51
|
Nejad Biglari H, Sinaei R, Pezeshki S, Khajeh Hasani F. Acute transverse myelitis of childhood due to novel coronavirus disease 2019: The first pediatric case report and review of literature. IRANIAN JOURNAL OF CHILD NEUROLOGY 2021; 15:107-112. [PMID: 33558819 PMCID: PMC7856438 DOI: 10.22037/ijcn.v15i1.31579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 08/25/2020] [Indexed: 11/25/2022]
Abstract
The global coronavirus disease 2019 (COVID-19) pandemic appears to have some streaks of severity in pediatrics. These streaks include variable signs of respiratory distress, a new entity called multi-system inflammatory syndrome, and some evidences of neurological symptoms involving both central and peripheral nervous systems. Here, we described the first pediatric patient with COVID-19 who presented with acute transverse myelitis. An 11-year-old otherwise healthy girl presented to our clinic with acute onset of lower limbs paresis, urinary and fecal retention, alongside epigastric pain, and fever for 3 days. A neurological examination revealed a severe flaccid paraplegia in her lower limbs associated with a sensory level at T5. She was evaluated systematically for all probable causes of her symptoms, and finally, due to having a positive nasopharyngeal PCR test, she was considered to suffer from post-COVID-19 transverse myelitis. She underwent intravenous-immunoglobulin, methylprednisolone pulse, and other supportive cares without obvious results. Therefore, she underwent seven sessions of plasma exchange with little effects on muscle strength. The focal inflammation and injury of the spinal cord, otherwise known as transverse myelitis, have a wide array of potential etiologies. Transverse myelitis has been well documented to be the result of viral and bacterial infections. We believe our patient was not involved in a cytokine storm status due to good CRP, IL-6 and Ferritin levels. Albeit, we cannot certainly consider the patient to have a direct viral impactor involved in a late immunity process. To our knowledge, this is the first report of TM in the field of pediatrics occurred after COVID-19. Thus, this is critical to note that children can present with some severe types of COVID-19.
Collapse
Affiliation(s)
- Habibeh Nejad Biglari
- Pediatric Neurology, Neuroscience Research Center, institute of neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Reza Sinaei
- Pediatrics Rheumatology, Department of Pediatrics, Kerman University of Medical Sciences, Kerman, Iran
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Pezeshki
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Khajeh Hasani
- Department of Radiology, School of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
52
|
Attal N, Martinez V, Bouhassira D. Potential for increased prevalence of neuropathic pain after the COVID-19 pandemic. Pain Rep 2021; 6:e884. [PMID: 33537521 PMCID: PMC7850724 DOI: 10.1097/pr9.0000000000000884] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 12/25/2022] Open
Abstract
Although coronavirus disease 2019 (COVID-19) most commonly manifests with acute respiratory symptoms, one very common symptom of COVID-19 is pain. As COVID-19 often causes peripheral or central neurological complications, it is anticipated that a number of the chronic pain complications of COVID-19 will be neuropathic. This review first examines the most common viral infections responsible for neurological complications including neuropathic pain. These encompass herpes zoster, HIV, poliovirus, enteroviruses, and several tropical viruses. Neurological complications of COVID-19 including in particular Guillain-Barré syndrome, myelitis, and stroke are reviewed with regards to their potential risk of chronic neuropathic pain. Prospective longitudinal cohorts of patients should be implemented to evaluate the exact risk of neuropathic pain after COVID-19.
Collapse
Affiliation(s)
- Nadine Attal
- INSERM U 987, CETD, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
| | - Valéria Martinez
- INSERM U 987, CETD, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
- Université Versailles Saint Quentin, Versailles, France
- Department of Anesthesiology and Pain Unit, Hôpital Raymond Poincaré, APHP, Garches, France
| | - Didier Bouhassira
- INSERM U 987, CETD, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
- Université Versailles Saint Quentin, Versailles, France
| |
Collapse
|
53
|
Neurological manifestations of coronavirus disease 2019: exploring past to understand present. Neurol Sci 2021; 42:773-785. [PMID: 33428055 PMCID: PMC7798003 DOI: 10.1007/s10072-020-04964-8] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 infection, resulting in Coronavirus disease 2019 (COVID-19), has significantly affected the entire world. It was labelled a pandemic by World Health Organization. Although it commonly produces respiratory symptoms, neurological features have been described. Neurological manifestations may vary from non-specific symptoms such as headache, dizziness, myalgia and/or fatigue, olfactory or taste dysfunction to specific syndromes including meningitis, stroke, acute transverse myelitis and Guillain-Barre syndrome. This review describes potential pathogenetic mechanisms and neurological manifestations of COVID-19 along with its management. Considering structural and pathogenetic similarity of SARS-CoV-2 with SARS-CoV and MERS viruses, we compared their neurological manifestations and mentioned few features expected in COVID-19 in future. Interestingly, many COVID-19 cases may present with pure neurological manifestations at onset with non-neurological features manifesting few days later and we propose the term "Neuro-COVID syndrome" for such cases. Awareness of neurological manifestations may facilitate its management and improve outcome in such patients.
Collapse
|
54
|
Abstract
PURPOSE OF REVIEW We present biological and psychological factors implicated in psychiatric manifestations of SARS-CoV-2, as well as its neuroinvasive capability and immune pathophysiology. RECENT FINDINGS Preexisting mental illness leads to worse clinical outcomes in COVID-19. The presence of the virus was reported in the cerebrospinal fluid (CSF) and brain tissue post-mortem. Most common psychiatric manifestations include delirium, mood disorders, anxiety disorders, and posttraumatic stress disorder. "Long-COVID" non-syndromal presentations include "brain-fogginess," autonomic instability, fatigue, and insomnia. SARS-CoV-2 infection can trigger prior vulnerabilities based on the priming of microglia and other cells, induced or perpetuated by aging and mental and physical illnesses. COVID-19 could further induce priming of neuroimmunological substrates leading to exacerbated immune response and autoimmunity targeting structures in the central nervous system (CNS), in response to minor immune activating environmental exposures, including stress, minor infections, allergens, pollutants, and traumatic brain injury.
Collapse
|
55
|
Khedr EM, Karim AA, Soliman RK. Case Report: Acute Spinal Cord Myelopathy in Patients With COVID-19. Front Neurol 2020; 11:610648. [PMID: 33414763 PMCID: PMC7784375 DOI: 10.3389/fneur.2020.610648] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 11/16/2020] [Indexed: 12/23/2022] Open
Abstract
COVID-19 is typically associated with fever and severe respiratory symptoms including dry cough and dyspnea. However, COVID-19 may also affect both central and peripheral nervous systems. To date, the incidence rate of spinal cord involvement in COVID-19 is not known and the pathogenesis is still not fully understood. We report here two female patients admitted to Assiut University Hospitals/Egypt during the period from first of July to August 10, 2020. Both presented with a positive SARS-CoV-2 polymerase chain reaction (PCR) nasopharyngeal swab, elevated serum d-dimer and ferritin levels, and bilateral ground glass appearance in a CT chest scan. The first was a 60-year-old female with acute onset of flaccid paraplegia 10 days after flu-like symptoms, in whom MRI revealed transverse myelitis. The second was a 21-year-old female with symptoms of acute quadriplegia, fever, headache, and anosmia in whom an MRI scan revealed long cervico-thoracic myelopathy. Anterior spinal artery occlusion and possibly transverse myelitis were considered as differential diagnosis of long segment myelopathy.
Collapse
Affiliation(s)
- Eman M Khedr
- Department of Neuropsychiatry, Assiut University Hospitals, Assiut, Egypt
| | - Ahmed A Karim
- Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Radwa K Soliman
- Department of Radiology, Assiut University Hospitals, Assiut, Egypt
| |
Collapse
|
56
|
Nagu P, Parashar A, Behl T, Mehta V. CNS implications of COVID-19: a comprehensive review. Rev Neurosci 2020; 32:219-234. [PMID: 33550782 DOI: 10.1515/revneuro-2020-0070] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 10/03/2020] [Indexed: 02/06/2023]
Abstract
COVID-19 was first reported in December 2019 in the Wuhan city of China, and since then it has spread worldwide taking a heavy toll on human life and economy. COVID-19 infection is commonly associated with symptoms like coughing, fever, and shortness of breath, besides, the reports of muscle pain, anosmia, hyposmia, and loss of taste are becoming evident. Recent reports suggest the pathogenic invasion of the SARS-CoV-2 into the CNS, that could thereby result in devastating long term complications, primarily because some of these complications may go unnoticed for a long time. Evidence suggest that the virus could enter the CNS through angiotensin-converting enzyme-2 (ACE-2) receptor, neuronal transport, haematogenous route, and nasal route via olfactory bulb, cribriform plate, and propagates through trans-synaptic signalling, and shows retrograde movement into the CNS along nerve fiber. COVID-19 induces CNS inflammation and neurological degenerative damage through a diverse mechanism which includes ACE-2 receptor damage, cytokine-associated injury or cytokine storm syndrome, secondary hypoxia, demyelination, blood-brain barrier disruption, neurodegeneration, and neuroinflammation. Viral invasion into the CNS has been reported to show association with complications like Parkinsonism, Alzheimer's disorder, meningitis, encephalopathy, anosmia, hyposmia, anxiety, depression, psychiatric symptoms, seizures, stroke, etc. This review provides a detailed discussion of the CNS pathogenesis of COVID-19. Authors conclude that the COVID-19 cannot just be considered as a disorder of the pulmonary or peripheral system, rather it has a significant CNS involvement. Therefore, CNS aspects of the COVID-19 should be monitored very closely to prevent long term CNS complications, even after the patient has recovered from COVID-19.
Collapse
Affiliation(s)
- Priyanka Nagu
- Department of Pharmaceutics, Government College of Pharmacy, Rohru, District Shimla, Himachal Pradesh, India
| | - Arun Parashar
- Faculty of Pharmaceutical Sciences, Shoolini University of Biotechnology and Management Sciences, Solan, District Shimla, Himachal Pradesh, India
| | - Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Rajpura, Punjab, India
| | - Vineet Mehta
- Department of Pharmacology, Government College of Pharmacy, Rohru 171207, District Shimla, Himachal Pradesh, India
| |
Collapse
|
57
|
Keyhanian K, Umeton RP, Mohit B, Davoudi V, Hajighasemi F, Ghasemi M. SARS-CoV-2 and nervous system: From pathogenesis to clinical manifestation. J Neuroimmunol 2020; 350:577436. [PMID: 33212316 PMCID: PMC7647896 DOI: 10.1016/j.jneuroim.2020.577436] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/21/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023]
Abstract
Since the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a growing body of evidence indicates that besides common COVID-19 symptoms, patients may develop various neurological manifestations affecting both the central and peripheral nervous systems as well as skeletal muscles. These manifestations can occur prior, during and even after the onset of COVID-19 general symptoms. In this Review, we discuss the possible neuroimmunological mechanisms underlying the nervous system and skeletal muscle involvement, and viral triggered neuroimmunological conditions associated with SARS-CoV-2, as well as therapeutic approaches that have been considered for these specific complications worldwide.
Collapse
Affiliation(s)
- Kiandokht Keyhanian
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA
| | - Raffaella Pizzolato Umeton
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA; Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Babak Mohit
- Sleep Disorders Center, Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Vahid Davoudi
- Ann Romney Center for Neurologic Diseases, Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | - Fatemeh Hajighasemi
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
| | - Mehdi Ghasemi
- Department of Neurology, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| |
Collapse
|
58
|
Abstract
Purpose of Review Coronavirus disease 2019 (COVID-19) has become a global health crisis of our time. The disease arises from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that binds to angiotensin-converting enzyme 2 (ACE2) receptors on host cells for its internalization. COVID-19 has a wide range of respiratory symptoms from mild to severe and affects several other organs, increasing the complexity of the treatment. There is accumulating evidence to suggest that SARS-CoV-2 can target the nervous system. In this review, we provide an account of the COVID-19 central nervous system (CNS) manifestations. Recent Findings A broad spectrum of the CNS manifestations including headache, impaired consciousness, delirium, loss of smell and taste, encephalitis, seizures, strokes, myelitis, acute disseminated encephalomyelitis, neurogenic respiratory failure, encephalopathy, silent hypoxemia, generalized myoclonus, neuroleptic malignant syndrome and Kawasaki syndrome has been reported in patients with COVID-19. Summary CNS manifestations associated with COVID-19 should be considered in clinical practice. There is a need for modification of current protocols and standing orders to provide better care for COVID-19 patients presenting with neurological symptoms.
Collapse
|
59
|
Verma K, Amitabh, Prasad DN, Kumar B, Kohli E. Brain and COVID-19 Crosstalk: Pathophysiological and Psychological Manifestations. ACS Chem Neurosci 2020; 11:3194-3203. [PMID: 33006881 DOI: 10.1021/acschemneuro.0c00446] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The world is experiencing one of the major viral outbreaks of this millennium, caused by a plus sense single-stranded RNA virus belonging to the Coronaviridae family, COVID-19, declared as pandemic by WHO. The clinical manifestations vary from asymptomatic to mild symptoms like fever, dry cough, and diarrhea, with further increase in severity leading to the development of acute respiratory distress syndrome. Though primary manifestations are respiratory and cardiac, various studies have shown the neuroinvasive capability of this virus resulting in neurological complications, which sometimes can precede common typical symptoms like fever and cough. Common neurological symptoms are headache, dizziness, anosmia, dysgeusia, confusion, and muscle weakening, progressing toward severe complications like cerebrovascular disease, seizures, or paralysis. Older adults and critically ill people are in the high risk group and have shown severe neurological symptoms upon infection. COVID-19 also has a profound impact on the mental health of people across the world. In this review, we briefly discuss the neurological pathologies and psychological impact due to COVID-19, which has not only stressed the physical health of people but has also created social and economic problems resulting in mental health issues.
Collapse
Affiliation(s)
- Kalyani Verma
- Neurobiology Division, Defence Institute of Physiology and Allied Sciences, Delhi 110054, India
| | - Amitabh
- Neurobiology Division, Defence Institute of Physiology and Allied Sciences, Delhi 110054, India
| | - Dipti N. Prasad
- Neurobiology Division, Defence Institute of Physiology and Allied Sciences, Delhi 110054, India
| | - Bhuvnesh Kumar
- Defence Institute of Physiology and Allied Sciences, Delhi 110054, India
| | - Ekta Kohli
- Neurobiology Division, Defence Institute of Physiology and Allied SciencesDefence Research and Development Organization, Ministry of Defence, Lucknow Road, Timarpur, Delhi 110054, India
| |
Collapse
|
60
|
Águila-Gordo D, Manuel Flores-Barragán J, Ferragut-Lloret F, Portela-Gutierrez J, LaRosa-Salas B, Porras-Leal L, Carlos Villa Guzmán J. Acute myelitis and SARS-CoV-2 infection. A new etiology of myelitis? J Clin Neurosci 2020; 80:280-281. [PMID: 33099361 PMCID: PMC7525324 DOI: 10.1016/j.jocn.2020.07.074] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 12/22/2022]
Abstract
The etiological agent of coronavirus disease-19 (COVID-19), SARS-coronavirus-2 (SARS-CoV-2), emerged in Wuhan, China, and quickly spread worldwide leading the World Health Organization (WHO) to recognize it not only as a pandemic but also as an important thread to public health. Beyond respiratory symptoms, new neurological manifestations are being identified such as headache, ageusia, anosmia, encephalitis or acute cerebrovascular disease. Here we report the case of an acute transverse myelitis (TM) in a patient with SARS-CoV-2 infection detected by the nasopharyngeal swab technique but not in cerebrospinal fluid (CSF) analysis. Anti-herpes simplex virus (HSV) 1 and varicella-zoster IgM antibodies were not detected in serum samples and spinal and brain magnetic resonance imaging (MRI) showed no abnormal findings. This case remarks that COVID-19 nervous system damage could be caused by immune-mediated mechanisms.
Collapse
Affiliation(s)
- Daniel Águila-Gordo
- Cardiology Department, University Hospital of Ciudad Real, Obispo Torija s/n, 13005, Ciudad Real, Spain.
| | | | | | | | | | | | | |
Collapse
|
61
|
Saini SK, Anand KS, Juneja A, Mahajan RK. Neurological Problems in COVID-19 Pandemic. ANNALS OF THE NATIONAL ACADEMY OF MEDICAL SCIENCES (INDIA) 2020. [DOI: 10.1055/s-0040-1717833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
AbstractCoronavirus disease 2019 (COVID-19) is a potentially severe acute respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This outbreak, which emerged in Wuhan city, rapidly spread throughout China and has now become a global public health concern. SARS-CoV-2 is a highly pathogenic and transmissible virus. Common clinical manifestations of COVID-19 include fever, dry cough, shortness of breath, muscle ache, headache, and confusion. Currently, there is no confirmed effective therapeutic strategy for COVID-19 because the pathological mechanism is poorly understood. In addition to the respiratory system involvement, recent evidence has shown that SARS-CoV-2 can affect other organ systems including nervous, vascular, digestive, and urinary system. Various neurological complications have also been described in various studies. Nervous system involvement in the case of SARS-CoV-2 is explained by direct neuro invasion, immune mechanism, and other systemic factors. Neurological complications due to SARS-CoV-2 include both central and peripheral nervous system involvement. Central nervous system complications range from mild headache to seizures, encephalitis, myelitis, and acute cerebrovascular accidents. Peripheral nervous system complications range from vague muscle pains to Guillain–Barré syndrome. This article briefly discusses the various neurological and mental health issues related to COVID-19.
Collapse
Affiliation(s)
- Shiv Kumar Saini
- Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | | - Abhishek Juneja
- Department of Neurology, Dr Ram Manohar Lohia Hospital, New Delhi, India
| | | |
Collapse
|
62
|
Förster M, Weyers V, Küry P, Barnett M, Hartung HP, Kremer D. Neurological manifestations of severe acute respiratory syndrome coronavirus 2-a controversy 'gone viral'. Brain Commun 2020; 2:fcaa149. [PMID: 33210085 PMCID: PMC7543269 DOI: 10.1093/braincomms/fcaa149] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 08/18/2020] [Accepted: 08/20/2020] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 first appeared in December 2019 in Wuhan, China, and developed into a worldwide pandemic within the following 3 months causing severe bilateral pneumonia (coronavirus disease 2019) with in part fatal outcomes. After first experiences and tentative strategies to face this new disease, several cases were published describing severe acute respiratory syndrome coronavirus 2 infection related to the onset of neurological complaints and diseases such as, for instance, anosmia, stroke or meningoencephalitis. Of note, there is still a controversy about whether or not there is a causative relation between severe acute respiratory syndrome coronavirus 2 and these neurological conditions. Other concerns, however, seem to be relevant as well. This includes not only the reluctance of patients with acute neurological complaints to report to the emergency department for fear of contracting severe acute respiratory syndrome coronavirus 2 but also the ethical and practical implications for neurology patients in everyday clinical routine. This paper aims to provide an overview of the currently available evidence for the occurrence of severe acute respiratory syndrome coronavirus 2 in the central and peripheral nervous system and the neurological diseases potentially involving this virus.
Collapse
Affiliation(s)
- Moritz Förster
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Vivien Weyers
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Patrick Küry
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Michael Barnett
- Department of Neurology, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Hans-Peter Hartung
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
- Center of Neurology and Neuropsychiatry, LVR Klinikum, Medical Faculty, Heinrich-Heine-University, 40629 Düsseldorf, Germany
| | - David Kremer
- Department of Neurology, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| |
Collapse
|
63
|
Rahman A, Niloofa R, De Zoysa IM, Cooray AD, Kariyawasam J, Seneviratne SL. Neurological manifestations in COVID-19: A narrative review. SAGE Open Med 2020; 8:2050312120957925. [PMID: 32974019 PMCID: PMC7491214 DOI: 10.1177/2050312120957925] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/20/2020] [Indexed: 01/05/2023] Open
Abstract
COVID-19, a respiratory viral infection, has affected more than 10 million individuals worldwide. Common symptoms include fever, dry cough, fatigue and shortness of breath. Some patients show neurological manifestations such as headache, dizziness, cerebrovascular disease, peripheral nerve and muscle symptoms and smell and taste impairment. In previous studies, SARS-CoV-1 and MERS-CoV were found to affect the nervous system. Given the high similarity between SARS-CoV-1 and SARS-CoV-2, effects on the nervous system by SARS-CoV-2 are a possibility. We have outlined the common neurological manifestations in COVID-19 (information are up-to-date as of June 2020) and discussed the possible pathogenetic mechanisms and management options.
Collapse
Affiliation(s)
- Asma Rahman
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Roshan Niloofa
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - Ishan M De Zoysa
- Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Akila D Cooray
- Department of Zoology and Environment Sciences, Faculty of Science, University of Colombo, Colombo, Sri Lanka
| | - Jayani Kariyawasam
- Institute of Biochemistry, Molecular Biology and Biotechnology, University of Colombo, Colombo, Sri Lanka
| | | |
Collapse
|
64
|
AlKetbi R, AlNuaimi D, AlMulla M, AlTalai N, Samir M, Kumar N, AlBastaki U. Acute myelitis as a neurological complication of Covid-19: A case report and MRI findings. Radiol Case Rep 2020; 15:1591-1595. [PMID: 32685076 PMCID: PMC7275163 DOI: 10.1016/j.radcr.2020.06.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 01/11/2023] Open
Abstract
During the recent outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 coronavirus, there is rising concerns about neurological complications of COVID-19. Fever, headache, and anosmia may occur early during the disease course. Other neurological sequalae such as encephalitis may occur in later phases. We report a case of acute myelitis in a 32-year old male COVID-19 positive patient who presented with a 2-day history of flu-like symptoms then sudden onset paraplegia and urinary retention. The incidence is not known and the pathogenesis of the disease behind this manifestation is still not fully understood. Nevertheless considering the broad differential diagnosis of acute myelitis, prompt clinical, and diagnostic work up was crucial to exclude other causes. Patients presenting with neurological symptoms such as loss of consciousness, ataxia, convulsions, status epilepticus, encephalitis, myelitis or neuritis should raise concerns for COVID-19 infection during this pandemic prompting early diagnosis and initiation of proper management.
Collapse
Affiliation(s)
- Reem AlKetbi
- Department of Radiology, Dubai Health Authority , PO Box 4545 Dubai, United Arab Emirates
| | - Dana AlNuaimi
- Department of Radiology, Dubai Health Authority , PO Box 4545 Dubai, United Arab Emirates
| | - Muna AlMulla
- Department of Radiology, Dubai Health Authority , PO Box 4545 Dubai, United Arab Emirates
| | - Nouf AlTalai
- Department of Neurology, Dubai Health Authority, PO Box 4545 Dubai, United Arab Emirates
| | - Mohammed Samir
- Department of Radiology, Dubai Health Authority , PO Box 4545 Dubai, United Arab Emirates
| | - Navin Kumar
- Department of Radiology, Dubai Health Authority , PO Box 4545 Dubai, United Arab Emirates
| | - Usama AlBastaki
- Department of Radiology, Dubai Health Authority , PO Box 4545 Dubai, United Arab Emirates
| |
Collapse
|
65
|
Chakraborty U, Chandra A, Ray AK, Biswas P. COVID-19-associated acute transverse myelitis: a rare entity. BMJ Case Rep 2020; 13:e238668. [PMID: 32843475 PMCID: PMC7449353 DOI: 10.1136/bcr-2020-238668] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/12/2020] [Indexed: 01/28/2023] Open
Abstract
SARS-CoV-2 has wreaked havoc globally and has claimed innumerable lives all over the world. Apart from the characteristic respiratory illness, this disease has been associated with florid extrapulmonary manifestations and complications. A 59-year-old female healthcare worker presented with features of acute-onset non-compressive myelopathy with a sensory level at T10 segment along with high-grade fever for 4 days. MRI of dorsal spine was suggestive of myelitis at T7 vertebral level. She was initiated on injectable steroids and did show some initial signs of recovery. A day later, she developed an acute-onset respiratory failure but could not be revived despite our best efforts. Her nasopharyngeal and oropharyngeal swab turned out to be positive for SARS-CoV-2 reverse transcriptase polymerase chain reaction (RT-PCR). We hereby report a case of acute transverse myelitis with COVID-19 as a probable aetiology.
Collapse
Affiliation(s)
| | - Atanu Chandra
- Internal Medicine, R G Kar Medical College and Hospital, Kolkata, India
| | - Aritra Kumar Ray
- Internal Medicine, R G Kar Medical College and Hospital, Kolkata, India
| | - Purbasha Biswas
- Internal Medicine, R G Kar Medical College and Hospital, Kolkata, India
| |
Collapse
|