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Soh Y, Yoo EA, Kim ES, Kim SJ. MRI Features of Multiple Cranial Neuropathies in Guillain-Barré Syndrome Occurring after COVID-19 Vaccination: A Case Report. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:964-969. [PMID: 37559813 PMCID: PMC10407074 DOI: 10.3348/jksr.2022.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 11/02/2022] [Accepted: 11/13/2022] [Indexed: 08/11/2023]
Abstract
Guillain-Barré syndrome (GBS) is an immune-mediated demyelinating polyneuropathy characterized by progressive, ascending, and symmetrical paralysis. It is known to be triggered by an antecedent infection or vaccination. Recently, GBS development following coronavirus disease 2019 (COVID-19) vaccination has been reported. Cranial neuropathies in typical GBS patients usually involve the facial and the lower cranial nerves (from IX to XII). We report a rare case of multiple cranial neuropathies involving trigeminal, abducens, and facial nerves in a patient who developed GBS following COVID-19 vaccination on the basis of obvious MRI features.
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Roshanzamir S, Mohamadi Jahromi LS. Study of sympathetic skin response in patients with COVID-19 infection. Acta Neurol Belg 2023; 123:949-955. [PMID: 36273112 PMCID: PMC9589609 DOI: 10.1007/s13760-022-02120-x] [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: 07/21/2022] [Accepted: 10/10/2022] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Many articles hypothesized the potential role of autonomic nervous system in the pathogenesis and outcome of COVID-19 infection. Several studies reported both central and peripheral nervous system involvement in COVID-19 as well. Up to our knowledge, there is no study evaluating whether this virus could invade the autonomic nervous system affecting its function adversely. Sympathetic skin response (SSR) has long been used as a method of evaluating the autonomic nervous system. Regarding the importance of the autonomic nervous system in hemostasis and wide consequences of COVID-19 infection, we designed this study to evaluate the autonomic nervous system function in patients recovered from COVID-19 compared with normal population who are not yet infected by this virus by the means of SSR. METHODS This case-control study included 70 patients surviving COVID-19 who met the inclusion and exclusion criteria that went under SSR. The data gathered were compared with those without the history of any symptoms attributable to COVID-19 during the pandemic. RESULTS There was a correlation between COVID-19 infection and abnormal SSR (p value < 0.0001) with the most effect on the latency prolongation of the action potential recorded from the median nerve at palms (effect size: right: 3.90, left: 3.69). Moreover, the greater severity of the disease correlated with more abnormality of parameters recorded by SSR technique. CONCLUSIONS Abnormal SSR parameters could be a good indicator of autonomic nervous system involvement in patients with COVID-19 infection. It might be a predictor of disease severity, clinical outcomes and prognosis as well.
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Affiliation(s)
- Sharareh Roshanzamir
- Physical Medicine and Rehabilitation Department, Shiraz Medical School, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
| | - Leila Sadat Mohamadi Jahromi
- Physical Medicine and Rehabilitation Department, Shiraz Medical School, Shiraz University of Medical Sciences (SUMS), Shiraz, Iran
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3
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Okrzeja J, Garkowski A, Kubas B, Moniuszko-Malinowska A. Imaging and neuropathological findings in patients with Post COVID-19 Neurological Syndrome-A review. Front Neurol 2023; 14:1136348. [PMID: 36846139 PMCID: PMC9947471 DOI: 10.3389/fneur.2023.1136348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
Post COVID-19 syndrome is determined as signs and symptoms that appear during or after an infection consistent with SARS-CoV-2 disease, persist for more than 12 weeks and are not explained by an alternative diagnosis. This review presents the neuropathological findings and imaging findings in Post COVID-19 Neurological Syndrome: the focal point is on the manifestations of involvement evident on brain and spine imaging.
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Affiliation(s)
- Jakub Okrzeja
- Medical University of Białystok, Białystok, Poland,*Correspondence: Jakub Okrzeja ✉
| | - Adam Garkowski
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Bożena Kubas
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Anna Moniuszko-Malinowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
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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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5
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Jacob S, Kapadia R, Soule T, Luo H, Schellenberg KL, Douville RN, Pfeffer G. Neuromuscular Complications of SARS-CoV-2 and Other Viral Infections. Front Neurol 2022; 13:914411. [PMID: 35812094 PMCID: PMC9263266 DOI: 10.3389/fneur.2022.914411] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/25/2022] [Indexed: 12/15/2022] Open
Abstract
In this article we review complications to the peripheral nervous system that occur as a consequence of viral infections, with a special focus on complications of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). We discuss neuromuscular complications in three broad categories; the direct consequences of viral infection, autoimmune neuromuscular disorders provoked by viral infections, and chronic neurodegenerative conditions which have been associated with viral infections. We also include discussion of neuromuscular disorders that are treated by immunomodulatory therapies, and how this affects patient susceptibility in the current context of the coronavirus disease 2019 (COVID-19) pandemic. COVID-19 is associated with direct consequences to the peripheral nervous system via presumed direct viral injury (dysgeusia/anosmia, myalgias/rhabdomyolysis, and potentially mononeuritis multiplex) and autoimmunity (Guillain Barré syndrome and variants). It has important implications for people receiving immunomodulatory therapies who may be at greater risk of severe outcomes from COVID-19. Thus far, chronic post-COVID syndromes (a.k.a: long COVID) also include possible involvement of the neuromuscular system. Whether we may observe neuromuscular degenerative conditions in the longer term will be an important question to monitor in future studies.
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Affiliation(s)
- Sarah Jacob
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Ronak Kapadia
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Tyler Soule
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Honglin Luo
- Centre for Heart and Lung Innovation, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Kerri L. Schellenberg
- Division of Neurology, Department of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Renée N. Douville
- Division of Neurodegenerative Disorders, Department of Biology, Albrechtsen St. Boniface Research Centre, University of Winnipeg, Winnipeg, MB, Canada
| | - Gerald Pfeffer
- Hotchkiss Brain Institute, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Medical Genetics, Alberta Child Health Research Institute, University of Calgary, Calgary, AB, Canada
- *Correspondence: Gerald Pfeffer
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Singh J, Kumar N, Dinkar A. Demographic, clinical, investigational characteristics of COVID-19 related Guillain-Barré syndrome with differences from typical and another virus-related Guillain-Barré syndrome. Infect Disord Drug Targets 2022; 22:IDDT-EPUB-123097. [PMID: 35507796 DOI: 10.2174/1871526522666220429134113] [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: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUNDS SARS-CoV-2 infection typically presents with fever and respiratory symptoms. Besides this, COVID-19 related central and peripheral nervous system manifestations are emerging. OBJECTIVES This study summarises the demographics, clinical profile, laboratory findings, management strategies, and outcomes in a large number of patients with COVID-19 related GBS and its variants. We also compared its clinical profile with Zika and dengue virus-related GBS. METHODS Authors carried out a literature search up to Dec 31, 2020, in MEDLINE, PubMed, SCOPUS, Cochrane database, and Google Scholar for all published articles. RESULTS The study identified 54 different types of articles consisting of 70 cases from 17 countries worldwide. Maximum cases 15 (21.4%) were identified from Italy, followed by USA 12 (17.1%), Spain 11 (15.7%), and Iran 10 (14.3%). The age group more than 60 years had most cases with 32 (45.7%) cases followed by age group 40-60 with cases 25 (35.7%) with male and female ratio 2. Maximum cases were treated with IVIG infusion 58 (82.9%), followed by Plasma exchange 13 (18.6%) cases. Out of 70 cases, 7 (10%) cases were manifested as Miller-Fisher syndrome. The most predominant electrodiagnostic variant was demyelinating neuropathy in 41 (73.21%) cases. The outcome reported in 67 cases was survival in 63 (90%) cases and the death of 4 (5.7%) cases. CONCLUSION Covid 19 related GBS were reported worldwide with a better outcome. Both postinfectious or parainfectious patterns were reported. Early recognition with prompt management of GBS can prevent further severe morbidity and mortality.
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Affiliation(s)
- Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
| | - Nilesh Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
| | - Anju Dinkar
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
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Aladawi M, Elfil M, Abu-Esheh B, Abu Jazar D, Armouti A, Bayoumi A, Piccione E. Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review. Can J Neurol Sci 2022; 49:38-48. [PMID: 33949300 PMCID: PMC8267336 DOI: 10.1017/cjn.2021.102] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/04/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. METHODS We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. RESULTS We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. CONCLUSIONS Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.
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Affiliation(s)
- Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Baha Abu-Esheh
- Department of Neurology, Mercy Hospital, Oklahoma City, Oklahoma, USA
| | - Deaa Abu Jazar
- Department of Neurology, University of Texas Medical Branch – Galveston, Galveston, Texas, USA
| | - Ahmad Armouti
- Department of Neurology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Ahmed Bayoumi
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Ezequiel Piccione
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
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Guillain-Barré Syndrome in the COVID-19 Pandemic. Neurol Int 2021; 14:34-48. [PMID: 35076589 PMCID: PMC8788454 DOI: 10.3390/neurolint14010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
There have been several reported cases of severe acute respiratory syndrome (SARS-CoV-2) infection that were associated with an increased incidence of neurological manifestations, including Guillain–Barré syndrome (GBS). This review aims to present information on the reports of GBS associated with coronavirus disease 2019 (COVID-19) infection. Our review is retrospective work examining articles published from the 1 April 2020 to the 8 May 2021 in the English language. We used the diagnostic criteria and classification published by the National Institute of Neurological Disorders and Stroke and Brighton Collaboration. GBS is usually a postinfectious syndrome, but GBS in the COVID-19 pandemic also takes on a para-infectious profile. In the reports, the genetic factor has a role in developing GBS in some patients. In conclusion, the association between COVID-19 and GBS is not very clear. Still, one mechanism is strongly associated with COVID-19 and immune-mediated neurological complications, which is molecular mimicry between SARS-CoV-2 and human autoantigens.
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Ramirez N, Ujueta D, Diaz LF, Folleco LE, Rodríguez A, Gaona I, Nava-Mesa MO. Guillain-Barré syndrome with bilateral facial diplegia secondary to severe acute respiratory syndrome coronavirus-2 infection: a case report. J Med Case Rep 2021; 15:558. [PMID: 34782002 PMCID: PMC8591425 DOI: 10.1186/s13256-021-03120-w] [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: 12/12/2020] [Accepted: 09/18/2021] [Indexed: 11/29/2022] Open
Abstract
Background The new coronavirus, known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) owing to its similarity to the previous severe acute respiratory syndrome (SARS), is characterized by causing, in most patients, nonspecific symptoms similar to those of the common flu. It has been reported that many coronavirus disease 2019 (COVID-19) patients presented neurological symptoms that involve the central and peripheral nervous systems. In addition, there have been several reports of patients who presented Guillain–Barré syndrome related to COVID-19 , with sensory and motor compromise in the extremities.
Case presentation In this report, we describe a rare case of Guillain–Barré syndrome in a 50-year-old Hispanic male with bilateral facial palsy as the only neurological manifestation, following SARS-CoV-2 infection. A complete neurophysiological study showed severe axonal neuropathy of the right and left facial nerves. Conclusion Regardless of severity, clinicians must to be aware of any neurological manifestation generated by COVID-19 and start performing more neurophysiological tests to determine if the infection induces an axonal, myelin, or mixed involvement of the peripheral nervous system. Supplementary Information The online version contains supplementary material available at 10.1186/s13256-021-03120-w.
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Affiliation(s)
- Natalia Ramirez
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | - David Ujueta
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | - Luis Felipe Diaz
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | | | - Andrea Rodríguez
- Departamento de Medicina Física y Rehabilitación,, Departamento de Neurofisiología, FCI, 110131, Bogotá, Colombia
| | - Ivan Gaona
- Department of Neurology, Fundación Cardioinfantil (FCI), 110131, Bogotá, Colombia
| | - Mauricio O Nava-Mesa
- Escuela de Medicina y Ciencias de la Salud, GI en Neurociencias-NeURos, Universidad del Rosario, 111221, Bogotá, Colombia.
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Kakumoto T, Kobayashi S, Yuuki H, Kainaga M, Shirota Y, Hamada M, Hashimoto Maeda M, Kubota A, Kawai M, Saito M, Ishiura H, Toda T. Cranial Nerve Involvement and Dysautonomia in Post-COVID-19 Guillain-Barré Syndrome. Intern Med 2021; 60:3477-3480. [PMID: 34433712 PMCID: PMC8627825 DOI: 10.2169/internalmedicine.7355-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The clinical characteristics of Guillain-Barré syndrome (GBS) after coronavirus disease 2019 (COVID-19) remain unclear due to the small number of cases. We herein report a case of a Japanese patient with post-COVID-19 GBS who presented with facial and limb muscle weakness, sensory deficits, and autonomic dysfunction. Nerve conduction studies revealed demyelination. Head magnetic resonance imaging showed contrast enhancement in the bilateral facial nerves. Systemic management, including intubation, intravenous immunoglobulin therapy, and rehabilitation, improved the patient's condition. This was the first Japanese case of acute inflammatory demyelinating polyneuropathy after COVID-19 and was characterized by autonomic dysfunction and facial nerve enhancement.
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Affiliation(s)
- Toshiyuki Kakumoto
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Hayato Yuuki
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mitsuhiro Kainaga
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Yuichiro Shirota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, Japan
| | - Masashi Hamada
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Meiko Hashimoto Maeda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Akatsuki Kubota
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Mizuho Kawai
- Department of Neurology, Tokyo Kyosai Hospital, Japan
| | - Masaaki Saito
- Department of Neurology, Tokyo Kyosai Hospital, Japan
| | - Hiroyuki Ishiura
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
| | - Tatsushi Toda
- Department of Neurology, Graduate School of Medicine, The University of Tokyo, Japan
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Relevance of CSF, Serum and Neuroimaging Markers in CNS and PNS Manifestation in COVID-19: A Systematic Review of Case Report and Case Series. Brain Sci 2021; 11:brainsci11101354. [PMID: 34679418 PMCID: PMC8533964 DOI: 10.3390/brainsci11101354] [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: 08/26/2021] [Revised: 10/02/2021] [Accepted: 10/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The data on neurological manifestations in COVID-19 patients has been rapidly increasing throughout the pandemic. However, data on CNS and PNS inflammatory disorders in COVID-19 with respect to CSF, serum and neuroimaging markers is still lacking. METHODS We screened all articles resulting from a search of PubMed, Google Scholar and Scopus, using the keywords "SARS-CoV-2 and neurological complication", "SARS-CoV-2 and CNS Complication" and "SARS-CoV-2 and PNS Complication" looking for transverse myelitis, vasculitis, acute disseminated encephalomyelitis, acute hemorrhagic necrotizing encephalitis (AHNE), cytotoxic lesion of the corpus callosum (CLOCC) and Guillain-Barré syndrome (GBS), published between 1 December 2019 to 15 July 2021. RESULTS Of the included 106 CNS manifestations in our study, CNS inflammatory disorders included transverse myelitis (17, 14.7%), AHNE (12, 10.4%), ADEM (11, 9.5%), CLOCC/MERS (10, 8.6%) and vasculitis (4, 3.4%). Others were nonspecific encephalopathy, encephalitis, seizures and stroke. Most patients were >50 years old (75, 70.8%) and male (64, 65.3%). Most (59, 63.4%) were severe cases of COVID-19 and 18 (18%) patients died. Of the included 94 PNS manifestations in our study, GBS (89, 92.7%) was the most common. Most of these patients were >50 years old (73, 77.7%) and male (59, 64.1%). Most (62, 67.4%) were non-severe cases of COVID-19, and ten patients died. CONCLUSION Our comprehensive review of the clinical and paraclinical findings in CNS and PNS manifestations of COVID-19 provide insights on the pathophysiology of SARS-CoV-2 and its neurotropism. The higher frequency and severity of CNS manifestations should be noted by physicians for increased vigilance in particular COVID-19 cases.
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Goudarzi S, Esmaeeli S, Valencia JD, Lu ME, Hales RR, Fehnel CR, Conley CM, Quraishi SA, Nozari A. Treatment Options for COVID-19-Related Guillain-Barré Syndrome: A Systematic Review of Literature. Neurologist 2021; 26:196-224. [PMID: 34491938 PMCID: PMC8423032 DOI: 10.1097/nrl.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19-related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure. REVIEW SUMMARY We conducted a systematic review of published cases for COVID-19-related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19-related GBS. CONCLUSIONS Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19-related GBS are warranted.
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Affiliation(s)
| | - Shooka Esmaeeli
- Departments of Anesthesiology, Critical Care, and Pain Medicine
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | | | - Maegan E. Lu
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Riley R. Hales
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Corey R. Fehnel
- Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Christopher M. Conley
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Sadeq A. Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ala Nozari
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
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13
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Sullivan BN, Fischer T. Age-Associated Neurological Complications of COVID-19: A Systematic Review and Meta-Analysis. Front Aging Neurosci 2021; 13:653694. [PMID: 34408638 PMCID: PMC8366271 DOI: 10.3389/fnagi.2021.653694] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/08/2021] [Indexed: 12/15/2022] Open
Abstract
The outbreak of the novel and highly infectious severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has resulted in hundreds of millions of infections and millions of deaths globally. Infected individuals that progress to coronavirus disease-19 (COVID-19) experience upper and lower respiratory complications that range in severity and may lead to wide-spread inflammation and generalized hypoxia or hypoxemia that impacts multiple organ systems, including the central and peripheral nervous systems. Since the SARS-CoV-2 outbreak, multiple reports continue to emerge that detail neurological symptoms, ranging from relatively mild (e.g., impaired taste and/or smell) to severe (e.g., stroke), suggesting SARS-CoV-2 may be neurotropic and/or contribute to nervous system injury through direct and/or indirect mechanisms. To gain insight into the types of neurological complications associated with SARS-CoV-2 infection and their possible relationship with age, sex, COVID-19 severity, and comorbidities, we performed a systematic review of case reports and series published in 2020 - April 4, 2021 of infected patients with neurological manifestations. Meta-analyses were conducted using individual patient data from reports where these data could be extracted. Here, we report neurological injury occurs across the lifespan in the context of infection, with and without known comorbidities, and with all disease severities, including asymptomatic patients. Older individuals, however, are more susceptible to developing life-threatening COVID-19 and cerebrovascular disease (CVD), such as stroke. A mild but inverse correlation with age was seen with CNS inflammatory diseases, such as encephalitis, as well as taste and/or smell disorders. When reported, increased age was also associated with comorbid cardiovascular risk factors, including hypertension, diabetes mellitus, and lipid disorders, but not with obesity. Obesity did correlate with development of critical COVID-19. Discussion into potential pathophysiological mechanisms by which neurological symptoms arise and long-term consequences of infection to the nervous system is also provided.
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Affiliation(s)
- Brianne N. Sullivan
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
- Neuroscience Program, Tulane Brain Institute, School of Science and Engineering, Tulane University, New Orleans, LA, United States
| | - Tracy Fischer
- Department of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA, United States
- Division of Comparative Pathology, Tulane National Primate Research Center, Covington, LA, United States
- Tulane Brain Institute, Tulane University School of Medicine, New Orleans, LA, United States
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14
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Clinical and Radiological Profiles of COVID-19 Patients with Neurological Symptomatology: A Comparative Study. Viruses 2021; 13:v13050845. [PMID: 34066524 PMCID: PMC8148596 DOI: 10.3390/v13050845] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 04/25/2021] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
Patients with COVID-19 can require radiological examination, with chest CT being more frequent than neuro-imaging. The objective is to identify epidemiological, clinical and radiological factors considered as predictors of neurological involvement in patients with COVID-19 assessed by neuroimaging and to describe the neuroimaging findings. This retrospective study was performed with 232 consecutive confirmed COVID-19 patients, from two radiological units, which were divided into two groups: (1) those who underwent a brain CT/MRI scan (n = 35) versus (2) those who did not undergo the brain CT/MRI scan, but underwent only chest CT (n = 197). There was a statistically significant difference with associations regarding the COVID-19 brain scan group for: admission to ICU, greater severity of lung injuries, the use of a mechanical ventilator and sepsis. Statistical tendency was found for chronic renal failure and systemic arterial hypertension. Forty-percent of COVID-19 patients from the brain scan group were abnormal on brain CT and/or brain MRI (22.9% of the cases with bleeding or microbleeding, 8.6% with restricted diffusion lesions). One ischemic stroke case was associated with irregularity at the M1 segment of the right middle cerebral artery. There was a case of left facial nerve palsy with enhancement of the left geniculate ganglia. An analysis of the olfactory bulbs was possible in 12 brain MRIs and 100% had enhancement and/or microbleeding. In conclusion, a more severe COVID-19 disease from ICU, a more severe form of lung disease, the use of mechanical ventilator and sepsis were associated to the COVID-19 patients with neurological involvement who had undergone brain scans. Microvascular phenomenon was a frequent finding in the brain and olfactory bulbs evaluated by neuroimaging.
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15
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Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol 2021; 268:1133-1170. [PMID: 32840686 PMCID: PMC7445716 DOI: 10.1007/s00415-020-10124-x] [Citation(s) in RCA: 228] [Impact Index Per Article: 76.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.
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Affiliation(s)
| | - Ahmed Abdelhak
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Department of Neurology and Stroke, University Hospital of Tübingen, 72076, Tübingen, Germany
- Hertie Institute of Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
| | - Matteo Foschi
- Neurology Unit, S. Maria delle Croci Hospital-AUSL Romagna, ambito di Ravenna, 48121, Ravenna, Italy
| | - Hayrettin Tumani
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Specialty Hospital of Neurology Dietenbronn, 88477, Schwendi, Germany
| | - Markus Otto
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany.
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16
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Tandon M, Kataria S, Patel J, Mehta TR, Daimee M, Patel V, Prasad A, Chowdhary AA, Jaiswal S, Sriwastava S. A Comprehensive Systematic Review of CSF analysis that defines Neurological Manifestations of COVID-19. Int J Infect Dis 2021; 104:390-397. [PMID: 33434662 PMCID: PMC7837002 DOI: 10.1016/j.ijid.2021.01.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 12/28/2020] [Accepted: 01/05/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Limited literature exists on Cerebrospinal fluid (CSF) findings in COVID-19 patients with neurological symptoms. In this review, we conducted a descriptive analysis of CSF findings in patients with COVID-19 to understand prognosis and explore therapeutic options. METHODS We searched PubMed, Google Scholar, and Scopus databases using the keywords "SARS-CoV-2 in cerebrospinal fluid" and "SARS-CoV-2 and CNS Complications"" for reports of CSF findings in COVID-19 related neurological manifestations. Descriptive analyses were conducted to observe the CSF protein and cell counts based on age, gender, severity, fatality of COVID-19, and whether central (CNS) or peripheral nervous system (PNS) was associated. RESULTS A total of 113 patients were identified from 67 studies. Of these, 7 patients (6.2%) were fatal COVID-19 cases and 35 patients (31%) were considered severe COVID-19 cases. CSF protein was elevated in 100% (7/7) of the fatal cases with an average of 61.28 mg/dl and in 65.0% (52/80) in non-fatal cases with an average 56.73 mg/dl. CSF protein levels were elevated in 74.5% (38/51) patients with non-severe COVID-19 and 68.6% (24/35) in those with a severe COVID-19 infection. CSF cell count was increased in 43% of fatal cases, 25.7% severe cases, and 29.4% of non-severe cases. CONCLUSION Our analysis showed that the most common CSF findings situation in COVID-19 infection is elevated protein with, very occasionally, mild lymphocyte predominant pleocytosis. Further studies to elucidate the pathophysiology of neurological complications in COVID-19 are recommended.
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Affiliation(s)
| | - Saurabh Kataria
- Department of Neurology, University of Missouri Healthcare at Columbia, MO, United States
| | - Jenil Patel
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas Medical Sciences at Little Rock, AR, United States
| | - Tejas R Mehta
- Department of Neurology, University of Missouri Healthcare at Columbia, MO, United States
| | - Maha Daimee
- Department of Neurology, MedStar Georgetown University, Washington, DC, United States
| | - Viral Patel
- Jefferson Medical Center, West Virginia University, United States
| | - Apoorv Prasad
- Berkley Medical Center, West Virginia University, School of Medicine, Morgantown, WV, United States
| | | | - Shruti Jaiswal
- West Virginia Clinical and Translational Science Institute, United States
| | - Shitiz Sriwastava
- West Virginia Clinical and Translational Science Institute, United States; Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States; Department of Neurology, Wayne State University, Detroit, MI, United States.
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17
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Borah P, Deb PK, Chandrasekaran B, Goyal M, Bansal M, Hussain S, Shinu P, Venugopala KN, Al-Shar'i NA, Deka S, Singh V. Neurological Consequences of SARS-CoV-2 Infection and Concurrence of Treatment-Induced Neuropsychiatric Adverse Events in COVID-19 Patients: Navigating the Uncharted. Front Mol Biosci 2021; 8:627723. [PMID: 33681293 PMCID: PMC7930836 DOI: 10.3389/fmolb.2021.627723] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) binds to the angiotensin-converting enzyme 2 (ACE2) receptor and invade the human cells to cause COVID-19-related pneumonia. Despite an emphasis on respiratory complications, the evidence of neurological manifestations of SARS-CoV-2 infection is rapidly growing, which is substantially contributing to morbidity and mortality. The neurological disorders associated with COVID-19 may have several pathophysiological underpinnings, which are yet to be explored. Hypothetically, SARS-CoV-2 may affect the central nervous system (CNS) either by direct mechanisms like neuronal retrograde dissemination and hematogenous dissemination, or via indirect pathways. CNS complications associated with COVID-19 include encephalitis, acute necrotizing encephalopathy, diffuse leukoencephalopathy, stroke (both ischemic and hemorrhagic), venous sinus thrombosis, meningitis, and neuroleptic malignant syndrome. These may result from different mechanisms, including direct virus infection of the CNS, virus-induced hyper-inflammatory states, and post-infection immune responses. On the other hand, the Guillain-Barre syndrome, hyposmia, hypogeusia, and myopathy are the outcomes of peripheral nervous system injury. Although the therapeutic potential of certain repurposed drugs has led to their off-label use against COVID-19, such as anti-retroviral drugs (remdesivir, favipiravir, and lopinavir-ritonavir combination), biologics (tocilizumab), antibiotics (azithromycin), antiparasitics (chloroquine and hydroxychloroquine), and corticosteroids (dexamethasone), unfortunately, the associated clinical neuropsychiatric adverse events remains a critical issue. Therefore, COVID-19 represents a major threat to the field of neuropsychiatry, as both the virus and the potential therapies may induce neurologic as well as psychiatric disorders. Notably, potential COVID-19 medications may also interact with the medications of pre-existing neuropsychiatric diseases, thereby further complicating the condition. From this perspective, this review will discuss the possible neurological manifestations and sequelae of SARS-CoV-2 infection with emphasis on the probable underlying neurotropic mechanisms. Additionally, we will highlight the concurrence of COVID-19 treatment-associated neuropsychiatric events and possible clinically relevant drug interactions, to provide a useful framework and help researchers, especially the neurologists in understanding the neurologic facets of the ongoing pandemic to control the morbidity and mortality.
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Affiliation(s)
- Pobitra Borah
- School of Pharmacy, Graphic Era Hill University, Dehradun, India
| | - Pran Kishore Deb
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Balakumar Chandrasekaran
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, Philadelphia University, Amman, Jordan
| | - Manoj Goyal
- Department of Anesthesia Technology, College of Applied Medical Sciences in Jubail, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Monika Bansal
- Department of Neuroscience Technology College of Applied Medical Sciences in Jubail, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Snawar Hussain
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Pottathil Shinu
- Department of Biomedical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | - Katharigatta N Venugopala
- Department of Pharmaceutical Sciences, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Kingdom of Saudi Arabia.,Department of Biotechnology and Food Technology, Durban University of Technology, Durban, South Africa
| | - Nizar A Al-Shar'i
- Department of Medicinal Chemistry and Pharmacognosy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Satyendra Deka
- Pratiksha Institute of Pharmaceutical Sciences, Chandrapur Road, Panikhaiti, Guwahati, India
| | - Vinayak Singh
- Drug Discovery and Development Centre (H3D), University of Cape Town, Rondebosch, South Africa.,South African Medical Research Council Drug Discovery and Development Research Unit, Department of Chemistry and Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Rondebosch, South Africa
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18
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Abstract
Purpose of Review The present review discusses the peripheral nervous system (PNS) manifestations associated with coronavirus disease 2019 (COVID-19). Recent Findings Nerve pain and skeletal muscle injury, Guillain-Barré syndrome, cranial polyneuritis, neuromuscular junction disorders, neuro-ophthalmological disorders, neurosensory hearing loss, and dysautonomia have been reported as PNS manifestations in patients with COVID-19. Summary Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. COVID-19 has shown syndromic complexity. Not only does SARS-CoV-2 affect the central nervous system but also it involves the PNS. The PNS involvement may be due to dysregulation of the immune system attributable to COVID-19. Here we review the broad spectrum of PNS involvement of COVID-19.
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19
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Odriozola A, Ortega L, Martinez L, Odriozola S, Torrens A, Corroleu D, Martínez S, Ponce M, Meije Y, Presas M, Duarte A, Belén Odriozola M, Malik RA. Widespread sensory neuropathy in diabetic patients hospitalized with severe COVID-19 infection. Diabetes Res Clin Pract 2021; 172:108631. [PMID: 33346072 PMCID: PMC7746125 DOI: 10.1016/j.diabres.2020.108631] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/23/2020] [Accepted: 12/12/2020] [Indexed: 12/11/2022]
Abstract
AIMS To characterize the distribution and severity of sensory neuropathy using a portable quantitative sensory testing (QST) device in diabetic patients (DM) hospitalized with severe COVID-19 infection. METHODS Four patients with diabetes and severe SARS-CoV-2 requiring non-invasive ventilation for a protracted duration underwent clinical, laboratory and radiologic assessment and detailed evaluation of neuropathic symptoms, neurological assessment, QST on the dorsum of the foot and face using NerveCheck Master with assessment of taste and smell. RESULTS All four subjects developed neuropathic symptoms characterized by numbness in the feet with preserved reflexes. QST confirmed symmetrical abnormality of vibration and thermal thresholds in both lower limbs in all patients and an abnormal heat pain threshold on the face of two patients and altered taste and smell. CONCLUSIONS Severe COVID-19 infection with hypoxemia is associated with neuropathic symptoms and widespread sensory dysfunction in patients with DM.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
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20
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Abdullahi A, Candan SA, Soysal Tomruk M, Elibol N, Dada O, Truijen S, Saeys W. Is Guillain-Barré Syndrome Associated With COVID-19 Infection? A Systemic Review of the Evidence. Front Neurol 2021; 11:566308. [PMID: 33519663 PMCID: PMC7838680 DOI: 10.3389/fneur.2020.566308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background: There is emerging evidence that Guillain-Barré syndrome (GBS) may be associated with coronavirus disease 2019 (COVID-19) infection. The aim of this review was to investigate the strength of the evidence. Method: The review was registered in PROSPERO (CDR42020184822). Three electronic databases, MEDLINE, PubMed, and Web of Science, and three preprint servers, MedRvix, ChemRvix, and BioRvix, were searched from December 2019 to 24th September 2020. Studies were included if they were on COVID-19 and of any design. Articles that are reviews or opinion were excluded. The selection process was carried out using EndNote and Rayyan software. The main outcomes in the study were study design, sample size, sex, age, overall GBS symptoms, other COVID-19 symptoms, comorbidity, timing between infection and the onset of neurological symptoms, CT, MRI, and EMG results. Methodological quality of the studies was assessed using the McMaster Critical Review Form. The collected data was analyzed using qualitative synthesis. Findings: Fifty-one high-quality studies (mostly) consisting of 83 patients were included in the study. All of the patients (except in a very few) in the included studies had confirmed diagnosis of COVID-19. Similarly, the diagnosis of GBS was based on standard clinical, electrophysiological, and cerebrospinal fluid (CSF) criteria. Conclusion: GBS may be associated with COVID-19, and therefore, testing for COVID-19 is recommended in patients presenting with GBS during this pandemic.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University, Kano, Nigeria
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
| | - Sevim Acaroz Candan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Melda Soysal Tomruk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mehmet Akif University, Burdur, Turkey
| | - Nuray Elibol
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Olumide Dada
- Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria
| | - Steven Truijen
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
| | - Wim Saeys
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
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21
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Aasfara J, Hajjij A, Bensouda H, Ouhabi H, Benariba F. A unique association of bifacial weakness, paresthesia and vestibulocochlear neuritis as post-COVID-19 manifestation in pregnant women: a case report. Pan Afr Med J 2021; 38:30. [PMID: 33777298 PMCID: PMC7955605 DOI: 10.11604/pamj.2021.38.30.27646] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
SARS-CoV-2 is an infection due to a novel virus belonging to the coronavirus family. Since December 2019, first human cases of COVID-19 have been identified in Wuhan (China) and rapidly has been progressed to a global pandemic declared by the world health organization (WHO) on March 11th 2020. The major complication of COVID-19, is pneumonia, but other presentations like cardiovascular and neurological complications have been reported. Herein, we report a first case of pregnant women presented with bifacial weakness and paraesthesia (BFP) associated to a vestibulocochlear neuritis as post-COVID-19 manifestation. This is a 36-year-old Moroccan female patient with a history of SARS-CoV-2 positive 6 weeks before admission. She presented to the emergency department with rapid bifacial paralysis, bilateral lower extremity paresthesia, vertigo, nausea, vomiting and right auricular pain. An acute stroke was ruled out after neurological examination and brain MRI. Clinical presentation, neurophysiological, audiometry and videonystagmography workup additionally to CSF findings were suggestive of a variant of Guillain Barré Syndrome (GBS), which is BFP associated to right vestibulocochlear neuritis. The patient was treated with Intravenous immunoglobulins (IVIG) therapy associated with intravenous steroids. The patient made a complete recovery of the right facial palsy and the sensorineural hearing loss but still have tingling in lower limbs and left facial palsy at 2 weeks´ follow-up. BFP can be induced by COVID-19 as a postinfectious immune-mediated complication. Regarding the pathophysiology of vestibular neuritis, is probably similar to other viral infection causing nerve damage. Clinicians should consider the association of vestibulocochlear neuritis and BFP as a post SARS-CoV-2 manifestation.
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Affiliation(s)
- Jehanne Aasfara
- Department of Neurology, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Amal Hajjij
- Department of Otolaryngology, Head and Neck Surgery, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Hatim Bensouda
- Department of Otolaryngology, Head and Neck Surgery, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Hamid Ouhabi
- Department of Neurology, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Fouad Benariba
- Department of Otolaryngology, Head and Neck Surgery, Cheikh Khalifa International University Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco.,Department of Otolaryngology, Head and Neck Surgery, Mohammed V Military Training Hospital, Rabat, Morocco
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22
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Ladopoulos T, Zand R, Shahjouei S, Chang JJ, Motte J, Charles James J, Katsanos AH, Kerro A, Farahmand G, Vaghefi Far A, Rahimian N, Ebrahimzadeh SA, Abedi V, Papathanasiou M, Labedi A, Schneider R, Lukas C, Tsiodras S, Tsivgoulis G, Krogias C. COVID-19: Neuroimaging Features of a Pandemic. J Neuroimaging 2021; 31:228-243. [PMID: 33421032 PMCID: PMC8014046 DOI: 10.1111/jon.12819] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND AND PURPOSE The ongoing Coronavirus Disease 2019 (COVID-19) pandemic is caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 is occasionally associated with manifold diseases of the central nervous system (CNS). We sought to present the neuroimaging features of such CNS involvement. In addition, we sought to identify typical neuroimaging patterns that could indicate possible COVID-19-associated neurological manifestations. METHODS In this systematic literature review, typical neuroimaging features of cerebrovascular diseases and inflammatory processes associated with COVID-19 were analyzed. Reports presenting individual patient data were included in further quantitative analysis with descriptive statistics. RESULTS We identified 115 studies reporting a total of 954 COVID-19 patients with associated neurological manifestations and neuroimaging alterations. A total of 95 (82.6%) of the identified studies were single case reports or case series, whereas 660 (69.2%) of the reported cases included individual information and were thus included in descriptive statistical analysis. Ischemia with neuroimaging patterns of large vessel occlusion event was revealed in 59.9% of ischemic stroke patients, whereas 69.2% of patients with intracerebral hemorrhage exhibited bleeding in a location that was not associated with hypertension. Callosal and/or juxtacortical location was identified in 58.7% of cerebral microbleed positive images. Features of hemorrhagic necrotizing encephalitis were detected in 28.8% of patients with meningo-/encephalitis. CONCLUSIONS Manifold CNS involvement is increasingly reported in COVID-19 patients. Typical and atypical neuroimaging features have been observed in some disease entities, so that familiarity with these imaging patterns appears reasonable and may assist clinicians in the differential diagnosis of COVID-19 CNS manifestations.
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Affiliation(s)
- Theodoros Ladopoulos
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ramin Zand
- Department of Neurology, Geisinger Medical Center, Danville, PA
| | - Shima Shahjouei
- Department of Neurology, Geisinger Medical Center, Danville, PA
| | - Jason J Chang
- Department of Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC.,Department of Neurology, Georgetown University Medical Center, Washington, DC
| | - Jeremias Motte
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | | | - Aristeidis H Katsanos
- Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, ON, Canada
| | - Ali Kerro
- SCL Health Neuroscience Department, Billings, MT
| | - Ghasem Farahmand
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alaleh Vaghefi Far
- Neurology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Vida Abedi
- Department of Molecular and Functional Genomics, Weis Center for Research, Geisinger Health System, Danville, PA
| | - Matilda Papathanasiou
- Second Department of Radiology, University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece
| | - Adnan Labedi
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Ruth Schneider
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Carsten Lukas
- Institute of Neuroradiology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Tsivgoulis
- Second Department of Neurology, "Attikon" University Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Department of Neurology, University of Tennessee Health Science Center, Memphis, TN
| | - Christos Krogias
- Department of Neurology, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
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23
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Yarlagadda A, Preston SL, Jeyadhas RP, Lang AE, Hammamieh R, Clayton AH. Blood-Brain Barrier: COVID-19, Pandemics, and Cytokine Norms. INNOVATIONS IN CLINICAL NEUROSCIENCE 2021; 18:21-23. [PMID: 34150359 PMCID: PMC8195557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Neuropsychiatric manifestations of COVID-19 have become increasingly common in published literature as the COVID-19 pandemic continues to devastate the world. Morbidity and mortality associated with COVID-19 infection is driving recognition of the need for potential research in prevention, effective treatment, and reducing fatalities. In this article, we highlighted discussions and proposals previously reported in our series of articles on the subject of the blood-brain barrier to prevent both neurological and psychiatric manifestations of viral infection. The time for a rapid translational approach to bring point-of-care diagnostics and early prevention/treatment tools to practice is now, and it deserves immediate attention.
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Affiliation(s)
- Atmaram Yarlagadda
- Dr. Yarlagadda is the Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Preston is with Uniformed Services University of Health Sciences in Bethesda, Maryland
- Dr. Jeyadhas is with the Hampton VA Medical Center in Hampton, Virginia
- Dr. Lang is with McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Hammamieh is with the Walter Reed Army Institute of Research in Silver Spring, Maryland
- Dr. Clayton is with the University of Virginia in Charlottesville, Virginia
| | - Samuel L Preston
- Dr. Yarlagadda is the Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Preston is with Uniformed Services University of Health Sciences in Bethesda, Maryland
- Dr. Jeyadhas is with the Hampton VA Medical Center in Hampton, Virginia
- Dr. Lang is with McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Hammamieh is with the Walter Reed Army Institute of Research in Silver Spring, Maryland
- Dr. Clayton is with the University of Virginia in Charlottesville, Virginia
| | - Rachel P Jeyadhas
- Dr. Yarlagadda is the Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Preston is with Uniformed Services University of Health Sciences in Bethesda, Maryland
- Dr. Jeyadhas is with the Hampton VA Medical Center in Hampton, Virginia
- Dr. Lang is with McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Hammamieh is with the Walter Reed Army Institute of Research in Silver Spring, Maryland
- Dr. Clayton is with the University of Virginia in Charlottesville, Virginia
| | - Adam Edward Lang
- Dr. Yarlagadda is the Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Preston is with Uniformed Services University of Health Sciences in Bethesda, Maryland
- Dr. Jeyadhas is with the Hampton VA Medical Center in Hampton, Virginia
- Dr. Lang is with McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Hammamieh is with the Walter Reed Army Institute of Research in Silver Spring, Maryland
- Dr. Clayton is with the University of Virginia in Charlottesville, Virginia
| | - Rasha Hammamieh
- Dr. Yarlagadda is the Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Preston is with Uniformed Services University of Health Sciences in Bethesda, Maryland
- Dr. Jeyadhas is with the Hampton VA Medical Center in Hampton, Virginia
- Dr. Lang is with McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Hammamieh is with the Walter Reed Army Institute of Research in Silver Spring, Maryland
- Dr. Clayton is with the University of Virginia in Charlottesville, Virginia
| | - Anita H Clayton
- Dr. Yarlagadda is the Installation Director of Psychological Health at McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Preston is with Uniformed Services University of Health Sciences in Bethesda, Maryland
- Dr. Jeyadhas is with the Hampton VA Medical Center in Hampton, Virginia
- Dr. Lang is with McDonald Army Health Center in Fort Eustis, Virginia
- Dr. Hammamieh is with the Walter Reed Army Institute of Research in Silver Spring, Maryland
- Dr. Clayton is with the University of Virginia in Charlottesville, Virginia
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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25
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Vanaparthy R, Malayala SV, Balla M. COVID-19-Induced Vestibular Neuritis, Hemi-Facial Spasms and Raynaud's Phenomenon: A Case Report. Cureus 2020; 12:e11752. [PMID: 33403182 PMCID: PMC7773294 DOI: 10.7759/cureus.11752] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2020] [Indexed: 02/06/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has created a global health crisis. Though respiratory symptoms have been the usual manifestations, the presentation in some cases may be atypical with various neurological and cutaneous manifestations. We present a case of a 63-year-old female diagnosed with COVID-19 and associated rare manifestations during her visit to Europe.
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Affiliation(s)
| | | | - Mamtha Balla
- Internal Medicine, ProMedica Toledo Hospital, Toledo, USA
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26
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Franca RA, Ugga L, Guadagno E, Russo D, Del Basso De Caro M. Neuroinvasive potential of SARS-CoV2 with neuroradiological and neuropathological findings: is the brain a target or a victim? APMIS 2020; 129:37-54. [PMID: 33098147 DOI: 10.1111/apm.13092] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/19/2020] [Indexed: 12/22/2022]
Abstract
Coronaviridae family includes pathogen viruses for humans, that lead to clinical conditions with main respiratory involvement; many of these viruses have notoriously a neuroinvasive potential, as demonstrated by published data on SARS-CoV and MERS-CoV epidemics, as well by results obtained in experimental models. During pandemic of coronavirus disease 2019 (COVID-19), it is noticed that the central nervous system involvement represented a truly significant moment in the history of some COVID-19 patients; indeed, clinical and radiological features published in literature regarding COVID-19 disease are consistent with a neurological involvement. It is also known that histopathological data related to SARS-CoV2 infection have been published with considerable delay, which was even greater for neuropathological information. Moreover, many published data are incomplete, and often the lesions described are not directly related to the action of the virus. In this review, we collected the available radiological and neuropathological information, in order to delineate a more complete picture of the relationship between SARS-Cov2 and brain, focusing our attention on the two most important neuroinvasion routes for the virus. We also highlighted what we consider methodological mistakes both in the autopsy procedures and brain study in COVID-19 deaths. We emphasize the need for a complete study of all the organs in case of autopsy. It is important that through this experience, we no longer do the mistake of neglecting the brain.
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Affiliation(s)
- Raduan Ahmed Franca
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples 'Federico II', Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, University of Naples 'Federico II', Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples 'Federico II', Naples, Italy
| | - Daniela Russo
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples 'Federico II', Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Pathology Section, University of Naples 'Federico II', Naples, Italy
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27
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Chen B, Chen C, Zheng J, Li R, Xu J. Insights Into Neuroimaging Findings of Patients With Coronavirus Disease 2019 Presenting With Neurological Manifestations. Front Neurol 2020; 11:593520. [PMID: 33240211 PMCID: PMC7680864 DOI: 10.3389/fneur.2020.593520] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/14/2020] [Indexed: 02/05/2023] Open
Abstract
Objective: This mini review aims to provide insight into the neurological imaging in patients with coronavirus disease 2019 (COVID-19). Methods: PubMed, Embase, and Web of Science were searched through July 21, 2020, for relevant studies reporting the neuroimaging findings in COVID-19 patients with neurological manifestations. Proportion estimates with a 95% confidence interval (CI) were pooled after the Freeman–Tukey transformation. The heterogeneity across the included studies was also assessed. Results: Overall, 11 studies with a total of 659 patients were included. The pooled proportion estimate of abnormal neuroimaging finding in patients who exhibited neurological manifestation and underwent brain CT or MRI was 59% (95% CI, 39–77%). The proportions of acute/subacute ischemic infarction, intracranial hemorrhage, and subcortical or deep white matter abnormalities were 22% (95% CI, 17–28%), 24% (95% CI, 17–30%), and 27% (95% CI, 12–45%), respectively. Conclusion: This mini review comprehensively detailed neuroimaging findings of patients with COVID-19 and neurological manifestations. Clinicians should be familiar with the neuroimaging patterns to catch the sight of brain abnormalities caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
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Affiliation(s)
- Boran Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyue Chen
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, China.,Collaborative Innovation Center for Biotherapy, Chengdu, China
| | - Junkai Zheng
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Ruoyu Li
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Jianguo Xu
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, China
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28
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Pan S, Chen WC, Baal JD, Sugrue LP. Neuroradiological Features of Mild and Severe SARS-CoV-2 Infection. Acad Radiol 2020; 27:1507-1514. [PMID: 32912668 PMCID: PMC7456302 DOI: 10.1016/j.acra.2020.08.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/19/2020] [Accepted: 08/21/2020] [Indexed: 12/24/2022]
Abstract
RATIONALE AND OBJECTIVES An increasing number of neurological complications and corresponding radiological findings have been reported in patients with COVID-19 infection. The purpose of this study is to systematically review the current literature on COVID-19-associated neuroradiological findings and examine the prevalence of different findings in patients with both severe and mild COVID-19 infection. MATERIALS AND METHODS A comprehensive literature search of the PubMed and Embase databases was performed. Any studies reporting CT or MRI neuroimaging findings in patients with confirmed COVID-19 infection were included. Patient demographics, main radiological findings, neurological symptoms, and severity of COVID-19 infection were tabulated and quantified according to infection severity. RESULTS Sixty-one studies published between 2019 and 2020 comprising 711 patients were analyzed according to severity of respiratory symptoms. The main neuroradiological findings for patients with mild classification were cranial nerve abnormalities, ischemic infarction, and white matter abnormalities, while the main findings in patients with severe classification were white matter abnormalities, ischemic infarction, and hemorrhagic events. CONCLUSION Neuroradiological manifestations in COVID-19 infection are highly heterogeneous and differ based on the severity of COVID-19 infection. Cranial nerve abnormalities appear exclusive to mild infection, with a high degree of olfactory tract involvement, while hemorrhagic events are more common in severe infection. Notably, ischemic infarction was equally prevalent in both mild and severe COVID-19 infection. Healthcare providers treating COVID-19 patients should be aware of these potential complications and consider neurological assessment and neuroimaging studies when indicated.
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Affiliation(s)
- Simon Pan
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California, San Francisco, California, USA
| | - Willam C Chen
- Department of Radiation Oncology, University of California, San Francisco, 505 Parnassus Ave, San Francisco, California, 94143, USA
| | - Joe D Baal
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California, San Francisco, California, USA
| | - Leo P Sugrue
- Department of Radiology and Biomedical Imaging, Neuroradiology Section, University of California, San Francisco, California, USA.
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29
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Luís ME, Hipólito-Fernandes D, Mota C, Maleita D, Xavier C, Maio T, Cunha JP, Tavares Ferreira J. A Review of Neuro-Ophthalmological Manifestations of Human Coronavirus Infection. Eye Brain 2020; 12:129-137. [PMID: 33154692 PMCID: PMC7608548 DOI: 10.2147/eb.s268828] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/05/2020] [Indexed: 12/17/2022] Open
Abstract
Introduction Human coronavirus (HCoVs) are a group of viruses with recognized neurotropic and neuroinvasive capabilities. The reports on the neurological and ocular findings are increasing day after day and several central and peripheral neurological manifestations are already described. However, none specifically describes the neuro-ophthalmological manifestation of HCoVs. This is the first article specifically reviewing neuro-ophthalmological manifestations of HCoVs infection. Methods PubMed and Google Scholar databases were searched using the keywords: coronaviridae, coronavirus, COVID-19, SARS-CoV-2, SARS-CoV-1, MERS, ocular, ophthalmology, ophthalmological, neuro-ophthalmology, neurological, manifestations. A manual search through the reference lists of relevant articles was also performed. There were no restrictions concerning language or study type and publications not yet printed but available online were considered. Results Coronavirus eye involvement is not frequent and includes mostly a typical viral follicular conjunctivitis. Recently, retinal anatomical alterations were described using optic coherence tomography. Neuro-ophthalmological symptoms and signs can appear isolated or associated with neurological syndromes. The manifestations include headache, ocular pain, visual impairment, diplopia, and cranial nerve palsies secondary to Miller Fisher syndrome, Guillain-Barré syndrome, or encephalitis, and nystagmus. Conclusion Neurological and neuro-ophthalmological syndromes, symptoms, and signs should not be neglected and a complete ophthalmological examination of these patients should be performed to fully describe ocular manifestations related to HCoVs. We believe that major ocular and neuro-ophthalmological manifestations reports lack due to safety issues concerning detailed ophthalmological examination; on the other hand, in a large number of cases, the presence of life-threatening coronavirus disease hinders ocular examination and ophthalmologist’s visit to the intensive care unit.
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Affiliation(s)
- Maria Elisa Luís
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | | | - Catarina Mota
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Diogo Maleita
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Catarina Xavier
- Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal
| | - Tiago Maio
- Ophthalmology Department, Hospital Pedro Hispano, Matosinhos, Portugal
| | - João Paulo Cunha
- Ophthalmology Department, Hospital CUF Cascais, Lisbon, Portugal.,Escola Superior de Tecnologia da Saúde de Lisboa do Instituto Politécnico de Lisboa, Lisbon, Portugal
| | - Joana Tavares Ferreira
- Ophthalmology Department, Hospital CUF Cascais, Lisbon, Portugal.,Escola Superior de Tecnologia da Saúde de Lisboa do Instituto Politécnico de Lisboa, Lisbon, Portugal.,Neuro-Ophthalmology Department, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.,Centro de Estudos das Ciências da Visão, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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30
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Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci 2020; 417:117085. [PMID: 32871412 PMCID: PMC7413162 DOI: 10.1016/j.jns.2020.117085] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. METHODS This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. RESULTS Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. CONCLUSION There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.
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31
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Satarker S, Nampoothiri M. Involvement of the nervous system in COVID-19: The bell should toll in the brain. Life Sci 2020; 262:118568. [PMID: 33035589 PMCID: PMC7537730 DOI: 10.1016/j.lfs.2020.118568] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/24/2020] [Accepted: 10/02/2020] [Indexed: 02/06/2023]
Abstract
The world is fuming at SARS-CoV-2 for being the culprit for causing the devastating COVID-19, claiming millions of lives across the globe in the form of respiratory disorders. But lesser known are its effects on the CNS that are slowly surfacing in the worldwide population. Our review illustrates findings that claim SARS-CoV-2's arrival onto the ACE2 receptors of neuronal and glial cells mainly via CSF, olfactory nerve, trigeminal nerve, neuronal dissemination, and hematogenous pathways. The role of SARS-CoV-2 structural proteins in its smooth viral infectivity of the host cannot be ignored, especially the spike proteins that mediate spike attachment and host membrane fusion. Worth mentioning the nucleocapsid, envelope, and membrane proteins make the proliferation of SARS-CoV-2 much simpler than expected in spreading infection. This has led to catastrophic conditions like seizures, Guillain-Barré syndrome, viral encephalitis, meningoencephalitis, acute cerebrovascular disease, and respiratory failures. Placing a magnifying lens on the lesser-explored CNS consequences of COVID-19, we attempt to shift the focus of our readers onto the new supporting threats to which further studies are needed.
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Affiliation(s)
- Sairaj Satarker
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India
| | - Madhavan Nampoothiri
- Department of Pharmacology, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal 576104, India.
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32
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Uncini A, Vallat JM, Jacobs BC. Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic. J Neurol Neurosurg Psychiatry 2020; 91:1105-1110. [PMID: 32855289 DOI: 10.1136/jnnp-2020-324491] [Citation(s) in RCA: 100] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/30/2022]
Abstract
A systematic review from 1 January to 30 June 2020 revealed 42 patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. Single cases and small series were reported from 13 countries, the majority from Europe (79.4%) and especially from Italy (30.9%). SARS-CoV-2 infection was demonstrated by nasopharyngeal swab (85.7%) and serology (14.3%). Median time between COVID-19 and GBS onset in 36 patients was 11.5 days (IQR: 7.7-16). The most common clinical features were: limb weakness (76.2%), hypoareflexia (80.9 %), sensory disturbances (66.7 %) and facial palsy (38.1%). Dysautonomia occurred in 19%, respiratory failure in 33.3% and 40.5% of patients were admitted in intensive care unit. Most patients (71.4%) had the classical clinical presentation but virtually all GBS variants and subtypes were reported. Cerebrospinal fluid (CSF) albumin-cytological dissociation was found in 28/36 (77.8%) and PCR for SARS-CoV-2 was negative in 25/25 patients. Electrodiagnosis was demyelinating in 80.5% and levels 1 and 2 of Brighton criteria of diagnostic certainty, when applicable, were fulfilled in 94.5% patients. Antiganglioside antibodies were positive in only 1/22 patients. Treatments were intravenous immunoglobulin and/or plasma exchange (92.8%) with, at short-time follow-up, definite improvement or recovery in 62.1% of patients. One patient died. In conclusion, the most frequent phenotype of GBS in SARS-CoV-2 infection is the classical sensorimotor demyelinating GBS responding to the usual treatments. The time interval between infectious and neuropathic symptoms, absence of CSF pleocytosis and negative PCR support a postinfectious mechanism. The abundance of reports suggests a pathogenic link between SARS-CoV-2 infection and GBS but a case-control study is greatly needed.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for "Rare Peripheral Neuropathies", CHU Dupuytren, Limoges, France
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus MC, Rotterdam, The Netherlands
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33
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Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci 2020; 41:3039-3056. [PMID: 32935156 PMCID: PMC7491599 DOI: 10.1007/s10072-020-04708-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.
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Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | | | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
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34
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Orrù G, Conversano C, Malloggi E, Francesconi F, Ciacchini R, Gemignani A. Neurological Complications of COVID-19 and Possible Neuroinvasion Pathways: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6688. [PMID: 32937949 PMCID: PMC7558767 DOI: 10.3390/ijerph17186688] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/23/2022]
Abstract
The Coronavirus Disease 2019 (COVID-19) outbreak has shocked the whole world with its unexpected rapid spread. The virus responsible for the disease, the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), enters host cells by means of the envelope spike protein, which binds to angiotensin-converting enzyme 2 receptors. These receptors are highly expressed in heart, lungs, respiratory tract epithelium, endothelial cells and brain. Since an increasing body of significant evidence is highlighting a possible neuroinvasion related to SARS-CoV-2, a state of the art on the neurological complications is needed. To identify suitable publications, our systematic review was carried out by searching relevant studies on PubMed and Scopus databases. We included studies investigating neurologic manifestations of SARS-CoV-2 in patients over 18. According to the analyzed studies, the most frequent disorders affecting central nervous system (CNS) seem to be the following: olfactory and taste disorders, ischemic/hemorrhagic stroke, meningoencephalitis and encephalopathy, including acute necrotizing encephalopathy, a rare type of encephalopathy. As regards the peripheral nervous system (PNS), Guillain-Barré and Miller Fisher syndromes are the most frequent manifestations reported in the literature. Important clinical information on the neurological manifestations of SARS-CoV-2 would help clinicians raise awareness and simultaneously improve the prognosis of critically ill patients.
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Affiliation(s)
- Graziella Orrù
- Department of Surgical, Medical and Molecular & Critical Area Pathology, University of Pisa, via Savi 10, 56126 Pisa, Italy; (C.C.); (E.M.); (F.F.); (R.C.); (A.G.)
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