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Mahmoud A, Romanato M, Squartini G, Ruggiero A, Spigarelli F, Morgantini A, De Tanti A, Spagnuolo C, Sawacha Z. Clinical gait analysis reveals altered walking patterns in critical Covid 19 survivors. Clin Biomech (Bristol, Avon) 2024; 118:106318. [PMID: 39116645 DOI: 10.1016/j.clinbiomech.2024.106318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 07/09/2024] [Accepted: 07/30/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Covid-19 has dramatically increased the number of admissions in intensive care units due to respiratory complications. In some cases, the arousal of neurological impairments, such as peripheral neuropathies, have been revealed. The purpose of this research was to characterize the gait pattern and muscle activity changes in Covid-19 survivors compared to physiological gait. METHODS Twelve post-Covid-19 participants admitted to intensive care units and twelve non-disabled controls were considered. Kinematics, kinetics and surface electromyographic data were collected for each participant during walking. Post Covid-19 participants were further divided into two sub-groups, according to the number of days spent in the intensive care units. Lower limb joint angles, moments and powers were extracted as well as the muscle activity of four muscles bilaterally, the spatial, temporal and spatiotemporal parameters of gait and the ground reaction forces. The extracted variables were compared through OneWay-ANOVA or Kruskal-Wallis tests where appropriate (p < 0.05). FINDINGS Overall, the considered parameters revealed statistically significant reduction in gait speed, cadence, range of motion in the sagittal plane, anteroposterior and vertical ground reaction forces between pathological and control participants. Larger alterations of the gait patterns were highlighted in the post-Covid-19 group hospitalized in intensive care units longer than 35 days, where a reduced muscle activity was observed on all the analyzed muscles. INTERPRETATION Results suggested that the severity of gait impairments in post-Covid-19 participants might be correlated with intensive care units-bedding period. Gait biomechanics assessment could be adopted in the clinical decision-making process to improve treatment protocols in post-Covid-19 survivors.
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Affiliation(s)
| | - Marco Romanato
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Giulia Squartini
- Department of Information Engineering, University of Padova, Padova, Italy
| | - Antonio Ruggiero
- Santo Stefano Rehabilitation Institute, KOS Care, Porto Potenza Picena, Macerata, Italy
| | - Francesco Spigarelli
- Santo Stefano Rehabilitation Institute, KOS Care, Porto Potenza Picena, Macerata, Italy
| | - Antonello Morgantini
- Santo Stefano Rehabilitation Institute, KOS Care, Porto Potenza Picena, Macerata, Italy
| | | | - Chiara Spagnuolo
- Santo Stefano Rehabilitation Institute, KOS Care, Porto Potenza Picena, Macerata, Italy
| | - Zimi Sawacha
- Department of Information Engineering, University of Padova, Padova, Italy.
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Morishima Y, Hata T, Nakajima S, Shindo K, Tsuchiya M, Watanabe T, Tahara I, Kondo T, Kimura A, Shimohata T, Ueno Y. Case report: Atypical case of autoimmune glial fibrillary acidic protein astrocytopathy following COVID-19 vaccination refractory to immunosuppressive treatments. Front Immunol 2024; 15:1361685. [PMID: 38665914 PMCID: PMC11043467 DOI: 10.3389/fimmu.2024.1361685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/29/2024] [Indexed: 04/28/2024] Open
Abstract
A 54-year-old Japanese man presented with headache and fever the day after SARS-CoV-2 vaccination. He became deeply unconscious within a week. Brain MRI showed periventricular linear enhancements and a few spotty lesions in the cerebral white matter. Cerebrospinal fluid (CSF) testing showed mild pleocytosis. He was treated with intravenous methylprednisolone and plasma exchange. However, the white matter lesions enlarged to involve the brainstem and cerebellum, and long cord spinal lesions appeared. Anti-glial fibrillary acidic protein (GFAP) antibody was positive in the CSF and serum, and he was therefore diagnosed as autoimmune GFAP-astrocytopathy (GFAP-A). In addition, high-dose immunoglobulin therapy was administered twice, but his symptoms did not improve; the white matter lesions enlarged further, and modified Rankin Scale score increased to 5. A brain biopsy specimen showed infiltration of macrophages and CD4 + lymphocytes together with neuron and oligodendrocytic injuries and glial scar. Although GFAP-A generally responds well to steroids, the present case developed GFAP-A following SARS-CoV-2 vaccination, with refractory to intensive immunosuppressive therapy and atypical pathologic findings of infiltration of CD4 + lymphocytes and demyelination.
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Affiliation(s)
- Yuto Morishima
- Department of Neurology, University of Yamanashi, Chuo, Japan
| | - Takanori Hata
- Department of Neurology, University of Yamanashi, Chuo, Japan
| | - Sho Nakajima
- Department of Neurology, University of Yamanashi, Chuo, Japan
| | - Kazumasa Shindo
- Department of Neurology, University of Yamanashi, Chuo, Japan
| | - Mai Tsuchiya
- Department of Neurology, University of Yamanashi, Chuo, Japan
| | | | - Ippei Tahara
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Chuo, Japan
| | - Akio Kimura
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Takayoshi Shimohata
- Department of Neurology, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Yuji Ueno
- Department of Neurology, University of Yamanashi, Chuo, Japan
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Deng B, Wang J, Yu H, Jin L, Qiu Y, Liu X, Wang P, Zhang X, Chen X. Area Postrema Syndrome in Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy. NEUROLOGY - NEUROIMMUNOLOGY NEUROINFLAMMATION 2022; 9:9/6/e200029. [PMID: 36163176 PMCID: PMC9513980 DOI: 10.1212/nxi.0000000000200029] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 08/01/2022] [Indexed: 11/18/2022]
Abstract
Background and Objectives To report the frequency of area postrema syndrome (APS) in glial fibrillary acidic protein-immunoglobulin G (GFAP-IgG)–positive patients and emphasize the importance of APS among the phenotypes in autoimmune GFAP astrocytopathy. Methods Eight GFAP-IgG–positive cases with APS were retrospectively identified during 2015–2021. The APS phenotypes were described. A literature review of 8 previously reported cases was also included in analysis. Results A total of 8 patients (11%) (1 woman, 7 men; mean age: 52.4 ± 18.4 years) presented with APS in a cohort of 74 GFAP-IgG–positive patients, 3 of whom (4%) had disease onset with APS. All patients had hiccups, and hiccups was the unique symptom of APS in 5 patients. The median time from disease onset to APS occurrence was 2 days (range 0–20), and the mean duration of APS episodes was 23.6 ± 11.4 days. No patient had isolated APS attack. All episodes were completely resolved with a mean duration of 9.3 ± 5.4 days after immunotherapy. APS manifestations of 8 cases in previous studies showed similar features with our cases. In total, coexisting aquaporin-4-IgG was only detected in one of the 16 cases. Discussion APS could be an early, but not isolated clinical manifestation of autoimmune GFAP astrocytopathy. Hiccups was the predominant symptom of APS in this disorder. APS attacks of autoimmune GFAP astrocytopathy have good response to immunotherapy.
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Affiliation(s)
- Bo Deng
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Jingguo Wang
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Hai Yu
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Lei Jin
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Yue Qiu
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Xiaoni Liu
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Pengyu Wang
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Xiang Zhang
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China
| | - Xiangjun Chen
- From the Department of Neurology (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.), Huashan Hospital and Insitute of Neurology, Fudan University; National Center for Neurological Disorders (B.D., J.W., H.Y., L.J., Y.Q., X.L., P.W., X.Z., X.C.); and Human Phenome Institute (X.C.), Fudan University, Shanghai, China.
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