiring mechanical ventilation. Intravenous immunoglobulins and cytokine blockade with tocilizumab, an IL-6 receptor antagonist, were added considering acute demyelinating encephalomyelitis. The patient made a full recovery, suggesting that it could have been related to host inflammatory response. Conclusion This case report indicates that COVID-19 may present as an encephalitis syndrome mimicking acute demyelinating encephalomyelitis that could be amenable to therapeutic modulation.
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Affiliation(s)
- Eric Freire-Álvarez
- Neurology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Lucía Guillén
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Karine Lambert
- Magnetic Resonance Imaging Unit, Radiology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Ana Baidez
- Neurology Department, Hospital General Universitario de Elche, Alicante, Spain
| | | | - María Andreo
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Jordi Alom
- Neurology Department, Hospital General Universitario de Elche, Alicante, Spain
| | - Mar Masiá
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
| | - Félix Gutiérrez
- Infectious Diseases Unit, Hospital General Universitario de Elche and Universidad Miguel Hernández, Alicante, Spain
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67
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Marini A, Vogrig A, Bax F, Pellitteri G, Surcinelli A, Valente M, Gigli GL. Reply to "Guillain‑Barré syndrome in the COVID‑19 era another occasional cluster?": Insights from two distinct clusters of Guillain-Barré syndrome detected in Europe in the COVID-19 era. J Neurol 2020; 268:1201-1202. [PMID: 32749602 PMCID: PMC7400752 DOI: 10.1007/s00415-020-10006-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Alessandro Marini
- Neurology Unit, Department of Medicine (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy.
| | - Alberto Vogrig
- Clinical Neurology Unit, Misericordia University Hospital, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Francesco Bax
- Neurology Unit, Department of Medicine (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Gaia Pellitteri
- Neurology Unit, Department of Medicine (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Andrea Surcinelli
- Neurology Unit, Department of Medicine (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
| | - Mariarosaria Valente
- Neurology Unit, Department of Medicine (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
- Clinical Neurology Unit, Misericordia University Hospital, Santa Maria della Misericordia University Hospital, Udine, Italy
| | - Gian Luigi Gigli
- Neurology Unit, Department of Medicine (DAME), University of Udine, Piazzale Santa Maria della Misericordia 15, 33100, Udine, Italy
- Clinical Neurology Unit, Misericordia University Hospital, Santa Maria della Misericordia University Hospital, Udine, Italy
- DMIF, University of Udine, Udine, Italy
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