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Massey D, Sawano M, Baker AD, Güthe DB, Güthe N, Shidlovsky SP, Fisher L, Grady CB, Caraballo C, Zhou T, Sharma R, Krumholz HM. Characterisation of internal tremors and vibration symptoms. BMJ Open 2023; 13:e077389. [PMID: 38154880 PMCID: PMC10759066 DOI: 10.1136/bmjopen-2023-077389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 11/16/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES To describe the experiences of patients who have postacute sequelae SARS-CoV-2 infection with internal vibrations and tremors as a prominent component, we leveraged the efforts by Survivor Corps, a grassroots COVID-19 patient advocacy group, to gather information from individuals belonging to its Facebook group with a history of COVID-19 suffering from vibrations and tremors. SETTING AND DESIGN A narrative analysis was performed on 140 emails and 450 social media comments from 140 individuals collected as a response to a call to >180 000 individuals participating in Survivor Corps between 15 July and 27 July 2021. We used common coding techniques and the constant comparative method for qualitative data synthesis and categorising emails. Coded data were entered into NVivo V.12 to identify recurrent themes, theme connections and supporting quotations. Comments were analysed using Word Clouds, generated with R V.4.0.3 using quanteda, wordcloud and tm packages. MAIN OUTCOME MEASURES Patient-reported long COVID symptom themes and domains related to internal tremors and vibration. RESULTS The respondents' emails represented 22 themes and 7 domains pertaining to their experience with internal tremor and vibrations. These domains were as follows: (1) symptom experience, description and anatomic location; (2) initial symptom onset; (3) symptom timing; (4) symptom triggers or alleviators; (5) change from baseline health status; (6) experience with medical establishment and (7) impact on individuals' lives and livelihood. There were 22 themes in total, each corresponding to one of the broader domains. Among the responses, many described symptoms that varied in location, timing and triggers, occurred soon after their COVID-19 infection, and were markedly debilitating. There were often frustrating experiences with the healthcare system. CONCLUSIONS This study describes key themes and experiences among a group of people reporting long COVID and having a prolonged and debilitating symptom complex that prominently features internal tremors and vibrations.
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Affiliation(s)
- Dorothy Massey
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Mitsuaki Sawano
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anna D Baker
- Section of Stroke and Vascular Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Nick Güthe
- Survivor Corps, Washington, DC, Washington, USA
| | | | - Liza Fisher
- Survivor Corps, Washington, DC, Washington, USA
| | - Connor B Grady
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Cesar Caraballo
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Tianna Zhou
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Richa Sharma
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale University, New Haven, Connecticut, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
- Center for Infection and Immunity, Yale School of Medicine, New Haven, Connecticut, USA
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2
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Lin TPH, Sen M, Gupta V, Agrawal R, Lanzetta P, Giannaccare G, Chan CKM, Agrawal K, Menia NK, Rojas-Carabali W, Arora A, Martinuzzi D, Taloni A, Rubinato L, Coco G, Sarao V, Veritti D, Chen L, Honavar SG, Lam DSC. Update on coronavirus disease 2019: Ophthalmic Manifestations and Adverse Reactions to Vaccination. Asia Pac J Ophthalmol (Phila) 2023; 12:512-536. [PMID: 38117598 DOI: 10.1097/apo.0000000000000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/12/2023] [Indexed: 12/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 was one of the most devastating public health issues in recent decades. The ophthalmology community is as concerned about the COVID-19 pandemic as the global public health community is, as COVID-19 was recognized to affect multiple organs in the human body, including the eyes, early in the course of the outbreak. Ophthalmic manifestations of COVID-19 are highly variable and could range from mild ocular surface abnormalities to potentially sight and life-threatening orbital and neuro-ophthalmic diseases. Furthermore, ophthalmic manifestations may also be the presenting or the only findings in COVID-19 infections. Meanwhile, global vaccination campaigns to attain herd immunity in different populations are the major strategy to mitigate the pandemic. As novel vaccinations against COVID-19 emerged, so were reports on adverse ophthalmic reactions potentially related to such. As the world enters a post-pandemic state where COVID-19 continues to exist and evolve as an endemic globally, the ophthalmology community ought to be aware of and keep abreast of the latest knowledge of ophthalmic associations with COVID-19 and its vaccinations. This review is a summary of the latest literature on the ophthalmic manifestations of COVID-19 and the adverse ophthalmic reactions related to its vaccinations.
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Affiliation(s)
- Timothy P H Lin
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Mrittika Sen
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Raghunath Netralaya, Mumbai, India
| | - Vishali Gupta
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rupesh Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
- Moorfields Eye Hospital, NHS Foundation Trust, London, UK
- Singapore Eye Research Institute, The Academia, Singapore, Singapore
- Duke NUS Medical School, National University of Singapore, Singapore
| | - Paolo Lanzetta
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Giuseppe Giannaccare
- Department of Surgical Sciences, Eye Clinic, University of Cagliari, Cagliari, Italy
| | - Carmen K M Chan
- Department of Ophthalmology and Visual Sciences, The Chinese University of Hong Kong, Hong Kong, China
- Hong Kong Eye Hospital, Hong Kong, China
| | - Kajal Agrawal
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
| | - Nitin Kumar Menia
- All India Institute of Medical Sciences, Jammu, Jammu and Kashmir, India
| | - William Rojas-Carabali
- Lee Kong Chiang School of Medicine, Nanyang Technological University, Singapore
- Department of Ophthalmology, Tan Tock Seng Hospital, Singapore
| | - Atul Arora
- Department of Ophthalmology, Advanced Eye Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Andrea Taloni
- University Magna Graecia of Catanzaro, Viale Europa, Catanzaro, Italy
| | - Leopoldo Rubinato
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Giulia Coco
- Department of Clinical Science and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Valentina Sarao
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
- Istituto Europeo di Microchirurgia Oculare, Udine, Italy
| | - Daniele Veritti
- Department of Medicine-Ophthalmology, University of Udine, Udine, Italy
| | - Lizhen Chen
- C-MER (Shenzhen) Dennis Lam Eye Hospital, Shenzhen, China
| | - Santosh G Honavar
- Ocular Oncology and Ophthalmic Plastic Surgery Services, Centre for Sight Eye Hospital, Hyderabad, India
| | - Dennis S C Lam
- The International Eye Research Institute of The Chinese University of Hong Kong (Shenzhen), Shenzhen, China
- The C-MER Dennis Lam and Partners Eye Center, C-MER International Eye Care Group, Hong Kong, China
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3
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Pillai KS, Misra S, Siripurapu G, Aliyar A, Bhat P, Rajan R, Srivastava A, Goyal V, Venkitachalam A, Radhakrishnan DM. De Novo Movement Disorders Associated with COVID-19- A Systematic Review of Individual Patients. Ann Indian Acad Neurol 2023; 26:702-707. [PMID: 38022478 PMCID: PMC10666879 DOI: 10.4103/aian.aian_572_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/28/2023] [Accepted: 08/14/2023] [Indexed: 12/01/2023] Open
Abstract
Background COVID-19 infection is associated with neurological manifestations, including various types of movement disorders (MD). A thorough review of individual patients with COVID-19-induced MD would help in better understanding the clinical profile and outcome of these patients and in prognostication. Objective We conducted an individual patient-systematic review to study the clinical and imaging profile and outcomes of patients with COVID-19-associated MD. Methods A systematic literature search of PubMed, EMBASE, and Cochrane databases was conducted by two independent reviewers. Individual patient data COVID from case reports and case series on COVID-19-associated MD, published between December 2019 and December 2022, were extracted and analyzed. Results Data of 133 patients with COVID-19-associated MD from 82 studies were analyzed. Mean age was 55 ± 18 years and 77% were males. A mixed movement disorder was most commonly seen (41%); myoclonus-ataxia was the most frequent (44.4%). Myoclonus significantly correlated with age (odds ratio (OR) 1.02 P = 0.03, CI 1-1.04). Tremor had the longest latency to develop after SARS-CoV-2 infection [median (IQR) 21 (10-40) days, P = 0.009, CI 1.01-1.05]. At short-term follow-up, myoclonus improved (OR 14.35, P value = 0.01, CI 1.71-120.65), whereas parkinsonism (OR 0.09, P value = 0.002, CI 0.19-0.41) and tremor (OR 0.16, P value = 0.016, CI 0.04-0.71) persisted. Conclusion Myoclonus-ataxia was the most common movement disorder after COVID-19 infection. Myoclonus was seen in older individuals and usually improved. Tremor and parkinsonism developed after a long latency and did not improve in the short-term.
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Affiliation(s)
- Kanchana S. Pillai
- Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, Maharashtra, India
| | - Shubham Misra
- Department of Neurology, Yale University School of Medicine, New Haven, CT, USA
| | - Govinda Siripurapu
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Aminu Aliyar
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Priyanka Bhat
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Roopa Rajan
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Achal Srivastava
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Vinay Goyal
- Institute of Neurosciences, Medanta the Medicity, Gurugram, Haryana, India
| | - Anil Venkitachalam
- Department of Neurology, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India
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4
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Finsterer J, Scorza FA. Opsoclonus Myoclonus Ataxia Syndrome Due to SARS-CoV-2. Neuroophthalmology 2022; 47:1-6. [PMID: 36798867 PMCID: PMC9928447 DOI: 10.1080/01658107.2022.2128378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 09/02/2022] [Accepted: 09/11/2022] [Indexed: 12/23/2022] Open
Abstract
Opsoclonus myoclonus syndrome (OMS)/opsoclonus myoclonus ataxia syndrome (OMAS), also known as Kinsbourne's syndrome or 'dancing eyes-dancing feet' syndrome, is a rare central nervous system manifestation of COVID-19 but an increasing number of articles have reported patients in whom COVID-19 was complicated by OMS/OMAS. This narrative review aims at summarising and discussing current knowledge about the clinical presentation, diagnosis, treatment and outcome of SARS-CoV-2 associated OMS/OMAS. Altogether, 29 articles reporting 45 patients with SARS-CoV-2 associated OMS/OMAS were retrieved. Their ages ranged from 2 to 88 years. Three patients were children and the remainder adults. Gender was male in 32 patients and female in 13 patients. Opsoclonus was described in 29 patients, which was associated with myoclonus in 28 cases. Myoclonus was described in 43 patients, which was associated with opsoclonus and ataxia in 18 patients. Cerebral magnetic resonance imaging and cerebrospinal fluid investigations were not informative in the majority of the cases. OMS/OMAS was treated with steroids in 28 patients and with intravenous immunoglobulin (IVIG) in 15 patients. Clonazepam was given to 18 patients, levetiracetam to 13 patients, and sodium valproate to eight patients. Complete recovery was achieved in 12 cases and incomplete recovery in 22 cases. Diagnosing SARS-CoV-2 associated OMS/OMAS requires extensive neurological work up and exclusion of various differentials. SARS-CoV-2 associated OMS/OMAS may not always present with the full spectrum of manifestations but as an abortive syndrome. OMS/OMAS should not be missed as it usually responds favourably to steroids or IVIG.
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Affiliation(s)
- Josef Finsterer
- Neurology Department, Neurology & Neurophysiology Center, Vienna, Austria
| | - Fulvio A. Scorza
- Disciplina de Neurociência, Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM), São Paulo, Brasil
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5
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Dinkin M, Sathi S. Efferent neuro-ophthalmic complications of coronavirus disease 2019. Curr Opin Ophthalmol 2022; 33:471-484. [PMID: 36165417 DOI: 10.1097/icu.0000000000000904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW We set out to describe efferent neuro-ophthalmological complications that have been reported in association with coronavirus disease 2019 (COVID-19) infection. We describe syndromes affecting ocular motility and elaborate on mechanisms of disease, including para-infectious inflammation, hypercoagulability, endothelial damage, and direct neurotropic viral invasion. Despite global vaccination programs, COVID-19 continues to pose an international threat that may rarely result in diplopia or nystagmus. RECENT FINDINGS Efferent complications include cranial nerve palsies leading to diplopia, either isolated or in association with Miller Fisher syndrome. Nystagmus has been observed in the setting of hemorrhagic acute necrotizing encephalopathy and brainstem infarcts, and opsoclonus syndrome has been described. SUMMARY Observed neuro-ophthalmic associations need to be confirmed through larger comparative studies. Meanwhile, the range of possible complications should be recognized by neurologists and ophthalmologists alike, to facilitate faster diagnosis and treatment of both COVID-19 and its neuro-ophthalmic manifestations.
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Affiliation(s)
- Marc Dinkin
- Departments of Ophthalmology and Neurology, Weill Cornell Medical College
| | - Swetha Sathi
- M2, Weill Cornell Medical College, New York, New York, USA
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6
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Dacosta-Aguayo R, Lamonja-Vicente N, Chacón C, Carrasco-Ribelles LA, Montero-Alia P, Costa-Garrido A, García-Sierra R, López-Lifante VM, Moreno-Gabriel E, Massanella M, Puig J, Muñoz-Moreno JA, Mateu L, Prats A, Rodríguez C, Mataró M, Prado JG, Martínez-Cáceres E, Violán C, Torán-Monserrat P. Neurocognitive Profile of the Post-COVID Condition in Adults in Catalonia-A Mixed Method Prospective Cohort and Nested Case-Control Study: Study Protocol. Vaccines (Basel) 2022; 10:849. [PMID: 35746457 PMCID: PMC9230542 DOI: 10.3390/vaccines10060849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 05/22/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023] Open
Abstract
The diagnosis of the post-COVID condition is usually achieved by excluding other diseases; however, cognitive changes are often found in the post-COVID disorder. Therefore, monitoring and treating the recovery from the post-COVID condition is necessary to establish biomarkers to guide the diagnosis of symptoms, including cognitive impairment. Our study employs a prospected cohort and nested case-control design with mixed methods, including statistical analyses, interviews, and focus groups. Our main aim is to identify biomarkers (functional and structural neural changes, inflammatory and immune status, vascular and vestibular signs and symptoms) easily applied in primary care to detect cognitive changes in post-COVID cases. The results will open up a new line of research to inform diagnostic and therapeutic decisions with special considerations for cognitive impairment in the post-COVID condition.
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Affiliation(s)
- Rosalia Dacosta-Aguayo
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Comparative Medicine and Bioimaging Center (CMCiB), Germans Trias i Pujol Research Institute, 08916 Badalona, Spain;
- Department of Clinical Psychology and Psychobiology, University of Barcelona, 08035 Barcelona, Spain;
| | - Noemí Lamonja-Vicente
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
| | - Carla Chacón
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
| | - Lucia Amalía Carrasco-Ribelles
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
| | - Pilar Montero-Alia
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Centre d’Atenció Primària La Riera (Mataró 1), Institut Català de la Salut, 08302 Barcelona, Spain
| | - Anna Costa-Garrido
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
| | - Rosa García-Sierra
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Nursing Department, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Barcelona, Spain
| | - Victor M. López-Lifante
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
- Palau-Solità Healthcare Centre, Palau-Solità Plegamans Institut Català de la Salut, 08124 Barcelona, Spain
| | - Eduard Moreno-Gabriel
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Department of Social Psychology, Universitat Autònoma de Barcelona, Cerdanyola de Vallès, 08193 Bellaterra, Spain
| | - Marta Massanella
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (IGTP), Can Ruti Campus, 08916 Badalona, Spain; (M.M.); (L.M.); (J.G.P.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
| | - Josep Puig
- Comparative Medicine and Bioimaging Center (CMCiB), Germans Trias i Pujol Research Institute, 08916 Badalona, Spain;
| | - Jose A. Muñoz-Moreno
- Infectious Diseases Department, Fight against AIDS Foundation (FLS), Germans Trias i Pujol Hospital, Can Ruti Campus, 08916 Badalona, Spain; (J.A.M.-M.); (A.P.)
- Facultat de Psicologia i Ciències de l’Educació, Universitat Oberta de Catalunya (UOC), 08035 Barcelona, Spain
| | - Lourdes Mateu
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (IGTP), Can Ruti Campus, 08916 Badalona, Spain; (M.M.); (L.M.); (J.G.P.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- University of Vic-Central University of Catalonia (UVic-UCC), 08500 Vic, Spain
- Infectious Diseases Department, Fight against AIDS Foundation (FLS), Germans Trias i Pujol Hospital, Can Ruti Campus, 08916 Badalona, Spain; (J.A.M.-M.); (A.P.)
- Germans Trias i Pujol Hospital, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Anna Prats
- Infectious Diseases Department, Fight against AIDS Foundation (FLS), Germans Trias i Pujol Hospital, Can Ruti Campus, 08916 Badalona, Spain; (J.A.M.-M.); (A.P.)
| | - Carmina Rodríguez
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Sant Fost de Campcentelles Healthcare Centre, Sant Fost de Campcentelles, Institut Català de la Salut, 08105 Barcelona, Spain
| | - Maria Mataró
- Department of Clinical Psychology and Psychobiology, University of Barcelona, 08035 Barcelona, Spain;
| | - Julia G. Prado
- IrsiCaixa-AIDS Research Institute and Germans Trias i Pujol Health Research Institute (IGTP), Can Ruti Campus, 08916 Badalona, Spain; (M.M.); (L.M.); (J.G.P.)
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28029 Madrid, Spain
- Germans Trias i Pujol Research Institute, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
| | - Eva Martínez-Cáceres
- Immunology Department, FOCIS Center of Excellence—Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain;
- Immunology Division, Laboratori Clinic Metropolitana Nord (LCMN), Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Spain
- Department of Medicine, Faculty of Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Concepción Violán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
- Germans Trias i Pujol Research Institute, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Pere Torán-Monserrat
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain; (R.D.-A.); (N.L.-V.); (C.C.); (L.A.C.-R.); (P.M.-A.); (A.C.-G.); (R.G.-S.); (V.M.L.-L.); (E.M.-G.); (C.R.); (P.T.-M.)
- Direcció d’Atenció Primària Metropolitana Nord Institut Català de Salut, 08916 Mataró, Spain
- Multidisciplinary Research Group in Health and Society GREMSAS (2017 SGR 917), 08007 Barcelona, Spain
- Germans Trias i Pujol Research Institute, Universitat Autònoma de Barcelona, 08916 Badalona, Spain
- Department of Medicine, Faculty of Medicine, Universitat de Girona, 17003 Girona, Spain
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7
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Salari M, Zaker Harofteh B, Etemadifar M, Sedaghat N, Nouri H. Movement Disorders Associated with COVID-19. PARKINSON'S DISEASE 2021; 2021:3227753. [PMID: 34790346 PMCID: PMC8592762 DOI: 10.1155/2021/3227753] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 09/27/2021] [Accepted: 10/27/2021] [Indexed: 01/07/2023]
Abstract
As neurological complications associated with COVID-19 keep unfolding, the number of cases with COVID-19-associated de novo movement disorders is rising. Although no clear pathomechanistic explanation is provided yet, the growing number of these cases is somewhat alarming. This review gathers information from 64 reports of de novo movement disorders developing after/during infection with SARS-CoV-2. Three new cases with myoclonus occurring shortly after a COVID-19 infection are also presented. Treatment resulted in partial to complete recovery in all three cases. Although the overall percentage of COVID-19 patients who develop movement disorders is marginal, explanations on a probable causal link have been suggested by numerous reports; most commonly involving immune-mediated and postinfectious and less frequently hypoxic-associated and ischemic-related pathways. The current body of evidence points myoclonus and ataxia out as the most frequent movement disorders occurring in COVID-19 patients. Some cases of tremor, chorea, and hypokinetic-rigid syndrome have also been observed in association with COVID-19. In particular, parkinsonism may be of dual concern in the setting of COVID-19; some have linked viral infections with Parkinson's disease (PD) based on results from cerebrospinal fluid analyses, and PD is speculated to impact the outcome of COVID-19 in patients negatively. In conclusion, the present paper reviewed the demographic, clinical, and treatment-associated information on de novo movement disorders in COVID-19 patients in detail; it also underlined the higher incidence of myoclonus and ataxia associated with COVID-19 than other movement disorders.
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Affiliation(s)
- Mehri Salari
- Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Masoud Etemadifar
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nahad Sedaghat
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Network of Immunity in Infection Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
| | - Hosein Nouri
- Alzahra Research Institute, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
- Network of Immunity in Infection Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Isfahan, Iran
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8
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Emekli AS, Parlak A, Göcen NY, Kürtüncü M. Anti-GAD associated post-infectious cerebellitis after COVID-19 infection. Neurol Sci 2021; 42:3995-4002. [PMID: 34328578 PMCID: PMC8322110 DOI: 10.1007/s10072-021-05506-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 07/18/2021] [Indexed: 12/20/2022]
Abstract
The coronavirus disease 2019 (COVID-19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), continues to spread rapidly all over the world. Besides severe pneumonia, it causes multisystemic disease, including neurological findings. Here, we present a patient with anti–glutamic acid decarboxylase (anti-GAD) antibody-associated cerebellitis developed after COVID-19 infection. The patient responded well to the immune treatments. Our knowledge about SARS-CoV-2 infection–related neurological disorders is limited. New data are needed to recognize the clinical spectrum of autoimmune neurological disorders that emerges after SARS-CoV-2 infection.
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Affiliation(s)
- Ahmed Serkan Emekli
- Department of Neurology, Karabuk University Training and Research Hospital, Karabuk, Turkey.
| | - Asuman Parlak
- Department of Neurology, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Nejla Yılmaz Göcen
- Department of Infectious Diseases, Karabuk University Training and Research Hospital, Karabuk, Turkey
| | - Murat Kürtüncü
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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9
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New-Onset Movement Disorders Associated with COVID-19. Tremor Other Hyperkinet Mov (N Y) 2021; 11:26. [PMID: 34277139 PMCID: PMC8269765 DOI: 10.5334/tohm.595] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/29/2021] [Indexed: 12/13/2022] Open
Abstract
Introduction Movement disorders are increasingly described in hospitalized and milder cases of SARS-CoV-2 infection, despite a very low prevalence compared to the total patients. Methods We reviewed the scientific literature published in English, spanning from the initial descriptions of COVID-19 until January 25, 2021, in the PubMed/MEDLINE database. Results We identified 93 new-onset movement disorders cases (44 articles) from 200 papers screened in the database or reference lists. Myoclonus was present in 63.4% (n = 59), ataxia in 38.7% (n = 36), action/postural tremor in 10.8% (n = 10), rigid-akinetic syndrome in 5.38% (n = 5), oculomotor abnormalities in 20.4% (n = 19), catatonia in 2.1% (n = 2), dystonia in 1.1% (n = 1), chorea in 1.1% (n = 1), functional (psychogenic) movement disorders in 3.2% (n = 3) of the reported COVID-19 cases with any movement disorder. Encephalopathy was a common association (n = 37, 39.78%). Discussion Comprehensive neurophysiological, clinical, and neuroimaging descriptions of movement disorders in the setting of SARS-CoV-2 infection are still lacking, and their pathophysiology may be related to inflammatory, postinfectious, or even indirect mechanisms not specific to SARS-CoV-2, such as ischemic-hypoxic brain insults, drug effects, sepsis, kidney failure. Cortical/subcortical myoclonus, which the cited secondary mechanisms can largely cause, seems to be the most common hyperkinetic abnormal movement, and it might occur in association with encephalopathy and ataxia. Conclusion This brief review contributes to the clinical description of SARS-CoV-2 potential neurological manifestations, assisting clinical neurologists in identifying features of these uncommon syndromes as a part of COVID-19 symptomatology. Highlights - Movement disorders are probably uncommon neurological manifestations in SARS-CoV-2 infection;- Myoclonus is the most reported movement disorder associated with COVID-19, its clinical complications or pharmacological management;- The pathophysiology is yet not well-understood but can include systemic inflammation, autoimmune mechanisms, or hypoxia.
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10
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Tisdale AK, Dinkin M, Chwalisz BK. Afferent and Efferent Neuro-Ophthalmic Complications of Coronavirus Disease 19. J Neuroophthalmol 2021; 41:154-165. [PMID: 33935220 DOI: 10.1097/wno.0000000000001276] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE To provide a summary of the neuro-ophthalmic manifestations of coronavirus disease 19 (COVID-19) documented in the literature thus far. METHODS The PubMed and Google Scholar databases were searched using the keywords: Neuro-Ophthalmology, COVID-19, SARS-CoV-2, and coronavirus. A manual search through reference lists of relevant articles was also performed. RESULTS/CONCLUSIONS The literature on COVID-associated neuro-ophthalmic disease continues to grow. Afferent neuro-ophthalmic complications associated with COVID-19 include optic neuritis, papillophlebitis, papilledema, visual disturbance associated with posterior reversible encephalopathy syndrome, and vision loss caused by stroke. Efferent neuro-ophthalmic complications associated with COVID-19 include cranial neuropathies, Miller Fisher syndrome, Adie's pupils, ocular myasthenia gravis, nystagmus and eye movement disorders. Proposed mechanisms of neurologic disease include immunologic upregulation, vasodilation and vascular permeability, endothelial dysfunction, coagulopathy, and direct viral neurotropism. When patients present to medical centers with new onset neuro-ophthalmic conditions during the pandemic, COVID-19 infection should be kept on the differential.
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Affiliation(s)
- Alanna K Tisdale
- Department of Ophthalmology and Visual Sciences (AKT), University of Iowa Hospital and Clinics, University of Iowa Carver College of Medicine, Iowa City, Iowa; Departments of Ophthalmology and Neurology (MD), New York- Presbyterian Hospital, Weill Cornell Medical College, New York City, New York; Department of Ophthalmology (BKC), Massachusetts Eye & Ear; and Department of Neurology (BKC), Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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11
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Werner J, Reichen I, Huber M, Abela IA, Weller M, Jelcic I. Subacute cerebellar ataxia following respiratory symptoms of COVID-19: a case report. BMC Infect Dis 2021; 21:298. [PMID: 33761897 PMCID: PMC7988684 DOI: 10.1186/s12879-021-05987-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Severe acute respiratory syndrome virus 2 (SARS-CoV-2) is spreading globally and causes most frequently fever and respiratory symptoms, i.e. Coronavirus disease 2019 (COVID-19), however, distinct neurological syndromes associated with SARS-CoV-2 infection have been described. Among SARS-CoV-2-infections-associated neurological symptoms fatigue, headache, dizziness, impaired consciousness and anosmia/ageusia are most frequent, but less frequent neurological deficits such as seizures, Guillain-Barré syndrome or ataxia may also occur. Case presentation Herein we present a case of a 62-year-old man who developed a subacute cerebellar syndrome with limb-, truncal- and gait ataxia and scanning speech 1 day after clinical resolution of symptomatic SARS-CoV-2 infection of the upper airways. Apart from ataxia, there were no signs indicative of opsoclonus myoclonus ataxia syndrome or Miller Fisher syndrome. Cerebral magnetic resonance imaging showed mild cerebellar atrophy. SARS-CoV-2 infection of the cerebellum was excluded by normal cerebrospinal fluid cell counts and, most importantly, absence of SARS-CoV-2 RNA or intrathecal SARS-CoV-2-specific antibody production. Other causes of ataxia such as other viral infections, other autoimmune and/or paraneoplastic diseases or intoxication were ruled out. The neurological deficits improved rapidly after high-dose methylprednisolone therapy. Conclusions The laboratory and clinical findings as well as the marked improvement after high-dose methylprednisolone therapy suggest a post-infectious, immune-mediated cause of ataxia. This report should make clinicians aware to consider SARS-CoV-2 infection as a potential cause of post-infectious neurological deficits with an atypical clinical presentation and to consider high-dose corticosteroid treatment in case that a post-infectious immune-mediated mechanism is assumed.
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Affiliation(s)
- Jana Werner
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Ina Reichen
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Irene A Abela
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Michael Weller
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland
| | - Ilijas Jelcic
- Department of Neurology, University Hospital Zurich, Zurich, Switzerland. .,Neuroimmunology and Multiple Sclerosis Research Section, Department of Neurology, University Hospital Zurich, Zurich, Switzerland.
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12
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Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review. J Neurol 2021; 268:3517-3548. [PMID: 33616739 PMCID: PMC7897737 DOI: 10.1007/s00415-021-10458-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 02/09/2021] [Indexed: 12/28/2022]
Abstract
Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019, neurological manifestations have been recognized as potential complications. Relatively rare movement disorders associated with COVID-19 are increasingly reported in case reports or case series. Here, we present a case and systematic review of myoclonus and cerebellar ataxia associated with COVID-19. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline using the PubMed and Ovid MEDLINE databases, from November 1, 2019 to December 6, 2020. Results 51 cases of myoclonus or ataxia associated with COVID-19, including our case, were identified from 32 publications. The mean age was 59.6 years, ranging from 26 to 88 years, and 21.6% were female. Myoclonus was multifocal or generalized and had an acute onset, usually within 1 month of COVID-19 symptoms. Myoclonus occurred in isolation (46.7%), or with ataxia (40.0%) or cognitive changes (30.0%). Most cases improved within 2 months, and treatment included anti-epileptic medications or immunotherapy. Ataxia had an acute onset, usually within 1 month of COVID-19 symptoms, but could be an initial symptom. Concurrent neurological symptoms included cognitive changes (45.5%), myoclonus (36.4%), or a Miller Fisher syndrome variant (21.2%). Most cases improved within 2 months, either spontaneously or with immunotherapy. Conclusions This systematic review highlights myoclonus and ataxia as rare and treatable post-infectious or para-infectious, immune-mediated phenomena associated with COVID-19. The natural history is unknown and future investigation is needed to further characterize these movement disorders and COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10458-0.
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13
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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.
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Latorre A, Rothwell JC. Myoclonus and COVID-19: A Challenge for the Present, a Lesson for the Future. Mov Disord Clin Pract 2020; 7:888-890. [PMID: 33163558 PMCID: PMC7604694 DOI: 10.1002/mdc3.13103] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/05/2020] [Accepted: 10/07/2020] [Indexed: 12/11/2022] Open
Affiliation(s)
- Anna Latorre
- Department of Clinical and Movement NeurosciencesUniversity College London (UCL) Queen Square Institute of NeurologyLondonUnited Kingdom
| | - John C. Rothwell
- Department of Clinical and Movement NeurosciencesUniversity College London (UCL) Queen Square Institute of NeurologyLondonUnited Kingdom
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