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Chang T, Wijeyekoon R, Keshavaraj A, Ranawaka U, Senanayake S, Ratnayake P, Senanayake B, Caldera MC, Pathirana G, Sirisena D, Wanigasinghe J, Gunatilake S. Neurological disorders associated with COVID-19 in Sri Lanka. BMC Neurol 2023; 23:351. [PMID: 37794324 PMCID: PMC10548601 DOI: 10.1186/s12883-023-03399-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Neurological manifestations of SARS-CoV-2 infection have been reported from many countries around the world, including the South Asian region. This surveillance study aimed to describe the spectrum of neurological disorders associated with COVID-19 in Sri Lanka. METHODS COVID-19 patients manifesting neurological disorders one week prior and up to six weeks after infection were recruited from all the neurology centres of the government hospitals in Sri Lanka from May 2021 - May 2022. Data was collected using a structured data form that was electronically transmitted to a central repository. All patients were evaluated and managed by a neurologist. Data were analysed using simple descriptive analysis to characterise demographic and disease related variables, and simple comparisons and logistic regression were performed to analyse outcomes and their associations. RESULTS One hundred and eighty-four patients with neurological manifestations associated with COVID-19 were recruited from all nine provinces in Sri Lanka. Ischaemic stroke (31%) was the commonest neurological manifestation followed by encephalopathy (13.6%), Guillain-Barre syndrome (GBS) (9.2%) and encephalitis (7.6%). Ischaemic stroke, encephalitis and encephalopathy presented within 6 days of onset of COVID-19 symptoms, whereas GBS and myelitis presented up to 10 days post onset while epilepsy and Bell palsy presented up to 20 - 40 days post onset. Haemorrhagic stroke presented either just prior to or at onset, or 10 - 25 days post onset of COVID-19 symptomatic infection. An increased frequency of children presenting with encephalitis and encephalopathy was observed during the Omicron variant predominant period. A poor outcome (no recovery or death) was associated with supplemental oxygen requirement during admission (Odds Ratio: 12.94; p = 0.046). CONCLUSIONS The spectrum and frequencies of COVID-19 associated neurological disorders in Sri Lanka were similar to that reported from other countries, with strokes and encephalopathy being the commonest. Requiring supplemental oxygen during hospitalisation was associated with a poor outcome.
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Affiliation(s)
- Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka.
| | - Ruwani Wijeyekoon
- Association of Sri Lankan Neurologists, Wijerama Mawatha, Colombo, Sri Lanka
| | | | - Udaya Ranawaka
- Department of Medicine, Faculty of Medicine, University of Kelaniya, Kelaniya, Sri Lanka
| | | | | | | | | | | | | | - Jithangi Wanigasinghe
- Department of Paediatrics, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Saman Gunatilake
- Department of Medicine, University of Sri Jayewardenepura, Nugegoda, Sri Lanka
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Magalhães JE, Sampaio Rocha-Filho PA. Neurological manifestations of COVID-19 in pregnancy: a cross-sectional study. J Neurovirol 2023; 29:472-478. [PMID: 37306922 DOI: 10.1007/s13365-023-01150-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/26/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023]
Abstract
The occurrence of neurological manifestations and complications in pregnant women compared to non-pregnant women with COVID-19 is unclear. This cross-sectional study included women aged over 18 years hospitalized with SARS-CoV-2 infection confirmed by RT-PCR from March to June 2020 in Recife, Brazil. We evaluated 360 women, including 82 pregnant patients who were significantly younger (27.5 vs. 53.6 years; p < 0.01) and less frequently obese (2.4% vs. 15.1%; p < 0.01) than the non-pregnant group. All pregnancies were confirmed using ultrasound imaging. Abdominal pain was the only more frequent COVID-19 manifestation during pregnancy (23.2% vs. 6.8%; p < 0.01), but was not associated with the outcomes. Almost half the pregnant women presented neurological manifestations, including anosmia (31.7%), headache (25.6%), ageusia (17.1%), and fatigue (12.2%). However, neurological manifestations occurred similarly in pregnant and non-pregnant women. Four (4.9%) pregnant women and 64 non-pregnant women (23%) presented delirium, but the frequency with age-adjustment was similar in the non-pregnant group. Pregnant women with COVID and preeclampsia (19.5%) or eclampsia (3.7%) were older (31.8 vs. 26.5 years; p < 0.01), and epileptic seizures occurred more often in association with eclampsia (18.8% vs. 1.5%; p < 0.01) regardless of previous epilepsy. There were three maternal deaths (3.7%), one dead fetus, and one miscarriage. The overall prognosis was good. There was no difference in prolonged hospital stay, the need for ICU and mechanical ventilation, or death when comparing pregnant and non-pregnant women.
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Affiliation(s)
- João Eudes Magalhães
- Department of Neurology, Faculdade de Ciências Médicas - Universidade de Pernambuco, Recife, Brazil
- Instituto de Medicina Integral Professor Fernando Figueira, Recife, Brazil
| | - Pedro A Sampaio Rocha-Filho
- Division of Neuropsychiatry, Centro de Ciências Médicas, Universidade Federal de Pernambuco (UFPE). Rua General Joaquim Inacio, 830, Sala 1412 - Edf The Plaza Business Center, Recife, Pernambuco, CEP: 50070-495, Brazil.
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Catherine C, Veitinger J, Chou SHY. COVID-19 and Cerebrovascular Disease. Semin Neurol 2023. [PMID: 37216977 DOI: 10.1055/s-0043-1768475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
COVID-19 has been associated with numerous neurological complications, with acute cerebrovascular disease being one of the most devastating complications. Ischemic stroke is the most common cerebrovascular complication of COVID-19, affecting between 1 and 6% of all patients. Underlying mechanisms for COVID-related ischemic strokes are thought to be due to vasculopathy, endotheliopathy, direct invasion of the arterial wall, and platelet activation. Other COVID-19-associated cerebrovascular complications include hemorrhagic stroke, cerebral microbleeds, posterior reversible encephalopathy syndrome, reversible cerebral vasoconstriction syndrome, cerebral venous sinus thrombosis, and subarachnoid hemorrhage. This article discusses the incidence of these cerebrovascular complications, risk factors, management strategies, prognosis and future research directions, as well as considerations in pregnancy-related cerebrovascular events in the setting of COVID-19.
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Affiliation(s)
- Christina Catherine
- Department of Neurology, UPMC Altoona Regional Hospital, Altoona, Pennsylvania
| | - Julia Veitinger
- Division of Neurocritical Care, The Ken and Ruth Davee Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois
| | - Sherry H-Y Chou
- Division of Neurocritical Care, The Ken and Ruth Davee Department of Neurology, Northwestern Feinberg School of Medicine, Chicago, Illinois
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Parmar MP, Kathal R, Bhavanam S, Baskaran P, Varsaale N, Padamati B, Bhuchakra HP, C MF, Sahu S, Davalgi S. A Systematic Review of Neurological Complications in Pregnant Women With COVID-19. Cureus 2023; 15:e36388. [PMID: 37090385 PMCID: PMC10114004 DOI: 10.7759/cureus.36388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2023] [Indexed: 03/22/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has killed millions of people around the world so far and has turned into a disaster for people and healthcare systems. Neurological problems are often seen in people with COVID-19 in the general population, but it is unclear how common they are in pregnant women. This study provides a summary of studies on pregnant women with proven SARS-CoV-2 infection and a particular neurologic diagnosis from different parts of the world. After applying the inclusion and exclusion criteria, a total of 15 papers were assessed to create this review article. Based on our findings, the peripheral and central nervous systems were both equally impacted: Guillain-Barré syndrome (GBS, n=1), bifacial weakness, paresthesia, and vestibulocochlear neuritis (n=1), eclampsia types (n=2), and neurological disease (n=2); case reports, retrospective studies, editorials, and prospective observational studies were included. The median gestational age was 34 (30-36.5) weeks, and the median maternal age was 32.5 (25-35) years. Given the number of reports of neurologic problems associated with COVID-19 in the general community, our findings might be overstated, and we chose the ones that fit our criteria. We hope that this review helps in the early detection and management of neurological diseases during pregnancy.
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Magalhães JE, Sampaio‐Rocha‐Filho PA. Reply: Neurological disease in pregnant females with COVID-19 may not only be attributable to SARS-CoV-2. Acta Neurol Scand 2022; 146:201-202. [PMID: 35712940 PMCID: PMC9349437 DOI: 10.1111/ane.13663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 06/01/2022] [Indexed: 11/30/2022]
Affiliation(s)
- João Eudes Magalhães
- Department of Neurology, Faculdade de Ciências MédicasUniversidade de PernambucoRecifeBrazil
- Instituto de Medicina Integral Professor Fernando FigueiraRecifeBrazil
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Finsterer J. Neurological disease in pregnant females with COVID-19 may not only be attributable to SARS-CoV-2. Acta Neurol Scand 2022; 146:199-200. [PMID: 35561124 PMCID: PMC9348043 DOI: 10.1111/ane.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 05/01/2022] [Indexed: 12/23/2022]
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Mohamed MMG, Jadhav A, Banuelos P, Lacasse A, Kumar V. Acute motor axonal neuropathy following SARS-CoV-2 infection in the third trimester of pregnancy. Proc (Bayl Univ Med Cent) 2022; 35:871-873. [DOI: 10.1080/08998280.2022.2096348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
| | - Amar Jadhav
- Critical Care Medicine, SSM Health St. Mary’s Hospital, St. Louis, Missouri
| | - Polo Banuelos
- Division of Neurology and Neurophysiology, SSM Health St. Mary’s Hospital, St. Louis, Missouri
| | - Alexandre Lacasse
- Internal Medicine Department, SSM Health St. Mary's Hospital, St. Louis, Missouri
| | - Vikas Kumar
- Division of Neurology and Neurophysiology, SSM Health St. Mary’s Hospital, St. Louis, Missouri
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Diamond G, Merrick J. Editorial: Children's neurodevelopment in the post-COVID era: From hospital to community. Front Pediatr 2022; 10:976884. [PMID: 36313881 PMCID: PMC9597300 DOI: 10.3389/fped.2022.976884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 09/20/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gary Diamond
- Alyn Hospital for Children's Rehabilitation, Jerusalem, Israel.,Clalit Health Services, Children's Developmental Services: Jaljulya-Kfar Kasem and Ramleh Centers, Tel Aviv, Israel
| | - Joav Merrick
- National Institute of Child Health and Human Development, Jerusalem, Israel.,Department of Pediatrics, Mt Scopus Campus, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Kentucky Children's Hospital, University of Kentucky, Lexington, KY, United States.,Center for Healthy Development, School of Public Health, Georgia State University, Atlanta, GA, United States
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