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Ozer F, Alkan O. Simultaneous Sudden Hearing Loss and Peripheral Facial Paralysis in a Patient With Covid-19. EAR, NOSE & THROAT JOURNAL 2023; 102:NP559-NP564. [PMID: 34219500 DOI: 10.1177/01455613211028094] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Although peripheral facial paralysis and sudden sensorineural hearing loss are not as common as anosmia, they are reported neurological manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We present a 62-year-old, serologically COVID-19 positive woman with seventh and eighth nerve involvement showed electrophysiologically with Auditory Brainstem Response and electroneurography and radiologically with internal acoustic canal magnetic resonance imaging. This single case report suggests a possible association between the SARS-CoV-2 infection with simultaneous sudden sensorineural hearing loss and isolated facial paralysis. However, further studies are needed to determine whether this relationship is coincidental or occasional.
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Affiliation(s)
- Fulya Ozer
- Department of Otorhinolaryngology-Head and Neck Surgery, Baskent University Faculty of Medicine, Ankara, Turkey
| | - Ozlem Alkan
- Department of Radiology, Baskent University Faculty of Medicine, Ankara, Turkey
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2
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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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Bîrluţiu V, Bîrluţiu RM, Feiereisz AI, Dobriţoiu ES. Facial palsy at the onset of SARS-CoV-2 infection. A case report. Germs 2023; 13:65-71. [PMID: 38023955 PMCID: PMC10659744 DOI: 10.18683/germs.2023.1368] [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: 07/18/2022] [Revised: 01/06/2023] [Accepted: 01/31/2023] [Indexed: 12/01/2023]
Abstract
Introduction SARS-CoV-2 infection has been associated with an increased number of deaths, due to severe respiratory damage, cardiovascular impairment, acute renal failure, and also neurological injury, including stroke, which is most commonly responsible for death. These are elements that determine patients to seek medical advice. Case report This is a case report of a female Caucasian patient, aged 65 years, with type 2 diabetes mellitus on metformin 1000 mg twice/day, and hypertension, who presented to the emergency department with one day history of left orbital hyperlacrimation and chewing and swallowing difficulty. On physical examination there was a decreased blink reflex, flattened nasolabial fold, and drooping left corner of the mouth, with left conjunctival hyperemia, and a present corneal reflex. Motion limited head CT and MRI revealed no pathological changes suggestive for the appearance of paresis. The patient was transferred to the Department of Infectious Diseases after laboratory confirmation of SARS-CoV-2 infection. Under treatment, improvement of paresis after three days was observed, with minimal asymmetry left five days after admission. A reassessment one month after discharge revealed complete recovery of the paresis, physical asthenia, and headache, in the context of long-COVID syndrome. Conclusions The appearance of paresis may be a consequence of the direct action of the virus on the nervous system, of hypercoagulability, or, later, of an immune mechanism. The case presented is judged as an early, direct action of the virus on the central nervous system, the respiratory symptoms were minimized by the patient at the time of presentation.
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Affiliation(s)
- Victoria Bîrluţiu
- Prof. habil., MD, PhD, Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Romania and County Clinical Emergency Hospital, 2A Lucian Blaga street, 550169, Sibiu, Romania
| | - Rareş Mircea Bîrluţiu
- MD, PhD, FOIŞOR Clinical Hospital of Orthopedics, Traumatology, and Osteoarticular TB, 35-37 Ferdinand boulevard, District 2, 021382, Bucharest, Romania
| | - Alin Iulian Feiereisz
- MD, PhD student, Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Romania and County Clinical Emergency Hospital, 2A Lucian Blaga street, 550169, Sibiu, Romania
| | - Elena Simona Dobriţoiu
- MD, PhD student, Lucian Blaga University of Sibiu, Faculty of Medicine Sibiu, Romania and County Clinical Emergency Hospital, 2A Lucian Blaga street, 550169, Sibiu, Romania
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Khan AJ, Szczepura A, Palmer S, Bark C, Neville C, Thomson D, Martin H, Nduka C. Physical therapy for facial nerve paralysis (Bell's palsy): An updated and extended systematic review of the evidence for facial exercise therapy. Clin Rehabil 2022; 36:1424-1449. [PMID: 35787015 PMCID: PMC9510940 DOI: 10.1177/02692155221110727] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/09/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To conduct a systematic review of the effectiveness of facial exercise therapy for facial palsy patients, updating an earlier broader Cochrane review; and to provide evidence to inform the development of telerehabilitation for these patients. DATA SOURCES MEDLINE, EMBASE, CINAHL, Cochrane Library, PEDro and AMED for relevant studies published between 01 January 2011 and 30 September 2020. METHODS Predetermined inclusion/exclusion criteria were utilised to shortlist abstracts. Two reviewers independently appraised articles, systematically extracted data and assessed the quality of individual studies and reviews (using GRADE and AMSTAR-2, respectively). Thematic analysis used for evidence synthesis; no quantitative meta-analysis conducted. The review was registered with PROSPERO (CRD42017073067). RESULTS Seven new randomised controlled trials, nine observational studies, and three quasi-experimental or pilot studies were identified (n = 854 participants). 75% utilised validated measures to record changes in facial function and/or patient-rated outcomes. High-quality trials (4/7) all reported positive impacts; as did observational studies rated as high/moderate quality (3/9). The benefit of therapy at different time points post-onset and for cases of varying clinical severity is discussed. Differences in study design prevented data pooling to strengthen estimates of therapy effects. Six new review articles identified were all rated critically low quality. CONCLUSION The findings of this targeted review reinforce those of the earlier more general Cochrane review. New research studies strengthen previous conclusions about the benefits of facial exercise therapy early in recovery and add to evidence of the value in chronic cases. Further standardisation of study design/outcome measures and evaluation of cost-effectiveness are recommended.
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Affiliation(s)
- Amir J Khan
- Department of Economics, Institute of Business
Administration, Karachi, Pakistan
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Ala Szczepura
- Centre for Healthcare Research, Coventry University, Coventry, UK
| | - Shea Palmer
- Centre for Healthcare Research, Coventry University, Coventry, UK
- Centre for Care Excellence, Coventry University & University
Hospital Coventry & Warwickshire, Coventry, UK
| | - Chris Bark
- Lanchester Library, Coventry University, Coventry, UK
| | - Catriona Neville
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - David Thomson
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
| | - Helen Martin
- St Helens and Knowsley Teaching Hospitals
NHS Trust, Liverpool, UK
| | - Charles Nduka
- Queen Victoria Hospital NHS Foundation
Trust, East Grinstead, West Sussex, UK
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5
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Khurshid A, Khurshid M, Sohail A, Raza IM, Ahsan MK, Alam Shah MUF, Taseer AR, Nashwan AJ, Ullah I. Facial palsy as a manifestation of COVID-19: A systematic review of cases. Health Sci Rep 2022; 5:e887. [PMID: 36320650 PMCID: PMC9616168 DOI: 10.1002/hsr2.887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 11/06/2022] Open
Abstract
Background and Aims Facial palsy is a rare complication of the COVID-19 infection. Herein, we conducted a systematic review of all published cases of facial palsy post-COVID-19 infection in an attempt to educate the general population and medical practitioners regarding the likely occurrence of facial palsy in COVID-19 patients, its detection, effective treatment plan, and prognosis of the condition. Methods We searched PubMed, Google Scholar, and Directory of Open Access Journals (DOAJ) from December 1, 2019 to September 21, 2021. Results We included 49 studies bearing accounts of 75 cases who had facial palsy. The mean age of patients was 42.9 ± 19.59 years, with a male-to-female ratio of 8:7. The majority of the cases were reported from Brazil (n = 14), USA (n = 9), Turkey (n = 9), and Spain (n = 9). Noticeably, 30.14% of COVID-19 patients were diagnosed with Guillain-Barré syndrome. In total, 22.97% of patients complained of bilateral facial paralysis (n = 17), whereas ipsilateral paralysis was observed in 77.03% (n = 57). These were common complaints of Lagophthalmos, otalgia, facial drooping, dysarthria, and compromised forehead wrinkling. The treatment regimen mainly included the use of corticosteroids (n = 51) (69.86%), antivirals (n = 23) (31.51%), IVIG (n = 18) (24.66%), antibiotics (n = 13) (17.81%), antiretroviral (n = 9) (12.33%), and antimalarial (n = 8) (10.96%) medications. In all, 35.62% of patients (n = 26) adhered to a combination of antiviral and corticosteroid-based therapy. Positive treatment outcomes were observed in 83.58% (n = 56) of cases. In contrast, 10 patients (14.93%) showed nonsignificant recovery, out of which 3 (4.48%) died from the disease. Conclusion The association of facial palsy with COVID-19 is controversial and therefore requires further investigation and published work to confirm a causal relationship. However, physicians should not overlook the likelihood of facial palsy post-COVID-19 infection and treat it accordingly.
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Affiliation(s)
- Aiman Khurshid
- Department of Forensic Medicine Abbasi Shaheed Hospital Karachi Pakistan
| | - Maman Khurshid
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Aruba Sohail
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Imran Mansoor Raza
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | | | | | - Anab Rehan Taseer
- Department of Pulmonology, Lady Reading Hospital (LRH) Peshawar Pakistan
| | | | - Irfan Ullah
- Kabir Medical College Gandhara University Peshawar Pakistan
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6
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Cavalcante TM, Gubert VT, Lima CDD, Luciano LA, Croda MG, Venturini J, Gasparoto ALDB, Santiago WMS, Motta-Castro ARC, Reis FP, Marques APDC, Lorenz AP, Fava WS, Zardin MCSU, Chaves CEV, Braga GP, Paniago AMM, de Oliveira SMDVL. Late peripheral facial paralysis after COVID-19: a rapid systematic review and two case reports. J Venom Anim Toxins Incl Trop Dis 2022; 28:e20220020. [PMID: 36305011 PMCID: PMC9581522 DOI: 10.1590/1678-9199-jvatitd-2022-0020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 08/16/2022] [Indexed: 11/06/2022] Open
Abstract
Peripheral facial paralysis (PFP) has been shown to be a neurological manifestation of COVID-19. The current study presents two cases of PFP after COVID-19, along with a rapid review of known cases in the literature. Both case reports were conducted following CARE guidelines. We also performed a systematic review of PFP cases temporally related to COVID-19 using PubMed, Embase, and Cochrane Library databases on August 30, 2021, using a rapid review methodology. The two patients experienced PFP 102 and 110 days after COVID-19 symptom onset. SARS-CoV-2 RNA was detected in nasal samples through reverse-transcription real-time polymerase chain reaction (RT-qPCR) testing. Anosmia was the only other neurological manifestation. PFP was treated with steroids in both cases, with complete subsequent recovery. In the rapid review, we identified 764 articles and included 43 studies. From those, 128 patients with PFP were analyzed, of whom 42.1% (54/128) were male, 39.06% (50/128) female, and in 23 cases the gender was not reported. The age range was 18 to 59 (54.68%). The median time between COVID-19 and PFP was three days (ranging from the first symptom of COVID-19 to 40 days after the acute phase of infection). Late PFP associated with COVID-19 presents mild symptoms and improves with time, with no identified predictors. Late PFP should be added to the spectrum of neurological manifestations associated with the long-term effects of SARS-CoV-2 infection as a post COVID-19 condition.
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Affiliation(s)
| | - Vanessa Terezinha Gubert
- Graduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.,Maria Aparecida Pedrossian University Hospital (UFMS/EBSERH), Campo Grande, MS, Brazil
| | - Carolina de Deus Lima
- School of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Larissa Anjos Luciano
- School of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Mariana Garcia Croda
- School of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - James Venturini
- School of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.,Graduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Antonio Luiz Dal Bello Gasparoto
- Graduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | | | - Ana Rita Coimbra Motta-Castro
- Graduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.,Fiocruz Mato Grosso do Sul, Oswaldo Cruz Foundation, Campo Grande, MS, Brazil
| | - Fernanda Paes Reis
- Maria Aparecida Pedrossian University Hospital (UFMS/EBSERH), Campo Grande, MS, Brazil
| | | | - Aline Pedroso Lorenz
- Institute of Biosciences, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil
| | - Wellington Santos Fava
- Central Laboratory of Public Health (LACEN) of Mato Grosso do Sul, Campo Grande, MS, Brazil
| | | | - Cláudia Elizabeth Volpe Chaves
- Maria Aparecida Pedrossian University Hospital (UFMS/EBSERH), Campo Grande, MS, Brazil.,Rosa Pedrossian Regional Hospital (HRMS), State Secretariat of Health, Campo Grande, MS, Brazil
| | - Gabriel Pereira Braga
- Maria Aparecida Pedrossian University Hospital (UFMS/EBSERH), Campo Grande, MS, Brazil
| | - Anamaria Mello Miranda Paniago
- School of Medicine, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.,Graduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.,Correspondence to: or
| | - Sandra Maria do Valle Leone de Oliveira
- Graduate Program in Infectious and Parasitic Diseases, Federal University of Mato Grosso do Sul (UFMS), Campo Grande, MS, Brazil.,Fiocruz Mato Grosso do Sul, Oswaldo Cruz Foundation, Campo Grande, MS, Brazil.,Correspondence to: or
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7
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Namavarian A, Eid A, Ziai H, Cheng EY, Enepekides D. Facial Nerve Paralysis and COVID-19: A Systematic Review. Laryngoscope 2022; 133:1007-1013. [PMID: 35938708 PMCID: PMC9538897 DOI: 10.1002/lary.30333] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/23/2022] [Accepted: 07/22/2022] [Indexed: 11/06/2022]
Abstract
Objective Several cases of facial nerve paralysis (FNP) post‐COVID‐19 infection have been reported with varying presentations and management. This study aims to identify FNP clinical characteristics and recovery outcomes among patients acutely infected with COVID‐19. We hypothesize that FNP is a potentially unique sequalae associated with COVID‐19 infections. Methods A systematic review of PubMed‐Medline, OVID Embase, and Web of Science databases from inception to November 2021 was conducted following the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. Results This search identified 630 studies with 53 meeting inclusion criteria. This resulted in 72 patients, of which 30 (42%) were diagnosed with Guillain‐Barré Syndrome (GBS). Non‐GBS patients were on average younger (36 vs. 53 years) and more likely to present with unilateral FNP (88%) compared to GBS patients who presented predominantly with bilateral FNP (74%). Among non‐GBS patients, majority (70%) of FNP presented a median of 8 [IQR 10] days after the onset of initial COVID‐19 symptom(s). Treatment for non‐GBS patients consisted of steroids (60%), antivirals (29%), antibiotics (21%), and no treatment (21%). Complete FNP recovery in non‐GBS patients was achieved in 67% patients within a median of 11 [IQR 24] days. Conclusion FNP is a possible presentation post COVID‐19 infections, associated with both GBS and non‐GBS patients. Although no causation can be assumed, the clinical course of isolated FNP associated with COVID‐19 raises the possibility of a unique presentation differing from Bell's palsy, seen with higher proportion of patients developing bilateral FNP and a shorter duration to complete recovery. Laryngoscope, 2022
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Affiliation(s)
- Amirpouyan Namavarian
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Anas Eid
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Hedyeh Ziai
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Emily YiQin Cheng
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Danny Enepekides
- Department of Otolaryngology Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada.,Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Epidemiology, clinical features, and treatment modalities of facial nerve palsy in COVID-19 patients: a systematic review. Acta Neurol Belg 2022; 122:1419-1432. [PMID: 35917018 PMCID: PMC9345018 DOI: 10.1007/s13760-022-02026-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 07/07/2022] [Indexed: 12/11/2022]
Abstract
Background Coronavirus disease 2019 (COVID-19) is responsible for a wide variety of multi-system clinical features. Facial nerve palsy (FNP) is identified as one of the neurological complications of the virus. This work aims to systematically review the clinical picture, laboratory/imaging findings, treatment options, and prognostic factors of FNP in COVID-19 patients. Methods Using six online databases, a search was conducted to include all articles with patients infected with COVID-19 and presenting with unilateral or bilateral FNP. Screening for eligibility and data extraction were done by three and four independent reviewers, respectively. Descriptive analyses and data visualizations were done using Google Sheets. Survival analysis and Kaplan–Meier plotting were done by R software. Results The data from 22 studies included 32 patients who were infected with COVID-19 and presented with clinical features of FNP. Fourteen patients were male while 18 were female. FNP affected 29 patients unilaterally and 3 patients bilaterally. The imaging findings confirmed that complications of FNP were COVID-19 related. Additionally, antivirals combined with steroids had the lowest median time (21, IQR = 8) to clinical improvement compared to steroid-only (30, IQR = 15) and antiviral-only (33, IQR = 3.5) treatments. Conclusion This study has shown a potential correlation between the increased incidence of FNP and COVID-19. We have also found that combining antivirals with steroids may have better outcomes in patients with FNP and COVID-19 although the evidence to support this claim is not strong enough. Further studies are required to assess the extent of linkage between the two conditions and how to properly manage FNP when encountered in COVID-19 patients. Supplementary Information The online version contains supplementary material available at 10.1007/s13760-022-02026-8.
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Berra E, Fundarò C, Chimento P, Buonocore M. Unusual sensory-motor neuropathies in post-COVID-19 patients admitted in rehabilitation hospitals: a case-series. Eur J Phys Rehabil Med 2022; 58:655-658. [PMID: 34542255 PMCID: PMC9980566 DOI: 10.23736/s1973-9087.21.06663-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Several neurological complications occurred in SARS-CoV-2 disease (COVID-19), mainly related to inflammatory and vascular disorders. The involvement of the peripheral nervous system (PNS) has been mostly reported as Guillain-Barré Syndrome, while focal peripheral neuropathies have been rarely described. CASE REPORT We report the cases of ten patients hospitalized in Rehabilitation Units after COVID-19, who presented severe focal motor involvement. Electrophysiological investigations revealed focal sensory-motor neuropathies, atypical for many aspects: bilaterality, location and contemporary involvement of different nervous districts. We speculate that their pathogenesis is possibly related to prolonged abnormal postures maintained during hospitalization in Intensive Care Unit, virus neurotropism and thrombotic vascular damage involving vasa nervorum. CLINICAL REHABILITATION IMPACT Motor neuropathies could induce severe disability and their early recognition in post COVID-19 patients is of primary importance for a specific rehabilitation treatment.
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Affiliation(s)
- Eliana Berra
- Unit of Clinical Neurophysiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy -
| | - Cira Fundarò
- Unit of Clinical Neurophysiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Pierluigi Chimento
- Unit of Clinical Neurophysiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Michelangelo Buonocore
- Unit of Clinical Neurophysiology, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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10
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Magalhães JE, Sampaio‐Rocha‐Filho PA. Pregnancy and neurologic complications of COVID-19: A scoping review. Acta Neurol Scand 2022; 146:6-23. [PMID: 35388457 PMCID: PMC9111489 DOI: 10.1111/ane.13621] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 12/17/2022]
Abstract
While neurologic complications are frequently reported among patients with COVID‐19 in the general population, they are unknown in pregnant women. This paper summarizes the case reports of pregnant women with confirmed SARS‐CoV‐2 infection plus a specified neurologic diagnosis. Until November 2021, 18 case reports were found. Both the central and peripheral nervous systems were equally affected: delirium (n = 1), posterior reversible encephalopathy syndrome (n = 4), cerebrovascular disease (n = 2), acute cerebral demyelinating disease (n = 1), acute necrotizing encephalopathy (n = 1), Guillain–Barré syndrome (n = 5), including one patient who also had vestibular neuritis, Bell's palsy (n = 3), and rhabdomyolysis (n = 1). The median maternal age was 32.5 (25—35) years, the median gestational age was 34 (30—36.5) weeks, and 38.9% presented previous medical conditions. Respiratory symptoms were reported in 76.5%, and 76.5% received immunotherapies to treat the COVID‐19 or the neurologic complications. Half the women required admission to ICU and, more often, were those with central nervous system involvement (77.8% vs. 22.2%; Chi‐square test, p = .018). For 64.7% of women, the most common method of delivery was surgical, although just one case was due to the neurologic complication. There were reports of one spontaneous abortion, two fetal deaths, and no maternal deaths. Only one case presented a poor neurologic outcome. It is possible that our findings are underestimated, considering that there are thousands of reports regarding neurologic complications in the general population with COVID‐19.
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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
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11
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Estakhr M, Tabrizi R, Ghotbi Z, Shahabi S, Habibzadeh A, Bashi A, Borhani-Haghighi A. Is facial nerve palsy an early manifestation of COVID-19? A literature review. Am J Med Sci 2022; 364:264-273. [PMID: 35429449 PMCID: PMC9007824 DOI: 10.1016/j.amjms.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
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12
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Sharma P, Malik S, Wadhwan V, Gotur Palakshappa S, Singh R. Prevalence of oral manifestations in COVID-19: A systematic review. Rev Med Virol 2022; 32:e2345. [PMID: 35271738 PMCID: PMC9111150 DOI: 10.1002/rmv.2345] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/21/2022] [Accepted: 02/26/2022] [Indexed: 12/16/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is a novel disease caused by a newly identified virus Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) causing diverse systemic manifestations. The oral cavity too is not spared and the symptoms appear either independently, concurrently, or sequentially. In view of the rising documented cases of oral lesions of COVID-19, this systematic review aims to assess the prevalence of oral manifestations in COVID-19 confirmed individuals. An extensive literature search was conducted in databases like Scopus, Pubmed/Medline, Livivo, Lilacs and Google Scholar and varied oral signs and symptoms were reported as per the PRISMA guidelines. Studies published in English language literature only were included and were subjected to the risk of bias using the Joana Briggs Institute Appraisal tools for prevalence studies, case series and case reports. In a two-phase selection, 34 studies were included: 21 observational, 3 case-series and 10 case reports. These observational studies included approximately 14,003 patients from 10 countries. In this review, we explored the most commonly encountered oral and dental manifestations in COVID-19 and identified that loss of taste acuity, xerostomia and anosmia were frequently reported. Elevated incidence of opportunistic infections like mucormycosis and aspergillosis were reported during the treatment due to prolonged intake of steroids. Immunosuppression and poor oral hygiene led to secondary manifestations like enanthematous lesions. However, it is not clear that oral signs and symptoms are due to COVID-19 infection itself or are the result of extensive treatment regimen followed [PROSPERO CRD42021258264].
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Affiliation(s)
- Preeti Sharma
- Department of Oral & Maxillofacial Pathology & Oral Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Sangeeta Malik
- Department of Oral Medicine & Radiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Vijay Wadhwan
- Department of Oral & Maxillofacial Pathology & Oral Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Suhasini Gotur Palakshappa
- Department of Oral & Maxillofacial Pathology & Oral Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
| | - Roli Singh
- Department of Oral & Maxillofacial Pathology & Oral Microbiology, Subharti Dental College and Hospital, Swami Vivekanand Subharti University, Meerut, Uttar Pradesh, India
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13
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Faulkner DL, Scott DS, Flint DNJ. Miller-Fisher syndrome associated with SARS-CoV-2: a case report. Microbes Infect 2022; 24:104954. [PMID: 35240290 PMCID: PMC8882477 DOI: 10.1016/j.micinf.2022.104954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/22/2022] [Accepted: 02/22/2022] [Indexed: 12/28/2022]
Abstract
SARS-CoV-2 infections are increasingly associated with neurological complications, including immune-mediated neuropathies. Miller–Fisher syndrome is a rare variant of Guillain-Barré syndrome characterised by the triad of ataxia, ophthalmoplegia and areflexia. Here we present a case of Miller–Fisher syndrome following COVID-19 infection. The clinical presentation was a short history of a rapidly-progressive peripheral sensorimotor neuropathy with bulbar dysfunction and facial weakness following mild COVID infection. Examination revealed global areflexia and a broad-based ataxic gait. CSF analysis revealed albuminocytological dissociation and neurophysiological testing later supported the diagnosis. The patient required high flow nasal oxygen therapy for respiratory dysfunction in a level 2 care setting and received immunological treatment with intravenous immunoglobulins. We conclude that Miller–Fisher syndrome needs to be considered in patients presenting with new sensorimotor dysfunction following SARS-COV-2 infection. Early recognition is key given the propensity to cause life-threatening respiratory failure, and early administration of immunological treatment is associated with improved prognosis.
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14
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Ferreira EF, Portugal D, Silva N, Peixoto C, Matos C, Pereira I, Prates L. Rehabilitation of peripheral facial palsy associated with COVID-19 in a child: A case report. Ann Phys Rehabil Med 2022; 65:101600. [PMID: 34757011 PMCID: PMC8554074 DOI: 10.1016/j.rehab.2021.101600] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 10/14/2021] [Accepted: 10/19/2021] [Indexed: 01/04/2023]
Abstract
COVID-19 has been associated with multiple neurological manifestations. Coronaviruses are known to have a neurotropic propensity, possibly leading to various neurological complications, including peripheral facial paralysis (PFP). However, the pathogenic mechanisms underlying neurological symptoms in COVID-19 are not completely understood. This report presents the first published case of facial palsy in an otherwise healthy child secondary to infection with the novel coronavirus SARS-Cov-2, with reflections on the natural course and the role of physical and rehabilitation medicine in this form of PFP. Thus, PFP may also be a manifestation of COVID-19 and in the current epidemiological context, physicians evaluating patients with facial palsy should exclude infection with SARS-Cov-2 to prevent diagnostic delays and further transmission of the disease. These patients may have a slower recovery and worse prognosis as compared with those with Bell's palsy. Thus, rehabilitation needs to be initiated promptly, and close follow-up must be assured to identify and address early complications.
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Affiliation(s)
- Eduardo Freitas Ferreira
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal.
| | - Diogo Portugal
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Nuno Silva
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Catarina Peixoto
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Catarina Matos
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Isabel Pereira
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Leonor Prates
- Physical and Rehabilitation Medicine Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
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15
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Dean A, Said A, Marri K, Chelius D. Stridor Due to Cranial Nerve X Palsy Progressing to Polyneuropathy in a Teenager With COVID-19. Pediatrics 2021; 148:183397. [PMID: 34851417 DOI: 10.1542/peds.2021-051534] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2021] [Indexed: 11/24/2022] Open
Abstract
The neurologic manifestations of coronavirus disease 2019 (COVID-19) are wide-ranging, including various cranial neuropathies, beyond anosmia and dysgeusia, the exact neuropathological mechanism of which are yet unknown. Acute cranial nerve (CN) X neuritis with vocal cord paralysis has not been reported in COVID-19 and is a rare presentation of neuropathy in general. A girl aged 14 years was admitted with stridor. She was diagnosed with symptomatic COVID-19 8 days before. By presentation, fever had resolved, but she had developed stridor; sore throat with dysphagia; chest, shoulder, and back pain; and generalized weakness. Neurologic examination and laryngoscopy were consistent with isolated left CN X palsy. Steroids were started, but neurologic disease progressed with subjective pain, right lower face numbness, and eye fatigability. Respiratory distress increased, and she was intubated for airway protection. MRI revealed abnormal enhancement of CNs III, V, XII, and X. Cerebrospinal fluid studies were normal. Nasopharyngeal severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test result was positive. She was treated with intravenous immunoglobulin, a total of 2 g/kg, and steroids were continued. She made a full neurologic recovery and was discharged after 9 days of hospitalization. This is a case of a teenager who presented with an acute, life-threatening CN X palsy and development of a progressive polyneuropathy in the setting of COVID-19. Although there was concern for Guillain-Barre syndrome, a definitive diagnosis could not be made, and the unusual features of this case, including presentation with stridor and predominate CN involvement seem to indicate a separate symptomatic COVID-19-associated polyneuritis.
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Affiliation(s)
| | | | | | - Daniel Chelius
- Otolaryngology, Baylor College of Medicine, Houston, Texas
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16
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Shinde KJ, Karanth T, Yeolekar AM. Otoneurological presentations of COVID-19. BMJ Case Rep 2021; 14:14/9/e241893. [PMID: 34518174 PMCID: PMC8438910 DOI: 10.1136/bcr-2021-241893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
COVID-19 usually begins with respiratory symptoms but may also cause neurological disturbances by direct (viral invasion) or indirect (immune-mediated) mechanism. Common neurological injury described in the literature include infectious toxic encephalopathy, viral encephalitis and Guillain-Barré syndrome. We present two cases diagnosed with COVID-19 who presented with isolated neurological deficit along facial nerve and vestibular nerve. Both recovered with medical management and rehabilitative exercises. Isolated neurological impairment in otorhinolaryngological practice may be the primary presentation or delayed feature of COVID-19.
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Affiliation(s)
- Kiran J Shinde
- ENT-HNS, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India
| | - Tulasi Karanth
- ENT-HNS, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India .,ENT-HNS, Kasturba Medical College, Manipal, Karnataka, India
| | - Aditya M Yeolekar
- ENT-HNS, Smt Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India.,ENT-HNS, Post Graduate Institute, YCM Hospital, PCMC, Pune, Maharashtra, India
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17
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Mutlu A, Kalcioglu MT, Gunduz AY, Bakici B, Yilmaz U, Cag Y. Does the SARS-CoV-2 pandemic really increase the frequency of peripheral facial palsy? Am J Otolaryngol 2021; 42:103032. [PMID: 33857779 PMCID: PMC8025538 DOI: 10.1016/j.amjoto.2021.103032] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 04/04/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE Publications about increased number of peripheral facial paralysis in the COVID-19 pandemic emerged in the literature. However, these studies comprised of an estimate rather than a broad analysis of exact numbers. In this study, we planned to investigate whether the pandemic really resulted in an increase in facial paralysis cases admitted to the hospital by evaluating the cases who applied to our hospital due to facial paralysis in the COVID-19 pandemic year and in the previous 4 years. MATERIALS AND METHODS Patients who applied to our hospital due to facial paralysis between March 2016-February 2017 (Group 1), between March 2017-February 2018 (Group 2), between March 2018-February 2019 (Group 3), between March 2019-February 2020 (Group 4), and between March 2020-February 2021 (Group 5) were investigated and detailed data were noted. RESULTS 156, 164, 149, 172 and 157 patients were admitted to the hospital due to peripheral facial paralysis in Group 1, 2, 3, 4, and 5, respectively. Of these patients, 155, 164, 145, 169, and 153 were Bell's palsy, respectively. SARS-CoV-2 RT-PCR test was positive in only 2 of the 153 patients who were diagnosed in the year of the pandemic. CONCLUSIONS This study showed that the number of peripheral facial paralysis detected during the COVID-19 pandemic was similar to previous years. Very few number of positive SARS-CoV-2 RT-PCR test results may have been found incidentally in Bell's palsy patients. Theses stating that SARS-CoV-2 causes peripheral facial paralysis should be supported by laboratory studies and postmortem research.
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Affiliation(s)
- Ahmet Mutlu
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Mahmut Tayyar Kalcioglu
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey.
| | - Ayse Yasemin Gunduz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Burcu Bakici
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Utku Yilmaz
- Istanbul Medeniyet University, Faculty of Medicine, Department of Otorhinolaryngology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
| | - Yasemin Cag
- Istanbul Medeniyet University, Faculty of Medicine, Department of Infectious Disseases and Clinical Microbiology, Istanbul, Turkey; Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul, Turkey
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18
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Aslan M, Çiçek MT. Can isolated sudden sensorineural hearing loss (SSNHL) and idiopathic acute facial paralysis (Bell's palsy) be symptoms of COVID-19? Am J Otolaryngol 2021; 42:103129. [PMID: 34214773 PMCID: PMC8239203 DOI: 10.1016/j.amjoto.2021.103129] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 06/14/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The symptoms of COVID-19 at the time of presentation mainly include fever, cough, respiratory distress and myalgia. On the other hand, as neurological symptoms, disruption of taste and smell and cerebrovascular pathologies are well-known, whereas other neurological symptoms and signs are being newly recognized. Sudden-onset sensorineural hearing loss (SSNHL) and idiopathic acute facial paralysis (Bell's palsy) are otologic emergencies that are frequently encountered by otorhinolaryngology specialists. Although there are many articles describing SSNHL and Bell's palsy in the literature, the literature describing their relationship to COVID-19 is limited. In our study, we aimed to present the neuro-otologic relationship of SSNHL and Bell's palsy with COVID-19. MATERIAL AND METHODS The pretreatment real-time oronasopharyngeal PCR tests, COVID-19 symptomatology and COVID-19 infection statuses of patients who presented to our clinic with isolated SSNHL and Bell's palsy between April 2020 and April 2021 were questioned, and the data of the patients were collected. Throughout their treatment, the patients were followed-up in terms of COVID-19 infection. This is a prospective study. Moreover, to observe the change in the incidence, the data of patients visiting between January 2019 and January 2020 were also collected. The data of the patients were statistically analyzed using SPSS. RESULTS The study included a total of 177 patients. The SSNHL group consisted of 91 patients, and the Bell's palsy group consisted of 86 patients. Neither group showed a statistically significant difference in comparison to the year without the pandemic in terms of the patient numbers (incidence), sex, age, morbidity, response to treatment or social habits. There was a statistically significant difference in age only in the Bell's palsy group, but this difference was not medically significant. CONCLUSION As a result of our study, we did not observe a relationship between COVID-19 and cases of SSNHL and Bell's palsy. It is recommended to apply standard otologic treatment to isolated SSNHL and Bell's palsy patients whose association with COVID-19 is not determined.
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Affiliation(s)
- Mehmet Aslan
- Department of Otorhinolaryngology Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, Turkey.
| | - Mehmet Turan Çiçek
- Department of Otorhinolaryngology Head and Neck Surgery, Inonu University Faculty of Medicine, Malatya, Turkey
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19
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Taouihar S, Bouabdallaoui A, Aabdi M, Kaouini A, El aidouni G, Merbouh M, Zaid I, Bkiyar H, Housni B. Peripheral facial paralysis as the only symptom revealing sars cov 2 infection: Case report. Ann Med Surg (Lond) 2021; 68:102550. [PMID: 34257954 PMCID: PMC8265209 DOI: 10.1016/j.amsu.2021.102550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023] Open
Abstract
The SARS cov 2 infection was initially marked by its respiratory symptomatology. Nevertheless, other non-respiratory manifestations have been raised as atypical revealing symptoms, namely cardiac and neurological attacks. Several neurological manifestations have been described during this pandemic. We describe in this case report the clinical, biological and radiological characteristics of two patients presenting to the emergency department with facial paralysis revealing a Sars cov 2 viral infections after investigation.
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Affiliation(s)
- S. Taouihar
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - A. Bouabdallaoui
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - M. Aabdi
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - A.El Kaouini
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - G. El aidouni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - M. Merbouh
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - I. Zaid
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - H. Bkiyar
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - B. Housni
- Intensive Care Unit, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
- Simulation Center for Medical Formation, Faculty of Medicine and Pharmacy, Oujda, Morocco
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20
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Gupta S, Jawanda MK, Taneja N, Taneja T. A systematic review of Bell's Palsy as the only major neurological manifestation in COVID-19 patients. J Clin Neurosci 2021; 90:284-292. [PMID: 34275565 DOI: 10.1016/j.jocn.2021.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Bell's palsy is an acute idiopathic paralysis of the facial nerve. The disease is caused by many viruses like Herpes simplex virus-1, Varicella zoster, Epstein-bar virus, Cytomegalovirus, Usutu virus, Human immunodeficiency virus, etc. Literature has reported few cases of COVID-19 patients with Bell's palsy as the only major neurological manifestation indicating the possible role of another virus in the etiopathogenesis of Bell's Palsy. This paper aims to evaluate the reported cases of COVID-19 positive patients, presented with Bell's palsy as the only major neurological manifestation from March 2020 to December 2020, and to investigate the association of SARS-CoV2 and Bell's palsy. MATERIALS AND METHODS A systematic review of the published literature was performed using an electronic search in PubMed/Medline, Science Direct, Web of Science, Embase, J- STAGE, Google Scholar, China National Knowledge Infrastructure (CKNI) and Scopus databases, from March 2020 to Dec 2020 using keywords like 'COVID-19', 'SARS-CoV-2', 'Coronavirus', 'Bell's palsy', 'Facial nerve', 'First', 'Only',' Neurological', 'Manifestation'. The studies reviewed were case series and case reports regarding the subject. RESULTS Search strategy revealed thirteen articles from March 2020 to Dec 2020 with a total of 20 cases of COVID-19 with Bell's palsy as the only major neurological manifestation. CONCLUSION Evidence of Bell's palsy as the only major neurological manifestation in COVID-19 patients signifies an important clinical finding but robust research is needed to investigate their association and the exact mechanisms by which SARS-CoV2 causes Bell's Palsy.
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Affiliation(s)
- Sonia Gupta
- Dept. of Oral Pathology and Microbiology & Forensic Odontology, Rayat and Bahra Dental College and Hospital, Mohali, Punjab, India.
| | - Manveen Kaur Jawanda
- Dept. of Oral Pathology and Microbiology & Forensic Odontology, Laxmi Bai Institute of Dental Sciences and Hospital, Patiala, Punjab, India
| | - Neeraj Taneja
- ABC Dentistry, multispeciality Dental Clinic, Dera Bassi, Dist: Mohali, Punjab, India
| | - Tannu Taneja
- Department of Oral Pathology and Microbiology & Forensic Odontology, Sri Sukhmani Dental College & Hospital, Dera Bassi, Dist: Mohali, Punjab, India
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21
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Protracted COVID-19 during Treatment of Facial Palsy. Case Rep Neurol Med 2021; 2021:5569841. [PMID: 34211790 PMCID: PMC8205590 DOI: 10.1155/2021/5569841] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/22/2021] [Accepted: 05/29/2021] [Indexed: 02/06/2023] Open
Abstract
Neurologic manifestations are increasingly reported as the coronavirus disease 2019 (COVID-19) pandemic continues. This is a report of a COVID-19 patient with Bell's palsy. Case Summary. A 52-year-old man with fever and malaise was tested positive for COVID-19. After a week, he developed right-sided peripheral facial palsy and was treated with corticosteroids in conjunction with antiviral treatment which resulted in complete recovery. Discussion. Concomitant treatment of corticosteroids and antiviral treatment can decrease morbidity in patients with COVID-19-related Bell's palsy.
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22
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Egilmez OK, Gündoğan ME, Yılmaz MS, Güven M. Can COVID-19 Cause Peripheral Facial Nerve Palsy? ACTA ACUST UNITED AC 2021; 3:1707-1713. [PMID: 34056546 PMCID: PMC8140315 DOI: 10.1007/s42399-021-00967-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/15/2022]
Abstract
The aim of our study is to evaluate the relationship between peripheral facial paralysis and the patients who had a contact with a coronavirus disease 2019 (COVID-19) patient or had COVID-19. Patients with a history of contact with a COVID-19 patient or having COVID-19 disease, who were admitted to the emergency department for peripheral facial paralysis in the last 6 months, were included in the study. Facial paralysis grade at first presentation, treatment modality, treatment duration, post-treatment facial paralysis grade, and additional findings were analyzed. A total of 34 patients, 20 females and 14 males, were included into the study. Nasal-oropharyngeal reverse transcriptase-polymerase chain reaction (RT-PCR) was test taken from patients with a history of contact, and patients having COVID-19 disease were determined as positive in 5 and 3 patients, respectively. Peripheral facial paralysis was detected as an initial finding in 5 of these 8 patients, and paralysis developed in 7-12 days after the diagnosis of the COVID-19 disease in the remaining 3 patients. The grade of first admission paralysis did not change in one patient in the (+) group, while improvement was observed in all patients in the (−) group. Neuroinvasive potential of COVID-19 in the central and peripheral nervous system was reported in current literature. Our study indicates peripheral facial palsy can also be encountered during the clinical course of COVID-19 and should be considered a finding of this disease.
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Affiliation(s)
- Oguz Kadir Egilmez
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Korucuk Campus, 54100 Sakarya, Turkey
| | - Mahmut Emre Gündoğan
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Korucuk Campus, 54100 Sakarya, Turkey
| | - Mahmut Sinan Yılmaz
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Korucuk Campus, 54100 Sakarya, Turkey
| | - Mehmet Güven
- Department of Otorhinolaryngology, Sakarya University Training and Research Hospital, Korucuk Campus, 54100 Sakarya, Turkey
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23
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Al-Salihi MM, Al-Jebur MS, Rahman MM. The role of neurosurgeons in management of post-COVID-19 syndrome. Br J Neurosurg 2021; 36:122-123. [PMID: 33983098 DOI: 10.1080/02688697.2021.1910202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
| | | | - Md Moshiur Rahman
- Neurosurgery Department, Holy Family Red Crescent Medical College & Hospital, University of Dhaka, Dhaka, Bangladesh
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24
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Dubey P, Thakur B, Reddy S, Martinez CA, Nurunnabi M, Manuel SL, Chheda S, Bracamontes C, Dwivedi AK. Current trends and geographical differences in therapeutic profile and outcomes of COVID-19 among pregnant women - a systematic review and meta-analysis. BMC Pregnancy Childbirth 2021; 21:247. [PMID: 33761892 PMCID: PMC7990381 DOI: 10.1186/s12884-021-03685-w] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 02/28/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Coronavirus disease (COVID-19) has been associated with adverse pregnancy outcomes. Due to the lack of effective treatments for COVID-19, it becomes imperative to assess the geographical differences and trends in the current clinical care and outcomes of COVID-19 in pregnant women. METHODS A PubMed search was performed to screen articles reporting therapeutics and outcomes of confirmed COVID-19 in pregnant women prior to August 27, 2020. We performed searches, quality assessments of eligible studies, extracted and reported data according to PRISMA guidelines. Meta-analyses and cumulative meta-analyses of proportions were performed for estimating each outcome and their pattern over time respectively. RESULTS One thousand two hundred thirty nine pregnant women with COVID-19 from 66 studies were analyzed. In case series analysis reflecting average-risk patients, the proportion of oxygen support, antibiotics, antivirals, and plasma therapy administration except for hydroxychloroquine was substantially higher in Asian studies (55, 78, 80, 6, and 0%) compared to the US (7, 1, 12, 0, and 7%) or European (33, 12, 14, 1, and 26%) studies, respectively. The highest preterm birth and the average length of hospital stay (35%, 11.9 days) were estimated in Asian studies compared to the US studies (13%, 9.4 days) and European studies (29%, 7.3 days), respectively. Even in case reports reflecting severe cases, the use of antivirals and antibiotics was higher in Asian studies compared to the US, Latin American, and European studies. A significant decline in the use of most therapeutics along with adverse outcomes of COVID-19 in pregnant women was observed. CONCLUSIONS Geographical differences in therapeutic practice of COVID-19 were observed with differential rates of maternal and clinical outcomes. Minimizing the use of some therapeutics particularly antibiotics, antivirals, oxygen therapy, immunosuppressants, and hydroxychloroquine by risk stratification and careful consideration may further improve maternal and clinical outcomes.
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Affiliation(s)
- Pallavi Dubey
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Bhaskar Thakur
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sireesha Reddy
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Carla A Martinez
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Md Nurunnabi
- School of Pharmacy, the University of Texas at El Paso, El Paso, TX, USA
| | - Sharron L Manuel
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Sadhana Chheda
- Department of Pediatrics, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Christina Bracamontes
- Department of Obstetrics and Gynecology, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA
| | - Alok K Dwivedi
- Division of Biostatistics & Epidemiology, Department of Molecular and Translational Medicine, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
- Biostatistics and Epidemiology Consulting Lab, Texas Tech University Health Sciences Center El Paso, El Paso, TX, USA.
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25
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Oke IO, Oladunjoye OO, Oladunjoye AO, Paudel A, Zimmerman R. Bell's Palsy as a Late Neurologic Manifestation of COVID-19 Infection. Cureus 2021; 13:e13881. [PMID: 33868845 PMCID: PMC8043567 DOI: 10.7759/cureus.13881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2021] [Indexed: 12/21/2022] Open
Abstract
Bell's palsy is acute peripheral facial nerve palsy; its cause is often unknown but it can be triggered by acute viral infection. Coronavirus disease 2019 (COVID-19) infection commonly presents with respiratory symptoms, but neurologic complications have been reported. A few studies have reported the occurrence of facial nerve palsy during the COVID-19 pandemic. We present a case of Bell's palsy in a 36-year-old man with COVID-19 infection and a past medical history of nephrolithiasis. He presented to the emergency room with a day history of sudden right facial weakness and difficulty closing his right eye four weeks following a diagnosis of COVID-19 infection. Physical examination revealed right lower motor neuron facial nerve palsy (House-Brackmann grade IV). Serologic screen for Lyme disease, human immunodeficiency virus (HIV), and herpes simplex virus (HSV) 1 and 2 were negative for acute infection; however, neuroimaging with MRI confirmed Bell's palsy. He made remarkable improvement following treatment with a course of valacyclovir and methylprednisolone. This case adds to the growing body of literature on neurological complications that should be considered when managing patients with COVID-19 infection.
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Affiliation(s)
- Ibiyemi O Oke
- Internal Medicine, Reading Hospital - Tower Health, West Reading, USA
| | | | - Adeolu O Oladunjoye
- Medical Critical Care, Boston Children's Hospital, Boston, USA
- Psychiatry, Reading Hospital - Tower Health, West Reading, USA
| | - Anish Paudel
- Internal Medicine, Reading Hospital - Tower Health, West Reading, USA
| | - Ryan Zimmerman
- Internal Medicine, Reading Hospital - Tower health, West Reading, USA
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26
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Kumar V, Narayanan P, Shetty S, Mohammed AP. Lower motor neuron facial palsy in a postnatal mother with COVID-19. BMJ Case Rep 2021; 14:e240267. [PMID: 33649026 PMCID: PMC7929834 DOI: 10.1136/bcr-2020-240267] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2021] [Indexed: 12/21/2022] Open
Abstract
COVID-19 is caused by the novel SARS-CoV-2 and is a potentially fatal disease that is of great global public health concern. In addition to respiratory symptoms, neurological manifestations have been associated with COVID-19. This is attributed to the neurotropic nature of coronaviruses. The authors present a case of Bell's palsy associated with COVID-19 in a term primigravida.
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Affiliation(s)
- Vignesh Kumar
- Department of General Medicine, Dr TMA Pai Hospital, Udupi, Karnataka, India
| | - Priyanka Narayanan
- Department of General Medicine, Dr TMA Pai Hospital, Udupi, Karnataka, India
| | - Seema Shetty
- Department of Medicine, Melaka Manipal Medical College, Manipal, Karnataka, India
| | - Afsal P Mohammed
- Department of Medicine, Melaka Manipal Medical College, Manipal, Karnataka, India
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27
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Amruta N, Chastain WH, Paz M, Solch RJ, Murray-Brown IC, Befeler JB, Gressett TE, Longo MT, Engler-Chiurazzi EB, Bix G. SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders. Cytokine Growth Factor Rev 2021; 58:1-15. [PMID: 33674185 PMCID: PMC7894219 DOI: 10.1016/j.cytogfr.2021.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2 is a novel coronavirus that severely affects the respiratory system, is the cause of the COVID-19 pandemic, and is projected to result in the deaths of 2 million people worldwide. Recent reports suggest that SARS-CoV-2 also affects the central nervous system along with other organs. COVID-19-associated complications are observed in older people with underlying neurological conditions like stroke, Alzheimer's disease, and Parkinson's disease. Hence, we discuss SARS-CoV-2 viral replication and its inflammation-mediated infection. This review also focuses on COVID-19 associated neurological complications in individuals with those complications as well as other groups of people. Finally, we also briefly discuss the current therapies available to treat patients, as well as ongoing available treatments and vaccines for effective cures with a special focus on the therapeutic potential of a small 5 amino acid peptide (PHSCN), ATN-161, that inhibits SARS-CoV-2 spike protein binding to both integrin α5β1 and α5β1/hACE2.
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Affiliation(s)
- Narayanappa Amruta
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Wesley H Chastain
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Meshi Paz
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Rebecca J Solch
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Isabel C Murray-Brown
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Jaime B Befeler
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Timothy E Gressett
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Michele T Longo
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA
| | - Elizabeth B Engler-Chiurazzi
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA
| | - Gregory Bix
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA.
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DE Sire A, Andrenelli E, Negrini F, Lazzarini SG, Patrini M, Ceravolo MG. Rehabilitation and COVID-19: the Cochrane Rehabilitation 2020 rapid living systematic review. Update as of August 31st, 2020. Eur J Phys Rehabil Med 2020; 56:839-845. [PMID: 33000932 DOI: 10.23736/s1973-9087.20.06614-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION A monthly systematic review update is carried out to maintain the currency of scientific literature on rehabilitation of patients with COVID-19 and/or describing consequences due to the disease and its treatment, as they relate to limitations in functioning of rehabilitation interest. The aim of this study was to provide an updated summary of the available evidence published in August 2020. EVIDENCE ACQUISITION An extensive search on the main medical literature databases from August 1st, 2020 to August 31st, 2020 was performed, according to the methodology described in the second edition of the Cochrane Rehabilitation 2020 rapid living systematic review. EVIDENCE SYNTHESIS After removing duplicates, 1136 papers were identified, and 51 studies were finally included. According to OCEBM 2011 Levels of Evidence Table, they were Level 4 in most cases (76.5%) and Level 3 in the remaining (23.5%). Randomized controlled trials (RCTs) were not found. Thirty-two studies (62.7%) included COVID-19 patients who were assessed in the acute (20/32) or postacute phases (12/32). The other studies reported data on the impact of COVID-19 infection (7/19) or on the effect of lockdown restrictions (12/19) on subjects with pre-existing health conditions. CONCLUSIONS The scientific literature of August 2020 mainly focused on limitations in functioning of nervous system structure and related functions. Albeit the increased availability of data from analytical studies (both cohort and cross-sectional), there is still a lack of well-conducted Level 2 studies, to improve the knowledge on the effects of rehabilitation in COVID-19 patients.
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Affiliation(s)
- Alessandro DE Sire
- Unit of Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont, Novara, Italy.,Rehabilitation Unit, Mons. L. Novarese Hospital, Moncrivello, Vercelli, Italy
| | - Elisa Andrenelli
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
| | | | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Politecnica delle Marche University, Ancona, Italy
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