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Kumar H, Gupta R. Neuroinvasion of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2): future risk of epilepsy. Int J Neurosci 2024; 134:323-332. [PMID: 35815479 DOI: 10.1080/00207454.2022.2100784] [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: 05/24/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 10/17/2022]
Abstract
Central nervous system (CNS) infection is one of the important risk factors for epilepsy. COVID-19 pandemic, which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has primarily been considered to involve respiratory system only, but it can also affect the CNS. A wide range of neurological manifestations have been reported in SARS-CoV-2 infected patients including seizures, status epilepticus, stroke, which are considered as important risk factors for the development of epilepsy. In post-mortem, brain tissue samples of COVID-19 patients have shown neuropathological changes and presence of SARS-CoV-2 RNA and viral proteins. In this review, mechanisms of SARS-CoV-2 neuroinvasion like neuronal retrograde trans-synaptic route and vascular route are described along with important neurological manifestations in COVID-19 patients such as seizures and cerebrovascular diseases, which have been found to be associated with the development of epilepsy. Hence, an increased risk of future burden of epilepsy in susceptible COVID-19 survivors has been proposed and preventive measures are suggested. The present review highlights about the possible association between neurological manifestations and future risk of epilepsy in COVID-19 patients.
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Affiliation(s)
- Hemant Kumar
- Department of Pharmacology, University College of Medical Sciences, University of Delhi, Delhi, India
| | - Rachna Gupta
- Department of Pharmacology, University College of Medical Sciences, University of Delhi, Delhi, India
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2
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Wang QH, Wang J, Wang YY, He W, Feng C, Gao J, Lu Q, Wang Y, Dun S, Zhang Q, Zou LP. Accelerated Course of Cerebral Adrenoleukodystrophy After Coronavirus Disease 2019 Infection. Pediatr Neurol 2024; 152:87-92. [PMID: 38237318 DOI: 10.1016/j.pediatrneurol.2023.12.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 12/18/2023] [Accepted: 12/23/2023] [Indexed: 02/20/2024]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) can not only infect the respiratory system but also affect the nervous system through the release of inflammatory factors. Our study aimed to investigate the effect of COVID-19 infection on cerebral adrenoleukodystrophy (ALD). METHODS Changes in the neurological symptoms of cerebral ALD after infection with COVID-19 from January 2022 to February 2023 were retrospectively analyzed. The primary assessment indicator was the Neurologic Function Scale (NFS) score. RESULTS A total of 17 male patients with cerebral ALD were enrolled, with a median age of 101 months (80 to 151 months). Among them, 11 (11 of 17, 64.7%) developed an exacerbation of neurological symptoms after COVID-19 infection. Two patients with NFS = 0 started presenting with neurological symptoms after infection. Fifteen patients were in the advanced stage (NFS >1 and/or Loes score >9), of which nine did not progress to major functional disabilities (MFDs). Seven of the nine patients (77.8%) experienced an increase in NFS scores, ranging from 1 to 9 points, within two weeks of COVID-19 infection, with four of them experiencing MFDs. For the other six patients who had progressed to MFDs, there was not much room for further degeneration, so the NFS score did not increase after COVID-19 infection. No deaths related to COVID-19 infection occurred. CONCLUSIONS COVID-19 infection may aggravate neurological symptoms of cerebral ALD, particularly among patients who have not yet progressed to MFDs. Therefore, COVID-19 may accelerate the course of cerebral ALD, so protecting patients from infection is essential for maintaining the stability of the disease.
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Affiliation(s)
- Qiu-Hong Wang
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Wang
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yang-Yang Wang
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Wen He
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Chen Feng
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jing Gao
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qian Lu
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Yi Wang
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Shuo Dun
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Qi Zhang
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Li-Ping Zou
- Medical School of Chinese PLA, Department of Pediatrics, The First Medical Center, Chinese PLA General Hospital, Beijing, China; Beijing Institute for Brain Disorders, Center for Brain Disorders Research, Capital Medical University, Beijing, China.
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Furman S, Green K, Lane TE. COVID-19 and the impact on Alzheimer's disease pathology. J Neurochem 2023:10.1111/jnc.15985. [PMID: 37850241 PMCID: PMC11024062 DOI: 10.1111/jnc.15985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/17/2023] [Accepted: 09/20/2023] [Indexed: 10/19/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has rapidly escalated into a global pandemic that primarily affects older and immunocompromised individuals due to underlying clinical conditions and suppressed immune responses. Furthermore, COVID-19 patients exhibit a spectrum of neurological symptoms, indicating that COVID-19 can affect the brain in a variety of manners. Many studies, past and recent, suggest a connection between viral infections and an increased risk of neurodegeneration, raising concerns about the neurological effects of COVID-19 and the possibility that it may contribute to Alzheimer's disease (AD) onset or worsen already existing AD pathology through inflammatory processes given that both COVID-19 and AD share pathological features and risk factors. This leads us to question whether COVID-19 is a risk factor for AD and how these two conditions might influence each other. Considering the extensive reach of the COVID-19 pandemic and the devastating impact of the ongoing AD pandemic, their combined effects could have significant public health consequences worldwide.
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Affiliation(s)
- Susana Furman
- Department of Neurobiology & Behavior, School of Biological Sciences, University of California, Irvine 92697
| | - Kim Green
- Department of Neurobiology & Behavior, School of Biological Sciences, University of California, Irvine 92697
| | - Thomas E. Lane
- Department of Neurobiology & Behavior, School of Biological Sciences, University of California, Irvine 92697
- Department of Molecular Biology & Biochemistry, School of Biological Sciences, University of California, Irvine 92697, USA
- Center for Virus Research, University of California, Irvine 92697, USA
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Li Z, Lin D, Xu X, Liu X, Zhang J, Huang K, Wang F, Liu J, Zhang Z, Tao E. Central nervous system complications in SARS-CoV-2-infected patients. J Neurol 2023; 270:4617-4631. [PMID: 37573554 PMCID: PMC10511589 DOI: 10.1007/s00415-023-11912-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 07/27/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE To investigate the clinical manifestations, treatment and prognosis of COVID-19-associated central nervous system (CNS) complications. METHODS In this single-centre observation study, we recruited patients with COVID-19-associated CNS complications at the neurology inpatient department of the Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen) from Dec 2022 to Feb 2023. Patients were analysed for demographics, clinical manifestations, cerebrospinal fluid properties, electroencephalographic features, neuroimaging characteristics, and treatment outcome. All patients were followed-up at 1 and 2 months after discharge until Apr 2023. RESULTS Of the 12 patients with COVID-19-associated CNS complications, the CNS symptoms occur between 0 days and 4 weeks after SARS-CoV-2 infection. The most common CNS symptoms were memory deficits (4/12, 33%), Unresponsiveness (4/12, 33%), mental and behavioural disorders (4/12, 33%). Seven of 12 cases can be categorized as probable SARS-CoV-2 encephalitis, and 5 cases can be described as brainstem encephalitis, acute disseminated encephalomyelitis, optic neuritis, multiple sclerosis or tremor probably associated with SARS-CoV-2 infection. Six patients received antiviral therapy, and 11 patients received glucocorticoid therapy, of which 3 patients received human immunoglobulin synchronously. Nine patients recovered well, two patients had residual neurological dysfunction, and one patient passed away from complications associated with tumor. CONCLUSION In this observational study, we found that the inflammatory or immune-related complications were relatively common manifestations of COVID-19-associated CNS complications, including different phenotypes of encephalitis and CNS inflammatory demyelinating diseases. Most patients recovered well, but a few patients had significant neurological dysfunctions remaining.
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Affiliation(s)
- Zhonggui Li
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Danyu Lin
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Xiaoshuang Xu
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Xiaohuan Liu
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Jieli Zhang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Kaixun Huang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Feiyifan Wang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Jianfeng Liu
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Zhi Zhang
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China
| | - Enxiang Tao
- Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China.
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Bechor Ariel T, Ariel B, Ben-Acon M, Sharon N. Focal and generalized onset seizures in children post-COVID (Omicron) recovery: 3 clinical case reports. Epilepsy Behav Rep 2023; 23:100608. [PMID: 37287942 PMCID: PMC10219669 DOI: 10.1016/j.ebr.2023.100608] [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: 02/01/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/09/2023] Open
Abstract
Description of three cases of 4-7-year-old male children presenting with a seizure without a prior history of epilepsy, 2-4 weeks after recovering from COVID-19. All three children were admitted to the pediatric department at Laniado Hospital in Netanya, Israel, and presented with seizures without fever. We found common characteristics among the children that can imply a predisposition for neurological complications of Covid-19.
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Affiliation(s)
| | - Ben Ariel
- Laniado Medical Center, Divrei Haim 16, Netanya, Israel
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Kwiatkowska A, Granicka LH. Anti-Viral Surfaces in the Fight against the Spread of Coronaviruses. MEMBRANES 2023; 13:membranes13050464. [PMID: 37233525 DOI: 10.3390/membranes13050464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 04/22/2023] [Accepted: 04/24/2023] [Indexed: 05/27/2023]
Abstract
This review is conducted against the background of nanotechnology, which provides us with a chance to effectively combat the spread of coronaviruses, and which primarily concerns polyelectrolytes and their usability for obtaining protective function against viruses and as carriers for anti-viral agents, vaccine adjuvants, and, in particular, direct anti-viral activity. This review covers nanomembranes in the form of nano-coatings or nanoparticles built of natural or synthetic polyelectrolytes--either alone or else as nanocomposites for creating an interface with viruses. There are not a wide variety of polyelectrolytes with direct activity against SARS-CoV-2, but materials that are effective in virucidal evaluations against HIV, SARS-CoV, and MERS-CoV are taken into account as potentially active against SARS-CoV-2. Developing new approaches to materials as interfaces with viruses will continue to be relevant in the future.
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Affiliation(s)
- Angelika Kwiatkowska
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4 St., 02-109 Warsaw, Poland
| | - Ludomira H Granicka
- Nalecz Institute of Biocybernetics and Biomedical Engineering, Polish Academy of Sciences, Ks. Trojdena 4 St., 02-109 Warsaw, Poland
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Alhazmi FH, Alsharif WM, Alshoabi SA, Gameraddin M, Aloufi KM, Abdulaal OM, Qurashi AA. Identifying cerebral microstructural changes in patients with COVID-19 using MRI: A systematic review. Brain Circ 2023; 9:6-15. [PMID: 37151797 PMCID: PMC10158661 DOI: 10.4103/bc.bc_77_22] [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: 10/08/2022] [Revised: 12/05/2022] [Accepted: 12/13/2022] [Indexed: 05/09/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is an epidemic viral disease caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the excessive number of neurological articles that have investigated the effect of COVID-19 on the brain from the neurological point of view, very few studies have investigated the impact of COVID-19 on the cerebral microstructure and function of the brain. The aim of this study was to summarize the results of the existing studies on cerebral microstructural changes in COVID-19 patients, specifically the use of quantitative volumetric analysis, blood oxygen level dependent (BOLD), and diffusion tensor imaging (DTI). We searched PubMed/MEDLINE, ScienceDirect, Semantic Scholar, and Google Scholar from December 2020 to April 2022. A well-constructed search strategy was used to identify the articles for review. Seven research articles have met this study's inclusion and exclusion criteria, which have applied neuroimaging tools such as quantitative volumetric analysis, BOLD, and DTI to investigate cerebral microstructure changes in COVID-19 patients. A significant effect of COVID-19 was found in the brain such as hypoperfusion of cerebral blood flow, increased gray matter (GM) volume, and reduced cortical thickness. The insula and thalamic radiation were the most frequent GM region and white matter tract, respectively, that are involved in SARS-CoV-2. COVID-19 was found to be associated with changes in cerebral microstructures. These abnormalities in brain areas might lead to be associated with behaviors, mental and neurological alterations that need to be considered carefully in future studies.
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Affiliation(s)
- Fahad H. Alhazmi
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Walaa M. Alsharif
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Sultan Abdulwadoud Alshoabi
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Moawia Gameraddin
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
- Address for correspondence: Dr. Moawia Gameraddin, Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia. E-mail:
| | - Khalid M. Aloufi
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Osama M. Abdulaal
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
| | - Abdualziz A. Qurashi
- Department of Diagnostic Radiology Technology, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia
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8
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Yepes M. Neurological Complications of SARS-CoV-2 Infection and COVID-19 Vaccines: From Molecular Mechanisms to Clinical Manifestations. Curr Drug Targets 2022; 23:1620-1638. [PMID: 36121081 DOI: 10.2174/1389450123666220919123029] [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: 02/04/2022] [Revised: 05/31/2022] [Accepted: 07/26/2022] [Indexed: 01/25/2023]
Abstract
Coronavirus Disease 2019 (COVID-19) is an infectious disease, caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2), that reached pandemic proportions in 2020. Despite the fact that it was initially characterized by pneumonia and acute respiratory distress syndrome, it is now clear that the nervous system is also compromised in one third of these patients. Indeed, a significant proportion of COVID-19 patients suffer nervous system damage via a plethora of mechanisms including hypoxia, coagulopathy, immune response to the virus, and the direct effect of SARS-CoV-2 on endothelial cells, neurons, astrocytes, pericytes and microglia. Additionally, a low number of previously healthy individuals develop a variety of neurological complications after receiving COVID-19 vaccines and a large proportion of COVID-19 survivors experience longlasting neuropsychiatric symptoms. In conclusion, COVID-19 is also a neurological disease, and the direct and indirect effects of the virus on the nervous system have a significant impact on the morbidity and mortality of these patients. Here we will use the concept of the neurovascular unit, assembled by endothelial cells, basement membrane, perivascular astrocytes, neurons and microglia, to review the effects of SARS-CoV-2 in the nervous system. We will then use this information to review data published to this date on the neurological manifestations of COVID-19, the post- COVID syndrome and COVID-19 vaccines.
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Affiliation(s)
- Manuel Yepes
- Division of Neuropharmacology and Neurologic Diseases, Yerkes National Primate Research Center, Atlanta, GA, USA.,Department of Neurology & Center for Neurodegenerative Disease, Emory University School of Medicine, Atlanta, GA, USA.,Department of Neurology, Veterans Affairs Medical Center, Atlanta, GA, USA
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9
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Zafar S, Aydemir S, Karceski S, Doria JW, Schaefer C, Swarnkar R, Afra P. COVID-19 Continuous-EEG Case Series: A Descriptive Study. J Clin Neurophysiol 2022; 39:575-582. [PMID: 33606430 DOI: 10.1097/wnp.0000000000000832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Corona virus disease 2019 (COVID-19) refers to coronavirus disease secondary to SARS-CoV2 infection mainly affecting the human respiratory system. The SARS-CoV2 has been reported to have neurotropic and neuroinvasive features and neurological sequalae with wide range of reported neurological manifestations, including cerebrovascular disease, skeletal muscle injury, meningitis, encephalitis, and demyelination, as well as seizures and focal status epilepticus. In this case series, we analyzed the continuous video-EEGs of patients with COVID-19 infection to determine the presence of specific EEG features or epileptogenicity. METHODS All continuous video-EEG tracings done on SARS-CoV2-positive patients during a 2-week period from April 5, 2020, to April 19, 2020, were reviewed. The demographics, clinical characteristics, imaging, and EEG features were analyzed and presented. RESULTS Of 23 patients undergoing continuous video-EEG, 16 were COVID positive and were included. Continuous video-EEG monitoring was ordered for "altered mental status" in 11 of 16 patients and for "clinical seizure" in 5 of 16 patients. None of the patients had seizures or status epilepticus as a presenting symptom of COVID-19 infection. Instead, witnessed clinical seizures developed as results of COVID-19-related medical illness(es): anoxic brain injury, stroke/hemorrhage, lithium (Li) toxicity (because of kidney failure), hypertension, and renal disease. Three patients required therapeutic burst suppression because of focal nonconvulsive status epilepticus, status epilepticus/myoclonus secondary to anoxic injury from cardiac arrest, and one for sedation (and with concomitant EEG abnormalities secondary to Li toxicity). CONCLUSIONS In this observational case series of 16 patients with COVID-19 who were monitored with continuous video-EEG, most patients experienced a nonspecific encephalopathy. Clinical seizures and electrographic status epilepticus were the second most commonly observed neurological problem.
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Affiliation(s)
- Saman Zafar
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
| | - Seyhmus Aydemir
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
| | - Steve Karceski
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
| | - Joseph W Doria
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
| | - Candace Schaefer
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
| | - Rohit Swarnkar
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
| | - Pegah Afra
- Department of Neurology, Weill-Cornell Medicine, New York, New York, U.S.A.; and
- Department of Neurology, University of Utah School of Medicine, Salt Lake City, Utah, U.S.A
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Ganesh A, Reis IR, Varma M, Patry DG, Cooke LJ. Neurological and Head/Eyes/Ears/Nose/Throat Manifestations of COVID-19: A Systematic Review and Meta-Analysis. Can J Neurol Sci 2022; 49:514-531. [PMID: 34287109 PMCID: PMC8460425 DOI: 10.1017/cjn.2021.180] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 07/10/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND/OBJECTIVE Coronavirus disease 2019 (COVID-19) has been associated with various neurological and atypical head/eyes/ears/nose/throat (HEENT) manifestations. We sought to review the evidence for these manifestations. METHODS In this systematic review and meta-analysis, we compiled studies published until March 31, 2021 that examined non-respiratory HEENT, central, and peripheral nervous system presentations in COVID-19 patients. We included 477 studies for qualitative synthesis and 59 studies for meta-analyses. RESULTS Anosmia, ageusia, and conjunctivitis may precede typical upper/lower respiratory symptoms. Central nervous system (CNS) manifestations include stroke and encephalopathy, potentially with brainstem or cranial nerve involvement. MRI studies support CNS para-/postinfectious etiologies, but direct neuroinvasion seems very rare, with few cases detecting Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in the CNS. Peripheral nervous system (PNS) manifestations include muscle damage, Guillain-Barre syndrome (GBS), and its variants. There was moderate-to-high study heterogeneity and risk of bias. In random-effects meta-analyses, anosmia/ageusia was estimated to occur in 56% of COVID-19 patients (95% CI: 0.41-0.71, I2:99.9%), more commonly than in patients without COVID-19 (OR: 14.28, 95% CI: 8.39-24.29, I2: 49.0%). Neurological symptoms were estimated to occur in 36% of hospitalized patients (95% CI: 0.31-0.42, I2: 99.8%); ischemic stroke in 3% (95% CI: 0.03-0.04, I2: 99.2%), and GBS in 0.04% (0.033%-0.047%), more commonly than in patients without COVID-19 (OR[stroke]: 2.53, 95% CI: 1.16-5.50, I2: 76.4%; OR[GBS]: 3.43,1.15-10.25, I2: 89.1%). CONCLUSIONS Current evidence is mostly from retrospective cohorts or series, largely in hospitalized or critically ill patients, not representative of typical community-dwelling patients. There remains a paucity of systematically gathered prospective data on neurological manifestations. Nevertheless, these findings support a high index of suspicion to identify HEENT/neurological presentations in patients with known COVID-19, and to test for COVID-19 in patients with such presentations at risk of infection.
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Affiliation(s)
- Aravind Ganesh
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Isabella R. Reis
- Department of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Malavika Varma
- Department of Emergency Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - David G. Patry
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Lara J. Cooke
- Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
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Aschman T, Mothes R, Heppner FL, Radbruch H. What SARS-CoV-2 does to our brains. Immunity 2022; 55:1159-1172. [PMID: 35777361 PMCID: PMC9212726 DOI: 10.1016/j.immuni.2022.06.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 05/22/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
Neurological symptoms in SARS-CoV-2-infected patients have been reported, but their cause remains unclear. In theory, the neurological symptoms observed after SARS-CoV-2 infection could be (1) directly caused by the virus infecting brain cells, (2) indirectly by our body’s local or systemic immune response toward the virus, (3) by coincidental phenomena, or (4) a combination of these factors. As indisputable evidence of intact and replicating SARS-CoV-2 particles in the central nervous system (CNS) is currently lacking, we suggest focusing on the host’s immune reaction when trying to understand the neurocognitive symptoms associated with SARS-CoV-2 infection. In this perspective, we discuss the possible immune-mediated mechanisms causing functional or structural CNS alterations during acute infection as well as in the post-infectious context. We also review the available literature on CNS affection in the context of COVID-19 infection, as well as observations from animal studies on the molecular pathways involved in sickness behavior.
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Abstract
PURPOSE OF REVIEW As of January 8, 2022, a global pandemic caused by infection with severe acute respiratory syndrome coronavirus (SARS-CoV)-2, a new RNA virus, has resulted in 304,896,785 cases in over 222 countries and regions, with over 5,500,683 deaths (www.worldometers.info/coronavirus/). Reports of neurological and psychiatric symptoms in the context of coronavirus infectious disease 2019 (COVID-19) range from headache, anosmia, and dysgeusia, to depression, fatigue, psychosis, seizures, delirium, suicide, meningitis, encephalitis, inflammatory demyelination, infarction, and acute hemorrhagic necrotizing encephalopathy. Moreover, 30-50% of COVID-19 survivors develop long-lasting neurologic symptoms, including a dysexecutive syndrome, with inattention and disorientation, and/or poor movement coordination. Detection of SARS-CoV-2 RNA within the central nervous system (CNS) of patients is rare, and mechanisms of neurological damage and ongoing neurologic diseases in COVID-19 patients are unknown. However, studies demonstrating viral glycoprotein effects on coagulation and cerebral vasculature, and hypoxia- and cytokine-mediated coagulopathy and CNS immunopathology suggest both virus-specific and neuroimmune responses may be involved. This review explores potential mechanistic insights that could contribute to COVID-19-related neurologic disease. RECENT FINDINGS While the development of neurologic diseases during acute COVID-19 is rarely associated with evidence of viral neuroinvasion, new evidence suggests SARS-CoV-2 Spike (S) protein exhibits direct inflammatory and pro-coagulation effects. This, in conjunction with immune dysregulation resulting in cytokine release syndrome (CRS) may result in acute cerebrovascular or neuroinflammatory diseases. Additionally, CRS-mediated loss of blood-brain barrier integrity in specific brain regions may contribute to the expression of proinflammatory mediators by neural cells that may impact brain function long after resolution of acute infection. Importantly, host co-morbid diseases that affect vascular, pulmonary, or CNS function may contribute to the type of neurologic disease triggered by SARS-COV-2 infection. SUMMARY Distinct effects of SARS-CoV-2 S protein and CNS compartment- and region-specific responses to CRS may underlie acute and chronic neuroinflammatory diseases associated with COVID-19.
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Affiliation(s)
- Robyn S Klein
- Center for Neuroimmunology & Neuroinfectious Diseases, Departments of Medicine, Pathology & Immunology, and Neuroscience, Washington University School of Medicine, St. Louis, Missouri, USA
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Jurkevičienė J, Vaišvilas M, Masiliūnas R, Matijošaitis V, Vaitkus A, Geštautaitė D, Taroza S, Puzinas P, Galvanauskaitė E, Jatužis D, Vilionskis A. Reperfusion Therapies for Acute Ischemic Stroke in COVID-19 Patients: A Nationwide Multi-Center Study. J Clin Med 2022; 11:jcm11113004. [PMID: 35683393 PMCID: PMC9181080 DOI: 10.3390/jcm11113004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 12/07/2022] Open
Abstract
(1) Background: Acute ischemic stroke (AIS) is a possible complication of the coronavirus disease 2019 (COVID-19). Safety and efficacy data on reperfusion therapies (RT)—intravenous thrombolysis and endovascular treatment (EVT)—in stroke patients with COVID-19 is lacking. (2) Methods: We performed a retrospective nationwide multi-center pair-matched analysis of COVID-19 patients with AIS who underwent RT. We included adult COVID-19 patients with AIS who were treated with RT between 16 March 2020 and 30 June 2021. All subjects were paired with non-infected controls, matched for age, sex, stroke arterial vascular territory, and RT modality. The primary outcome measure was a favorable functional outcome defined by the modified Rankin scale (mRS 0–2). (3) Results: Thirty-one subjects and thirty-one matched controls were included. The median baseline National Institutes of Health Stroke Scale (NIHSS) score was higher in the COVID-19 group (16 vs. 12, p = 0.028). Rates of ischemic changes and symptomatic intracerebral hemorrhages did not differ significantly between the two groups at 24 h after RT. The median NIHSS 24 h after reperfusion remained significantly higher in the COVID-19 group (16 vs. 5, p = 0.003). MRS 0–2 at discharge was significantly less common in COVID-19 patients (22.6% vs. 51.8%, p = 0.018). Three-month mortality was 54.8% in the COVID-19 group versus 12.9% in controls (p = 0.001). (4) Conclusion: Reperfusion therapies on AIS in COVID-19 patients appear to be safe; however, functional outcomes are significantly worse, and 3-month mortality is higher.
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Affiliation(s)
- Justina Jurkevičienė
- Stroke Centre, Republican Vilnius University Hospital, 04130 Vilnius, Lithuania;
- Correspondence:
| | - Mantas Vaišvilas
- Stroke Centre, Republican Vilnius University Hospital, 04130 Vilnius, Lithuania;
| | - Rytis Masiliūnas
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (R.M.); (D.J.)
| | - Vaidas Matijošaitis
- Department of Neurology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania; (V.M.); (A.V.); (D.G.)
| | - Antanas Vaitkus
- Department of Neurology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania; (V.M.); (A.V.); (D.G.)
| | - Dovilė Geštautaitė
- Department of Neurology, Lithuanian University of Health Sciences, 50009 Kaunas, Lithuania; (V.M.); (A.V.); (D.G.)
| | - Saulius Taroza
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, 00135 Palanga, Lithuania;
| | - Paulius Puzinas
- Department of Neurology, Republican Panevėžys Hospital, 35144 Panevėžys, Lithuania;
| | - Erika Galvanauskaitė
- Department of Neurology, Republican Šiauliai Hospital, 76231 Šiauliai, Lithuania;
| | - Dalius Jatužis
- Center of Neurology, Vilnius University, 08661 Vilnius, Lithuania; (R.M.); (D.J.)
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14
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Ibrahim W. Neurological manifestations in coronavirus disease 2019 (COVID-19) patients: a systematic review of literature. CNS Spectr 2022; 27:145-156. [PMID: 33081863 PMCID: PMC7737125 DOI: 10.1017/s1092852920001935] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/06/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The exact incidence of neurological complications from coronavirus disease 2019 (COVID-19) infection remains unknown. Neurological symptoms are more common with severe form of the disease. Through neuro-invasion, the virus can affect both neurons and glial cells and induce wide range of neurological pathologies. OBJECTIVES To systematically assess the neurological manifestations in patients diagnosed with COVID-19. METHODS A systematic literature search of the PubMed, Scopus, and Cochrane databases was performed. Randomized controlled trials, nonrandomized controlled trials, observational studies of neurological manifestations in patients diagnosed with COVID-19. RESULTS All three-database search identified 89 publications. A total of 22 full-text articles assessed for eligibility with 12 articles excluded. Altogether, the included studies reported 290 patients with neurological manifestations. Neurological manifestations were subdivided into central causes (CNS) and peripheral causes (PNS). CNS symptoms is commoner representing 91% of all neurological patients with 9% only with PNS. Headache represented the commonest neurological symptoms in regard to number of patients, meanwhile dizziness has the highest incidence with 11.9%. Neurological manifestations were divided according to COVID-19 severity into: (1) nonsevere and (2) severe; with all CNS manifestations were more in severe patients except headache were more in nonsevere patients. All included studies were on adult patients except one study in pediatric patients with limited number of participants. CONCLUSIONS From the descriptive analyses and available data of relatively small sample-sized studies, it can be concluded that in spite of the aforementioned limitations, that a wide spectrum of neurological manifestations including CNS and PNS can occur in COVID-19 patients.
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Affiliation(s)
- Wael Ibrahim
- Department of Neurology, Kasr Alainy Hospital, Faculty of Medicine, Cairo University, Cairo, Egypt
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15
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Firoz A, Talwar P. COVID-19 and Retinal Degenerative Diseases: Promising link “Kaempferol”. Curr Opin Pharmacol 2022; 64:102231. [PMID: 35544976 PMCID: PMC9080119 DOI: 10.1016/j.coph.2022.102231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 03/10/2022] [Accepted: 03/24/2022] [Indexed: 01/18/2023]
Abstract
Coronavirus disease (COVID-19) outbreak has caused unprecedented global disruption since 2020. Approximately 238 million people are affected worldwide where the elderly succumb to mortality. Post-COVID syndrome and its side effects have popped up with several health hazards, such as macular degeneration and vision loss. It thus necessitates better medical care and management of our dietary practices. Natural flavonoids have been included in traditional medicine and have also been used safely against COVID-19 and several other diseases. Kaempferol is an essential flavonoid that has been demonstrated to influence several vital cellular signaling pathways involved in apoptosis, angiogenesis, inflammation, and autophagy. In this review, we emphasize the plausible regulatory effects of Kaempferol on hallmarks of COVID-19 and macular degeneration.
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16
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Sarubbo F, El Haji K, Vidal-Balle A, Bargay Lleonart J. Neurological consequences of COVID-19 and brain related pathogenic mechanisms: A new challenge for neuroscience. Brain Behav Immun Health 2022; 19:100399. [PMID: 34870247 PMCID: PMC8629776 DOI: 10.1016/j.bbih.2021.100399] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 11/26/2021] [Accepted: 11/26/2021] [Indexed: 12/15/2022] Open
Abstract
Due to the infection by the SARS-CoV-2 virus (COVID-19) there were also reported neurological symptoms, being the most frequent and best cited those that affect the cerebrovascular, sensorial, cognitive and motor functions, together with the neurological diffuse symptoms as for examples headache or dizziness. Besides, some of them behave high risk of mortality. Consequently, it is crucial to elucidate the mechanisms of action in brain of SARS-CoV-2 virus in order to create new therapeutic targets to fight against this new disease. Since now the mechanisms of arrival to the brain seems to be related with the following processes: blood brain barrier (BBB) disruption together with nervous or axonal transport of the virus by the trigeminal nerve, the vagus nerve, or the brain-gut-axis. Being two the mechanisms of brain affectation most cited: a direct affectation of the virus in the brain through neuroinvasion and an indirect mechanism of action due to the effects of the systemic infection. Both processes include the triggering of inflammation, hypoxia and the increased likelihood of secondary infections. This topic supposes a major novel challenge for neuroscience. Therefore, the aim of this review is to provide summarized information about the neurological symptomatology and the brain pathogenic mechanisms involved and reported in COVID-19.
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Affiliation(s)
- Fiorella Sarubbo
- Research Unit, University Hospital Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Crta, Manacor Km 4, 07198, Palma, Spain
- University of the Balearic Islands (UIB), Biology Department, Mallorca, Spain
- University of the Balearic Islands (UIB), Medicine Faculty, Mallorca, Spain
| | - Khaoulah El Haji
- Research Unit, University Hospital Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Crta, Manacor Km 4, 07198, Palma, Spain
| | - Aina Vidal-Balle
- Research Unit, University Hospital Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Crta, Manacor Km 4, 07198, Palma, Spain
| | - Joan Bargay Lleonart
- Research Unit, University Hospital Son Llàtzer, Health Research Institute of the Balearic Islands (IdISBa), Crta, Manacor Km 4, 07198, Palma, Spain
- University of the Balearic Islands (UIB), Medicine Faculty, Mallorca, Spain
- Hematology Department, University Hospital Son Llàtzer, Crta, Manacor Km 4, 07198, Palma, Spain
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17
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Pellinen J, Holmes MG. Evaluation and Treatment of Seizures and Epilepsy During the COVID-19 Pandemic. Curr Neurol Neurosci Rep 2022; 22:11-17. [PMID: 35080752 PMCID: PMC8790547 DOI: 10.1007/s11910-022-01174-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 12/13/2022]
Abstract
Purpose of Review Seizures, including status epilepticus, have been reported in association with acute COVID-19 infection. People with epilepsy (PWE) have suffered from seizure exacerbations during the pandemic. This article reviews the data for clinical and electrographic seizures associated with COVID-19, technical EEG considerations for reducing risk of transmission, and factors contributing to seizure exacerbations in PWE as well as strategies to address this issue. Recent Findings An increasing number of studies of larger cohorts, accounting for a variety of variables and often utilizing EEG with standardized terminology, are assessing the prevalence of seizures in hospitalized patients with acute COVID-19 infections, and gaining insight into the prevalence of seizures and their effect on outcomes. Additionally, recent studies are evaluating the effect of the pandemic on PWE, barriers faced, and the usefulness of telehealth. Summary Although there is still much to learn regarding COVID-19, current studies help in assessing the risk of seizures, guiding EEG utilization, and optimizing the use of telehealth during the pandemic.
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Affiliation(s)
- Jacob Pellinen
- Department of Neurology, School of Medicine, University of Colorado, Aurora, CO USA
| | - Manisha Gupte Holmes
- Comprehensive Epilepsy Center, School of Medicine, New York University, New York, NY USA
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18
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Sanlier N, Guney-Coskun M. Vitamin D, the immune system, and its relationship with diseases. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2022; 70:39. [PMCID: PMC9573796 DOI: 10.1186/s43054-022-00135-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] [Indexed: 11/07/2022] Open
Abstract
Background Vitamin D is classified as an immunomodulatory hormone that is synthesized because of skin exposure to sunlight. It is known to come into play during the regulation of hormone secretion, immune functions, cell proliferation, and differentiation. Its deficiency can cause many diseases and their associated pleiotropic effects. In addition, in relation to its eminent function as regards adaptive immune response and innate immune response, vitamin D level is associated with immune tolerance. Methods Literature search prior to May 2021 was conducted through selected websites, including the MEDLINE, Embase, Web of Science, Cochrane Central, www.ClinicalTrials.gov, PubMed, Science Direct, Google Scholar, and EFSA. Results Vitamin D is found effective for the regulation of hormone secretion, immune functions, and cell proliferation along with differentiation. Its role as an immune modulator is based on the presence of receptors on many immune cells and the synthesis of its active metabolite from these cells. Vitamin D, an immune system modulator, inhibits cell proliferation and stimulates cell differentiation. A fair number of immune system diseases, encompassing autoimmune disorders alongside infectious diseases, can occur because of low serum vitamin D levels. Supplementation of vitamin D has positive effects in lessening the severity nature of disease activity; there exists no consensus on the dose to be used. Conclusion It is figured out that a higher number of randomized controlled trials are essential to evaluate efficacy pertaining to clinical cases, treatment duration, type, and dose of supplementation and pathophysiology of diseases, immune system functioning, and the effect of vitamin D to be administered.
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Affiliation(s)
- Nevin Sanlier
- Nutrition and Dietetics Department, Faculty of Health Science, Ankara Medipol University, Ankara, 06050 Turkey
| | - Merve Guney-Coskun
- grid.411781.a0000 0004 0471 9346Nutrition and Dietetics Department, Faculty of Health Science, Istanbul Medipol University, Istanbul, Turkey
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19
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Siahaan YMT, Puspitasari V, Pangestu A. COVID-19-Associated Encephalopathy: Systematic Review of Case Reports. J Clin Neurol 2022; 18:194-206. [PMID: 35196749 PMCID: PMC8926776 DOI: 10.3988/jcn.2022.18.2.194] [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: 06/17/2021] [Revised: 08/30/2021] [Accepted: 08/30/2021] [Indexed: 11/29/2022] Open
Abstract
Background and Purpose Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily attacks the respiratory system, but there are also several reports of the involvement of the central nervous system, with one of the manifestations being encephalopathy. The relatively new emergence of COVID-19 means that few studies have investigated the clinical profile of encephalopathy associated with this disease. This study aimed to determine the clinical profile, laboratory, and imaging results of encephalopathy associated with COVID-19. Methods Three databases, namely PubMed/MEDLINE, Embase, and Scopus, were systematically searched for case reports and case series related to COVID-19-associated encephalopathy published from January 1, 2019 to July 20, 2020. Results This review included 24 studies involving 33 cases. The most-reported neurological symptoms were disorientation/confusion (72.72%), decreased consciousness (54.54%), and seizures (27.27%). Laboratory examinations revealed increases in the C-reactive protein level (48.48%), the lactate dehydrogenase level (30.30%), and lymphopenia (27.27%). Brain imaging did not produce any pathological findings in 51.51% of the cases. Electroencephalography showed generalized slowing in 45.45% of the cases. Elevated protein (42.42%) and lymphocytosis (24.24%) were found in the cerebrospinal fluid. Fifteen patients were reportedly discharged from the hospital in a stable condition, while four cases of mortality were recorded. Conclusions The clinical, laboratory, and imaging findings in this review support the hypothesis that cerebral damage in COVID-19-associated encephalopathy is caused by cytokine-immune-mediated inflammation rather than by direct invasion.
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Affiliation(s)
- Yusak Mangara Tua Siahaan
- Department of Neurology, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - Vivien Puspitasari
- Department of Neurology, Universitas Pelita Harapan, Tangerang, Indonesia
- Department of Neurology, Siloam Hospital Lippo Village, Tangerang, Indonesia
| | - Aristo Pangestu
- Department of Neurology, Universitas Pelita Harapan, Tangerang, Indonesia
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20
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Neurologic Complications in Adult and Pediatric Patients with SARS-CoV-2 Infection. CLINICAL AND TRANSLATIONAL NEUROSCIENCE 2021. [DOI: 10.3390/ctn6010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
SARS-CoV-2 has an impact on the nervous system as a result of pathological cellular and molecular events at the level of vascular and neural tissue. Severe neurologic manifestations including stroke, ataxia, seizure, and depressed level of consciousness are prevalent in patients with SARS-CoV-2 infection. Although the mechanism is still unclear, SARS-CoV-2 has been associated with the pathogenesis of intravascular coagulation and angiotensin-converting enzyme-I, both exacerbating systemic inflammation and contributing to hypercoagulation or blood–brain barrier leakage, resulting in ischemic or hemorrhagic stroke. On the other hand, the SARS-CoV-2 spike protein in neural tissue and within the cerebrospinal fluid may induce neural dysfunction, resulting in neuroinflammation, which is exacerbated by peripheral and neural hypercytokinemia that can lead to neuronal damage and subsequent neuroinflammation. A deeper understanding of the fundamental biological mechanisms of neurologic manifestations in SARS-CoV-2 infection can pave the way to identifying a single biomarker or network of biomarkers to help target neuroprotective therapy in patients at risk for developing neurological complications.
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21
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Farahani M, Azadi K, Hashemnejad M, Agoushi A, Nirouei M. Ruled out of preeclampsia-like syndrome due to COVID-19: A case study. Clin Case Rep 2021; 9:e05195. [PMID: 34934502 PMCID: PMC8650748 DOI: 10.1002/ccr3.5195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/22/2021] [Accepted: 11/25/2021] [Indexed: 12/31/2022] Open
Abstract
Coronavirus disease (COVID-19) is an infectious disease. In this study, we report a 28-year-old pregnant woman who had a postpartum seizure with a background of HELLP syndrome and a proven COVID-19 infection. Her child survived, and at 12-week postpartum, all maternal COVID-19-related symptoms vanished, and she was cured.
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Affiliation(s)
- Masoumeh Farahani
- Department of Obstetrics and GynecologistsAlborz University of Medical SciencesKarajIran
| | | | - Maryam Hashemnejad
- Department of Obstetrics and GynecologistsAlborz University of Medical SciencesKarajIran
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22
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Mante PK, Adomako NO, Omuojine JP, Antwi P. Pharmacological management of seizures in patients with COVID-19: a systematic review. AAS Open Res 2021; 4:29. [DOI: 10.12688/aasopenres.13224.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 18 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laninamivir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.
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23
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Wan D, Du T, Hong W, Chen L, Que H, Lu S, Peng X. Neurological complications and infection mechanism of SARS-COV-2. Signal Transduct Target Ther 2021; 6:406. [PMID: 34815399 PMCID: PMC8609271 DOI: 10.1038/s41392-021-00818-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/27/2021] [Accepted: 11/02/2021] [Indexed: 02/05/2023] Open
Abstract
Currently, SARS-CoV-2 has caused a global pandemic and threatened many lives. Although SARS-CoV-2 mainly causes respiratory diseases, growing data indicate that SARS-CoV-2 can also invade the central nervous system (CNS) and peripheral nervous system (PNS) causing multiple neurological diseases, such as encephalitis, encephalopathy, Guillain-Barré syndrome, meningitis, and skeletal muscular symptoms. Despite the increasing incidences of clinical neurological complications of SARS-CoV-2, the precise neuroinvasion mechanisms of SARS-CoV-2 have not been fully established. In this review, we primarily describe the clinical neurological complications associated with SARS-CoV-2 and discuss the potential mechanisms through which SARS-CoV-2 invades the brain based on the current evidence. Finally, we summarize the experimental models were used to study SARS-CoV-2 neuroinvasion. These data form the basis for studies on the significance of SARS-CoV-2 infection in the brain.
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Affiliation(s)
- Dandan Wan
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Tingfu Du
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China
| | - Weiqi Hong
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Li Chen
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Haiying Que
- Laboratory of Aging Research and Cancer Drug Target, State Key Laboratory of Biotherapy, National Clinical Research Center for Geriatricts, West China Hospital, Sichuan University, No. 17, Block 3, Southern Renmin Road, 610041, Chengdu, Sichuan, PR China
| | - Shuaiyao Lu
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
| | - Xiaozhong Peng
- National Kunming High-level Biosafety Primate Research Center, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Yunnan, China.
- State Key Laboratory of Medical Molecular Biology, Department of Molecular, Biology and Biochemistry, Institute of Basic Medical Sciences, Medical Primate Research Center, Neuroscience Center, Chinese Academy of Medical Sciences, School of Basic Medicine Peking Union Medical College, Beijing, China.
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24
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Neurological Manifestations and Outcomes in a Retrospective Cohort of Mexican Inpatients with SARS-CoV-2 Pneumonia: Design of a Risk Profile. Healthcare (Basel) 2021; 9:healthcare9111501. [PMID: 34828547 PMCID: PMC8620259 DOI: 10.3390/healthcare9111501] [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: 09/21/2021] [Revised: 10/29/2021] [Accepted: 11/01/2021] [Indexed: 01/08/2023] Open
Abstract
We analyzed the neurological manifestations in Mexican patients hospitalized with pneumonia due to COVID-19 and investigated the association between demographic, clinical, and biochemical variables and outcomes, including death. A retrospective, analytical study was conducted using the electronic records of patients hospitalized between 1 April 2020 and 30 September 2020. Records of 1040 patients were analyzed: 31.25% died and 79.42% had neurological symptoms, including headache (80.62%), anosmia (32.20%), ageusia (31.96%), myopathy (28.08%), disorientation (14.89%), encephalopathy (12.22%), neuropathy (5.4%), stroke (1.3%), seizures (1.3%), cerebral hemorrhage (1.08%), encephalitis (0.84%), central venous thrombosis (0.36%), and subarachnoid hemorrhage (0.24%). Patients also had comorbidities, such as hypertension (42.30%), diabetes mellitus (38.74%), obesity (61.34%), chronic obstructive pulmonary disease (3.17%), and asthma (2.01%). Factors associated with neurological symptoms were dyspnea, chronic obstructive pulmonary disease, advanced respiratory support, prolonged hospitalization, and worsening fibrinogen levels. Factors associated with death were older age, advanced respiratory support, amine management, chronic obstructive pulmonary disease, intensive care unit management, dyspnea, disorientation, encephalopathy, hypertension, neuropathy, diabetes, male sex, three or more neurological symptoms, and obesity grade 3. In this study we designed a profile to help predict patients at higher risk of developing neurological complications and death following COVID-19 infection.
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25
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Nejad JH, Allahyari F, Hosseinzadeh R, Heiat M, Ranjbar R. Neurological symptoms of COVID-19 infection; a cross-sectional study on hospitalized COVID-19 patients in Iran. Clin Neurol Neurosurg 2021; 210:106985. [PMID: 34700274 PMCID: PMC8502683 DOI: 10.1016/j.clineuro.2021.106985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 09/15/2021] [Accepted: 10/06/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19), a global issue now, can have a variety of clinical manifestations. Hundreds of articles have discussed different aspects of this infectious disease, such as physiopathology, epidemiology, clinical manifestations and treatment protocols. Recently, neurological manifestations of the disease have been found to be pretty common among COVID-19 patients. Here, neurological symptoms of COVID-19 infection with a focus on non-cerebrovascular complications are discussed in a large study population. METHODS Neurological symptoms of 891hospitalized COVID-19 patients from March to June 2020 in a major Hospital, Tehran, Iran, were reviewed. Demographic characteristics and neurological manifestations were analyzed. RESULTS Among 891 hospitalized COVID-19 patients, the following symptoms were observed: headache (63.9%), sleeping problems (51.3%), hyposmia/anosmia (46%), dizziness (45.4%), hypogeusia (42.1%), memory issues (31.5%), auditory disturbances (17.5%), paralysis (3.7%) and seizures (1.7%). In 29.7% of the patients, a neurological symptom was the initiating symptoms of the infection. Females were more likely to show headache and dizziness compared to males (p value<0.05). Headache intensity was also higher in females compared to males (p value<0.05). Headache prevalence was lower in older patients (p value<0.05), while memory loss and impaired consciousness were higher by increasing age (p values=0.002 and 0.001, respectively). CONCLUSION Neurological manifestations were common among COVID-19 patients under study. Headache, as the most common neurological symptom among COVID-19 patients, was the most prevalent and intense among the female population. Headache, dizziness, sleeping problems, hyposmia/anosmia and hypogeusia were common COVID-19 neurological manifestations, while memory issues, auditory disturbances, paralysis, and seizures were less common.
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Affiliation(s)
- Javad Hosseini Nejad
- Neuroscience research center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Fakhri Allahyari
- Neuroscience research center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Ramin Hosseinzadeh
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohammad Heiat
- Baqiyatallah Research Center for Gastroenterology and Liver Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Reza Ranjbar
- Molecular Biology Research Center, Systems Biology and Poisonings Institute, Baqiyatallah University of Medical Sciences, Tehran.
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Zamani R, Pouremamali R, Rezaei N. Central neuroinflammation in Covid-19: a systematic review of 182 cases with encephalitis, acute disseminated encephalomyelitis, and necrotizing encephalopathies. Rev Neurosci 2021; 33:397-412. [PMID: 34536341 DOI: 10.1515/revneuro-2021-0082] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/19/2021] [Indexed: 12/11/2022]
Abstract
Growing evidence demonstrates the association of encephalitis, meningoencephalitis or encephalomyelitis, with SARS-CoV-2 infection. This study aims to determine the profile and possible mechanisms behind CNS inflammatory diseases in the context of Covid-19. We conducted a systematic review of case reports on Covid-19-related encephalitis, meningoencephalitis, acute necrotizing encephalitis, and acute disseminated encephalomyelitis in adults, published before January 2021. A total of 182 cases (encephalitis = 109, meningoencephalitis = 26, acute disseminated encephalomyelitis = 35, acute necrotizing (hemorrhagic) encephalitis = 12) were included. While cerebrospinal fluid (CSF) pleocytosis and increased protein level was present in less than 50%, magnetic resonance imaging (MRI) and electroencephalogram (EEG) were abnormal in 78 and 93.2% of all cases, respectively. Viral particles were detected in cerebrospinal fluid of only 13 patients and autoantibodies were present in seven patients. All patients presented with altered mental status, either in the form of impaired consciousness or psychological/cognitive decline. Seizure, cranial nerve signs, motor, and reflex abnormalities were among associated symptoms. Covid-19-associated encephalitis presents with a distinctive profile requiring thorough diagnosis and thereby a comprehensive knowledge of the disease. The clinical profile of brain inflammation in Covid-19 exhibits majority of abnormal imaging and electroencephalography findings with mild/moderate pleocytosis or proteinorrhachia as prevalent as normal cerebrospinal fluid (CSF). Oligoclonal bands and autoantibody assessments are useful in further evaluating neuro-covid patients, as supported by our pooled evidence. Despite the possibility that direct viral invasion cannot be easily estimated, it is still more likely that immune-mediated or autoimmune reactions play a more important role in SARS-CoV-2 neuroinflammation.
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Affiliation(s)
- Raha Zamani
- School of Medicine, Tehran University of Medical Sciences (TUMS), Children's Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Research Center for Immunodeficiencies, Tehran University of Medical Sciences (TUMS), Children's Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran
| | - Rozhina Pouremamali
- School of Medicine, Tehran University of Medical Sciences (TUMS), Children's Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Tehran University of Medical Sciences (TUMS), Children's Medical Center Hospital, Dr. Qarib St., Keshavarz Blvd, Tehran, 14194, Iran.,Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran,1419733151, Iran
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Jumkhawala SA, Bente JA. New-onset seizures after bamlanivimab infusion. Br J Clin Pharmacol 2021; 88:1395-1397. [PMID: 34532885 DOI: 10.1111/bcp.15066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/29/2021] [Accepted: 08/08/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Saahil A Jumkhawala
- Saint Barnabas Medical Center, Livingston, New Jersey, USA.,Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey, USA
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Raciti L, Calabrò RS. Neurological complications of COVID-19: from pathophysiology to rehabilitation. An overview. ACTA BIO-MEDICA : ATENEI PARMENSIS 2021; 92:e2021317. [PMID: 34487099 PMCID: PMC8477084 DOI: 10.23750/abm.v92i4.10620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To evaluate how the SARS-COV2 is able to affect the nervous system, the main neurological manifestation, and the treatment used, including neurorehabilitation. METHODS Studies performed during the current year that fulfilled inclusion criteria were selected from PubMed, Scopus, Cochrane, and Web of Sciences databases. The search combined the terms "Covid 19," "rehabilitation/treatment," and "neurological complications." RESULTS The exact route by which SARS-CoV-2 can penetrate the CNS is still unknown, although a possible retrograde transynaptic pathway from peripheral nerve endings, and/or through the olfactory bulb, have been suggested. An early management of COVID-19 by a multiprofessional team is fundamental to avoid long term sequaele. Rehabilitation is recommended to improve respiratory and cardiac function, as well as to avoid long term neurological complications. CONCLUSIONS As no specific conclusions in term of prognosis and treatment could be done, research and consensus paper are needed to provide NeuroCovid patients with the best treatment options, including neurorehabilitation.
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Khair AM, Husain S, Kaur G, Falchek S. Convulsive Status Epilepticus in a Child With Controlled Epilepsy and Concurrent COVID-19 Infection: A Case Report and a Quick Review. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2021; 13:1179547620984126. [PMID: 34456598 PMCID: PMC8388184 DOI: 10.1177/1179547620984126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/01/2020] [Indexed: 01/02/2023]
Abstract
The current unprecedented COVID-19 pandemic has been another step toward learning about the unique interaction between viral infections and human nervous system. Very few scientific papers explored neuroinvasive and neurotropic potentials of the SARS-CoV-2 virus in children. We report a child with convulsive status epilepticus and confirmed COVID-19 infection. Brief review of current available literature was discussed.
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Affiliation(s)
- Abdulhafeez M Khair
- Division of Neurology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Sumair Husain
- Division of Neurology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA
| | - Gurcharanjeet Kaur
- Division of Neurology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA.,Thomas Jefferson University, Philadelphia, PA, USA
| | - Stephen Falchek
- Division of Neurology, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA.,Thomas Jefferson University, Philadelphia, PA, USA
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30
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Zhao TS, Zeng HL, Zhang X, Chen X, Jiang WL, Du J, Liu HY, Zhao J, Yuan Y, Peng XF, Li JC, Yang T, Liu BC, Li HJ, Zhang XA, Fang LQ, Lu QB, Cui F, Liu W. Neurological manifestations in COVID-19 patients and their application in predicting fatal disease: A retrospective cohort study. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2021; 55:445-453. [PMID: 34503922 PMCID: PMC8384758 DOI: 10.1016/j.jmii.2021.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/11/2021] [Accepted: 07/19/2021] [Indexed: 01/06/2023]
Abstract
Background To explore the development of central nervous system (CNS) symptoms and clinical application in predicting the clinical outcomes of SARS-COV-2 patients. Methods A retrospective cohort study was performed on the hospitalized patients with SARS-COV-2 recruited from four hospitals in Hubei Province, China from 18 January to 10 March 2020. The patients with CNS symptoms were determined. Data regarding clinical symptoms and laboratory tests were collected from medical records. Results Of 1268 patients studied, 162 (12.8%) had CNS symptoms, manifested as unconsciousness (71, 5.6%), coma (69, 5.4%), dysphoria (50, 3.9%), somnolence (34, 2.7%) and convulsion (3, 0.2%), which were observed at median of 14 (interquartile range 9–18) days after symptom onset and significantly associated with older age (OR = 5.71, 95% confidence interval [CI] 2.78–11.73), male (OR = 1.73, 95% CI 1.22–2.47) and preexisting hypertension (OR = 1.78, 95% CI 1.23–2.57). The presence of CNS symptoms could be predicted by abnormal laboratory tests across various clinical stages, including by lymphocyte counts of <0.93 × 109/L, LDH≥435 U/L and IL-6≥28.83 pg/L at 0–10 days post disease; by lymphocyte count<0.86 × 109/L, IL-2R ≥ 949 U/L, LDH≥382 U/L and WBC≥8.06 × 109/L at 11–20 days post disease. More patients with CNS symptoms developed fatal outcome compared with patients without CNS symptoms (HR = 33.96, 95% CI 20.87–55.16). Conclusion Neurological symptoms of COVID-19 were related to increased odds of developing poor prognosis and even fatal infection.
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Affiliation(s)
- Tian-Shuo Zhao
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China
| | - Hao-Long Zeng
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Xin Zhang
- Huangmei People's Hospital, Huanggang, 436500, PR China
| | - Xi Chen
- Department of Thoracic and Vascular Surgery, Wuhan No. 1 Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, PR China
| | - Wan-Li Jiang
- Department of Thoracic Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, PR China
| | - Juan Du
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China
| | - Han-Yu Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China
| | - Jing Zhao
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Yang Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Xue-Fang Peng
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Jia-Chen Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Tong Yang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Bao-Cheng Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Hui-Jun Li
- Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, PR China
| | - Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China.
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China.
| | - Wei Liu
- Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, Beijing, 100191, PR China; State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, 100071, PR China.
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Dejani NN, Elshabrawy HA, Bezerra Filho CDSM, de Sousa DP. Anticoronavirus and Immunomodulatory Phenolic Compounds: Opportunities and Pharmacotherapeutic Perspectives. Biomolecules 2021; 11:biom11081254. [PMID: 34439920 PMCID: PMC8394099 DOI: 10.3390/biom11081254] [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] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/14/2021] [Accepted: 08/15/2021] [Indexed: 02/06/2023] Open
Abstract
In 2019, COVID-19 emerged as a severe respiratory disease that is caused by the novel coronavirus, Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). The disease has been associated with high mortality rate, especially in patients with comorbidities such as diabetes, cardiovascular and kidney diseases. This could be attributed to dysregulated immune responses and severe systemic inflammation in COVID-19 patients. The use of effective antiviral drugs against SARS-CoV-2 and modulation of the immune responses could be a potential therapeutic strategy for COVID-19. Studies have shown that natural phenolic compounds have several pharmacological properties, including anticoronavirus and immunomodulatory activities. Therefore, this review discusses the dual action of these natural products from the perspective of applicability at COVID-19.
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Affiliation(s)
- Naiara Naiana Dejani
- Department of Physiology and Pathology, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
| | - Hatem A. Elshabrawy
- Department of Molecular and Cellular Biology, College of Osteopathic Medicine, Sam Houston State University, Conroe, TX 77304, USA;
| | - Carlos da Silva Maia Bezerra Filho
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-900, Brazil
| | - Damião Pergentino de Sousa
- Department of Pharmaceutical Sciences, Federal University of Paraíba, João Pessoa 58051-900, Brazil;
- Postgraduate Program in Bioactive Natural and Synthetic Products, Federal University of Paraíba, João Pessoa 58051-900, Brazil
- Correspondence: ; Tel.: +55-83-3216-7347
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Zhan WR, Huang J, Zeng PM, Tian WY, Luo ZG. Emerging neurotropic features of SARS-CoV-2. J Mol Cell Biol 2021; 13:705-711. [PMID: 34289037 PMCID: PMC8344859 DOI: 10.1093/jmcb/mjab044] [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: 09/12/2020] [Revised: 05/06/2021] [Accepted: 05/12/2021] [Indexed: 01/08/2023] Open
Abstract
The prevailing coronavirus disease-19 (COVID-19) caused by a novel severe acute respiratory syndrome coronavirus (SARS-CoV-2) has presented some neurological manifestations including hyposmia, hypogeusia, headache, stroke, encephalitis, Guillain–Barre syndrome, and some neuropsychiatric disorders. Although several cell types in the brain express angiotensin-converting enzyme-2 (ACE2), the main SARS-CoV-2 receptor, and other related proteins, it remains unclear whether the observed neurological manifestations are attributed to virus invasion into the brain or just comorbidities caused by dysregulation of systemic factors. Here, we briefly review the neurological manifestations of SARS-CoV-2, summarize recent evidence for the potential neurotropism of SARS-CoV-2, and discuss the potential mechanisms of COVID-19-associated neurological diseases.
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Affiliation(s)
- Wen-Rong Zhan
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Jing Huang
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Peng-Ming Zeng
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Wei-Ya Tian
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
| | - Zhen-Ge Luo
- School of Life Science and Technology, ShanghaiTech University, Shanghai 201210, China
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33
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Khatoon F, Prasad K, Kumar V. COVID-19 associated nervous system manifestations. Sleep Med 2021; 91:231-236. [PMID: 34321155 PMCID: PMC8267101 DOI: 10.1016/j.sleep.2021.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 07/02/2021] [Accepted: 07/02/2021] [Indexed: 01/08/2023]
Abstract
The novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused a global pandemic in the last year. Along with major respiratory distress, a myriad of neurological manifestations was also reported to be associated with COVID-19 patients. These cases indicate that SARS-CoV-2 can be considered as an opportunistic pathogen of the brain. SARS-CoV-2 enters the brain through the olfactory bulb, retrograde axonal transport from peripheral nerve endings, or via hematogenous or lymphatic routes. Notably, COVID-19 infection can cause or even present with different neurological features including encephalopathy, impaired consciousness, confusion, agitation, seizure, ataxia, headache, anosmia, ageusia, neuropathies, and neurodegenerative diseases. In this paper, we provide a brief review of observed neurological manifestations associated with COVID-19.
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Affiliation(s)
- Fatima Khatoon
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, UP, 201303, India
| | - Kartikay Prasad
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, UP, 201303, India
| | - Vijay Kumar
- Amity Institute of Neuropsychology & Neurosciences, Amity University, Noida, UP, 201303, India.
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Mante PK, Adomako NO, Omuojine JP, Antwi P. Pharmacological management of seizures in patients with COVID-19: a systematic review. AAS Open Res 2021; 4:29. [DOI: 10.12688/aasopenres.13224.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/20/2022] Open
Abstract
Background: Some patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been reported to exhibit neurological symptoms such as seizures and impaired consciousness. Our study reviews reported cases to assess the pharmacological approach to managing seizures in SARS-CoV-2 patients and associated outcomes. Methods: A systematic review of case reports on the incidence of seizures following coronavirus disease 2019 (COVID-19) among patients that reported use of antiepileptic drugs (AEDs) in management was performed by using the PRISMA (preferred reporting items for systematic reviews and meta-analysis) guidelines. Databases used included EMBASE, PubMed, SCOPUS, and Google Scholar. Data was presented as qualitative and descriptive data. Results: In total, 67 articles were selected for full-text assessment, of which 19 were included in the final review. Patients had a median age of 54 years, most of whom were male. Remdisivir, dexamethasone, Laminavir, hydroxychloroquine, azithromycin, and Lopinavir-ritonavir were common agents used in the management of COVID-19. Most patients presented with either generalized tonic-clonic seizures or status epilepticus. Most patients received levetiracetam as drug choice or as part of their regimen. Other AEDs commonly prescribed included midazolam and sodium valproate. Some patients received no antiepileptic drug therapy. Most of the patients who died had more than one comorbidity. Also, most of the patients who died received COVID-19 treatment drugs. None of the patients who received midazolam as drug choice or as part of their regimen developed recurrent seizures in contrast to patients who received levetiracetam and sodium valproate as drug choice or as part of their regimen. Interestingly, none of the patients who received no AEDs suffered recurrent seizures or died. Conclusions: Standard guidelines for managing seizures in COVID-19 patients may be required. A limitation of this review is that it involved the use of case reports with no controls and a small number of patients.
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Kalra RS, Dhanjal JK, Meena AS, Kalel VC, Dahiya S, Singh B, Dewanjee S, Kandimalla R. COVID-19, Neuropathology, and Aging: SARS-CoV-2 Neurological Infection, Mechanism, and Associated Complications. Front Aging Neurosci 2021; 13:662786. [PMID: 34149397 PMCID: PMC8209245 DOI: 10.3389/fnagi.2021.662786] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/05/2021] [Indexed: 01/08/2023] Open
Abstract
The spectrum of health complications instigated by coronavirus disease 2019 (COVID-19, caused by the novel severe acute respiratory syndrome coronavirus 2 or SARS-CoV-2) pandemic has been diverse and complex. Besides the evident pulmonary and cardiovascular threats, accumulating clinical data points to several neurological complications, which are more common in elderly COVID-19 patients. Recent pieces of evidence have marked events of neuro infection and neuroinvasion, producing several neurological complications in COVID-19 patients; however, a systematic understanding of neuro-pathophysiology and manifested neurological complications, more specifically in elderly COVID-19 patients is largely elusive. Since the elderly population gradually develops neurological disorders with aging, COVID-19 inevitably poses a higher risk of neurological manifestations to the aged patients. In this report, we reviewed SARS-CoV-2 infection and its role in neurological manifestations with an emphasis on the elderly population. We reviewed neuropathological events including neuroinfection, neuroinvasion, and their underlying mechanisms affecting neuromuscular, central- and peripheral- nervous systems. We further assessed the imminent neurological challenges in the COVID-19 exposed population, post-SARS-CoV-2-infection. Given the present state of clinical preparedness, the emerging role of AI and machine learning was also discussed concerning COVID-19 diagnostics and its management. Taken together, the present review summarizes neurological outcomes of SARS-CoV-2 infection and associated complications, specifically in elderly patients, and underlines the need for their clinical management in advance.
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Affiliation(s)
- Rajkumar Singh Kalra
- AIST-INDIA DAILAB, National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba, Japan
| | - Jaspreet Kaur Dhanjal
- Department of Computational Biology, Indraprastha Institute of Information Technology Delhi, Okhla Industrial Estate, New Delhi, India
| | - Avtar Singh Meena
- CSIR-Centre for Cellular and Molecular Biology (CCMB), Hyderabad, India
| | - Vishal C. Kalel
- Department of Systems Biochemistry, Institute of Biochemistry and Pathobiochemistry, Faculty of Medicine, Ruhr-University Bochum, Bochum, Germany
| | - Surya Dahiya
- Conservative Dentistry and Endodontics, Maharishi Markandeshwar College of Dental Sciences and Research, Ambala, India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute (IVRI), Regional Station, Palampur, India
| | - Saikat Dewanjee
- Advanced Pharmacognosy Research Laboratory, Department of Pharmaceutical Technology, Jadavpur University, Kolkata, India
| | - Ramesh Kandimalla
- Applied Biology, CSIR-Indian Institute of Chemical Technology (IICT), Hyderabad, India
- Department of Biochemistry, Kakatiya Medical College, Warangal, India
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Guerrero JI, Barragán LA, Martínez JD, Montoya JP, Peña A, Sobrino FE, Tovar-Spinoza Z, Ghotme KA. Central and peripheral nervous system involvement by COVID-19: a systematic review of the pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings. BMC Infect Dis 2021; 21:515. [PMID: 34078305 PMCID: PMC8170436 DOI: 10.1186/s12879-021-06185-6] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/14/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND SARS-CoV-2 can affect the human brain and other neurological structures. An increasing number of publications report neurological manifestations in patients with COVID-19. However, no studies have comprehensively reviewed the clinical and paraclinical characteristics of the central and peripheral nervous system's involvement in these patients. This study aimed to describe the features of the central and peripheral nervous system involvement by COVID-19 in terms of pathophysiology, clinical manifestations, neuropathology, neuroimaging, electrophysiology, and cerebrospinal fluid findings. METHODS We conducted a comprehensive systematic review of all the original studies reporting patients with neurological involvement by COVID-19, from December 2019 to June 2020, without language restriction. We excluded studies with animal subjects, studies not related to the nervous system, and opinion articles. Data analysis combined descriptive measures, frequency measures, central tendency measures, and dispersion measures for all studies reporting neurological conditions and abnormal ancillary tests in patients with confirmed COVID-19. RESULTS A total of 143 observational and descriptive studies reported central and peripheral nervous system involvement by COVID-19 in 10,723 patients. Fifty-one studies described pathophysiologic mechanisms of neurological involvement by COVID-19, 119 focused on clinical manifestations, 4 described neuropathology findings, 62 described neuroimaging findings, 28 electrophysiology findings, and 60 studies reported cerebrospinal fluid results. The reviewed studies reflect a significant prevalence of the nervous system's involvement in patients with COVID-19, ranging from 22.5 to 36.4% among different studies, without mortality rates explicitly associated with neurological involvement by SARS-CoV-2. We thoroughly describe the clinical and paraclinical characteristics of neurological involvement in these patients. CONCLUSIONS Our evidence synthesis led to a categorical analysis of the central and peripheral neurological involvement by COVID-19 and provided a comprehensive explanation of the reported pathophysiological mechanisms by which SARS-CoV-2 infection may cause neurological impairment. International collaborative efforts and exhaustive neurological registries will enhance the translational knowledge of COVID-19's central and peripheral neurological involvement and generate therapeutic decision-making strategies. REGISTRATION This review was registered in PROSPERO 2020 CRD42020193140 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020193140.
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Affiliation(s)
- Juan I. Guerrero
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Luis A. Barragán
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Juan D. Martínez
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Juan P. Montoya
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Alejandra Peña
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
| | - Fidel E. Sobrino
- Translational Neuroscience Research Lab, Clinical Neurology Program, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
- Neurology Unit, Hospital Occidente de Kennedy, Bogota, Colombia
| | - Zulma Tovar-Spinoza
- Pediatric Neurosurgery, Pediatric Epilepsy Surgery, Neurosurgical Laser Ablation Program, Upstate University Hospital, 750 East Adams Street, Syracuse, NY 13210 USA
| | - Kemel A. Ghotme
- Translational Neuroscience Research Lab, Faculty of Medicine, Universidad de La Sabana, Autopista Norte, KM 7, Chía, 250001 Colombia
- Pediatric Neurosurgery, Department of Neurosurgery, Fundacion Santa Fe de Bogota, Bogota, Colombia
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Mohan N, Fayyaz MA, del Rio C, Khurana NKRS, Vaidya SS, Salazar E, Joyce J, Ali AA. Neurological manifestations and neuroimaging findings in patients with SARS-CoV2-a systematic review. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021; 57:68. [PMID: 34093004 PMCID: PMC8170868 DOI: 10.1186/s41983-021-00322-3] [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: 01/11/2021] [Accepted: 05/17/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has drastically affected everyone in a hit or miss manner. Since it began, evidence of the neuro-invasive potential of the virus has been intensifying significantly. Several pathways have been hypothesized to elucidate the neurotropic nature of SARS-CoV2. It is the need of the hour to collect vital information. OBJECTIVE To evaluate and correlate the neuro-radiological and neurological manifestations in patients diagnosed with SARS-CoV2.To identify neuro-invasive pathways of COVID infection. METHODS Relevant studies were identified through four databases-the Cochrane Library, PubMed, Science Direct, and Web of Science. These were searched using relevant keywords-"COVID-19," "SARS-CoV2," "neurological manifestations," "neuroimaging," "CT," and "MRI." Relevant articles were screened according to a pre-defined inclusion and exclusion criteria from December 2019 to August 2020. RESULTS Our review included a total of 63 full text publications with 584 patients, composed mainly of observational studies, case reports, and case series. The most common neurological manifestations associated with COVID-19 were altered mental status, stroke, and paralysis. About 17.85% patients who underwent neuroimaging were found to be having ischemic changes suggestive of a stroke. This was followed by hemorrhagic changes as the second most common finding. The most commonly involved vessel was the Middle Cerebral Artery. Besides stroke, we found that SARS-CoV2 could be the cause for new-onset seizures, Guillain-Barre Syndrome, encephalitis, and many other severe neurological diseases. CONCLUSION The information that we have obtained so far will prove dynamic to healthcare providers working against the COVID-19 pandemic. It is necessary to be aware of these atypical neurological findings for the early diagnosis and treatment of COVID-19 infected patients. However, to completely understand the connection between SARS-CoV2 and the nervous system, further research is necessary.
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Affiliation(s)
- Nikita Mohan
- Jawaharlal Nehru Medical College, Belagavi, Karnataka India
| | | | - Christopher del Rio
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico
| | | | | | - Esteban Salazar
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey Nuevo Leon, Mexico
| | - John Joyce
- M.S Ramaiah Medical College, Bangalore, Karnataka India
| | - Amrat Ayaz Ali
- Liaquat University of Medical and Health Sciences, Jamshoro, Pakistan
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Karuppan MKM, Devadoss D, Nair M, Chand HS, Lakshmana MK. SARS-CoV-2 Infection in the Central and Peripheral Nervous System-Associated Morbidities and Their Potential Mechanism. Mol Neurobiol 2021; 58:2465-2480. [PMID: 33439437 PMCID: PMC7805264 DOI: 10.1007/s12035-020-02245-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 12/02/2020] [Indexed: 12/15/2022]
Abstract
The recent outbreak of SARS-CoV-2 infections that causes coronavirus-induced disease of 2019 (COVID-19) is the defining and unprecedented global health crisis of our time in both the scale and magnitude. Although the respiratory tract is the primary target of SARS-CoV-2, accumulating evidence suggests that the virus may also invade both the central nervous system (CNS) and the peripheral nervous system (PNS) leading to numerous neurological issues including some serious complications such as seizures, encephalitis, and loss of consciousness. Here, we present a comprehensive review of the currently known role of SARS-CoV-2 and identify all the neurological problems reported among the COVID-19 case reports throughout the world. The virus might gain entry into the CNS either through the trans-synaptic route via the olfactory neurons or through the damaged endothelium in the brain microvasculature using the ACE2 receptor potentiated by neuropilin-1 (NRP-1). The most critical of all symptoms appear to be the spontaneous loss of breathing in some COVID-19 patients. This might be indicative of a dysfunction within the cardiopulmonary regulatory centers in the brainstem. These pioneering studies, thus, lay a strong foundation for more in-depth basic and clinical research required to confirm the role of SARS-CoV-2 infection in neurodegeneration of critical brain regulatory centers.
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Affiliation(s)
- Mohan Kumar Muthu Karuppan
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Dinesh Devadoss
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Madhavan Nair
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Hitendra S Chand
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA
| | - Madepalli K Lakshmana
- Department of Immunology and Nano-Medicine, Alzheimer's Disease Research Unit, Herbert Wertheim College of Medicine, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, USA.
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LaRovere KL, Riggs BJ, Poussaint TY, Young CC, Newhams MM, Maamari M, Walker TC, Singh AR, Dapul H, Hobbs CV, McLaughlin GE, Son MBF, Maddux AB, Clouser KN, Rowan CM, McGuire JK, Fitzgerald JC, Gertz SJ, Shein SL, Munoz AC, Thomas NJ, Irby K, Levy ER, Staat MA, Tenforde MW, Feldstein LR, Halasa NB, Giuliano JS, Hall MW, Kong M, Carroll CL, Schuster JE, Doymaz S, Loftis LL, Tarquinio KM, Babbitt CJ, Nofziger RA, Kleinman LC, Keenaghan MA, Cvijanovich NZ, Spinella PC, Hume JR, Wellnitz K, Mack EH, Michelson KN, Flori HR, Patel MM, Randolph AG. Neurologic Involvement in Children and Adolescents Hospitalized in the United States for COVID-19 or Multisystem Inflammatory Syndrome. JAMA Neurol 2021; 78:536-547. [PMID: 33666649 DOI: 10.1001/jamaneurol.2021.0504] [Citation(s) in RCA: 240] [Impact Index Per Article: 80.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Importance Coronavirus disease 2019 (COVID-19) affects the nervous system in adult patients. The spectrum of neurologic involvement in children and adolescents is unclear. Objective To understand the range and severity of neurologic involvement among children and adolescents associated with COVID-19. Setting, Design, and Participants Case series of patients (age <21 years) hospitalized between March 15, 2020, and December 15, 2020, with positive severe acute respiratory syndrome coronavirus 2 test result (reverse transcriptase-polymerase chain reaction and/or antibody) at 61 US hospitals in the Overcoming COVID-19 public health registry, including 616 (36%) meeting criteria for multisystem inflammatory syndrome in children. Patients with neurologic involvement had acute neurologic signs, symptoms, or diseases on presentation or during hospitalization. Life-threatening involvement was adjudicated by experts based on clinical and/or neuroradiologic features. Exposures Severe acute respiratory syndrome coronavirus 2. Main Outcomes and Measures Type and severity of neurologic involvement, laboratory and imaging data, and outcomes (death or survival with new neurologic deficits) at hospital discharge. Results Of 1695 patients (909 [54%] male; median [interquartile range] age, 9.1 [2.4-15.3] years), 365 (22%) from 52 sites had documented neurologic involvement. Patients with neurologic involvement were more likely to have underlying neurologic disorders (81 of 365 [22%]) compared with those without (113 of 1330 [8%]), but a similar number were previously healthy (195 [53%] vs 723 [54%]) and met criteria for multisystem inflammatory syndrome in children (126 [35%] vs 490 [37%]). Among those with neurologic involvement, 322 (88%) had transient symptoms and survived, and 43 (12%) developed life-threatening conditions clinically adjudicated to be associated with COVID-19, including severe encephalopathy (n = 15; 5 with splenial lesions), stroke (n = 12), central nervous system infection/demyelination (n = 8), Guillain-Barré syndrome/variants (n = 4), and acute fulminant cerebral edema (n = 4). Compared with those without life-threatening conditions (n = 322), those with life-threatening neurologic conditions had higher neutrophil-to-lymphocyte ratios (median, 12.2 vs 4.4) and higher reported frequency of D-dimer greater than 3 μg/mL fibrinogen equivalent units (21 [49%] vs 72 [22%]). Of 43 patients who developed COVID-19-related life-threatening neurologic involvement, 17 survivors (40%) had new neurologic deficits at hospital discharge, and 11 patients (26%) died. Conclusions and Relevance In this study, many children and adolescents hospitalized for COVID-19 or multisystem inflammatory syndrome in children had neurologic involvement, mostly transient symptoms. A range of life-threatening and fatal neurologic conditions associated with COVID-19 infrequently occurred. Effects on long-term neurodevelopmental outcomes are unknown.
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Affiliation(s)
- Kerri L LaRovere
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts
| | - Becky J Riggs
- Division of Pediatric Anesthesiology and Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tina Y Poussaint
- Department of Radiology, Boston Children's Hospital, Boston, Massachusetts
| | - Cameron C Young
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Margaret M Newhams
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Mia Maamari
- Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern, Children's Health Medical Center Dallas
| | - Tracie C Walker
- Department of Pediatrics, University of North Carolina at Chapel Hill Children's Hospital, Chapel Hill
| | - Aalok R Singh
- Pediatric Critical Care Division, Maria Fareri Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla
| | - Heda Dapul
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York University Grossman School of Medicine, New York
| | - Charlotte V Hobbs
- Division of Infectious Diseases, Department of Pediatrics, Department of Microbiology, University of Mississippi Medical Center, Jackson
| | - Gwenn E McLaughlin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Mary Beth F Son
- Division of Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Aline B Maddux
- Section of Critical Care Medicine, Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora
| | - Katharine N Clouser
- Department of Pediatrics, Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center, Hackensack, New Jersey
| | - Courtney M Rowan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis
| | - John K McGuire
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle
| | - Julie C Fitzgerald
- Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Shira J Gertz
- Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston, New Jersey
| | - Steven L Shein
- Division of Pediatric Critical Care Medicine, Rainbow Babies and Children's Hospital, Cleveland, Ohio
| | - Alvaro Coronado Munoz
- Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston
| | - Neal J Thomas
- Department of Pediatrics, Penn State Hershey Children's Hospital, Pennsylvania State University College of Medicine, Hershey
| | - Katherine Irby
- Section of Pediatric Critical Care, Department of Pediatrics, Arkansas Children's Hospital, Little Rock
| | - Emily R Levy
- Divisions of Pediatric Infectious Diseases and Pediatric Critical Care Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mary A Staat
- Department of Pediatrics, University of Cincinnati, Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mark W Tenforde
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Leora R Feldstein
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Natasha B Halasa
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - John S Giuliano
- Division of Critical Care, Yale University School of Medicine, New Haven, Connecticut
| | - Mark W Hall
- Division of Critical Care Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Michele Kong
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Alabama at Birmingham
| | | | - Jennifer E Schuster
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Sule Doymaz
- Division of Pediatric Critical Care, Department of Pediatrics, State University of New York Downstate Health Sciences University, Brooklyn
| | - Laura L Loftis
- Section of Critical Care Medicine, Department of Pediatrics, Texas Children's Hospital, Houston
| | - Keiko M Tarquinio
- Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | | | - Ryan A Nofziger
- Division of Critical Care Medicine, Akron Children's Hospital, Akron, Ohio
| | - Lawrence C Kleinman
- Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Michael A Keenaghan
- Pediatric Critical Care, New York City Health and Hospitals, Kings County Hospital, Brooklyn, New York
| | - Natalie Z Cvijanovich
- Division of Critical Care Medicine, University of California, San Francisco, Benioff Children's Hospital, Oakland
| | - Philip C Spinella
- Division of Critical Care, Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Janet R Hume
- Division of Pediatric Critical Care, University of Minnesota Masonic Children's Hospital, Minneapolis
| | - Kari Wellnitz
- Division of Pediatric Critical Care, Stead Family Department of Pediatrics, University of Iowa Carver College of Medicine, Iowa City, Iowa
| | - Elizabeth H Mack
- Division of Pediatric Critical Care Medicine, Medical University of South Carolina, Charleston
| | - Kelly N Michelson
- Division of Critical Care Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Heidi R Flori
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Mott Children's Hospital and University of Michigan, Ann Arbor
| | - Manish M Patel
- COVID-19 Response, Centers for Disease Control and Prevention, Atlanta, Georgia.,Influenza Division, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adrienne G Randolph
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts.,Departments of Anaesthesia and Pediatrics, Harvard Medical School, Boston, Massachusetts
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Khedr EM, Shoyb A, Mohammaden M, Saber M. Acute symptomatic seizures and COVID-19: Hospital-based study. Epilepsy Res 2021; 174:106650. [PMID: 33993018 PMCID: PMC8096525 DOI: 10.1016/j.eplepsyres.2021.106650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 04/01/2021] [Accepted: 05/02/2021] [Indexed: 12/24/2022]
Abstract
Background and purpose Post COVID-19 seizures are relatively rare. The aim of the present study was to estimate the frequency of acute symptomatic seizures among patients with COVID-19 and to discuss possible pathophysiological mechanisms. Material and methods Out of 439 cases with COVID-19 that were admitted to Assiut and Aswan University hospitals during the period from 1 June to 10 August 2020, 19 patients (4.3 %) presented with acute symptomatic seizures. Each patient underwent computed tomography (CT) or magnetic resonance imaging (MRI) of the brain and conventional electroencephalography (EEG). Laboratory investigations included: blood gases, complete blood picture, serum D-Dimer, Ferritin, C-reactive protein, renal and liver functions, and coagulation profile. Results Of the 19 patients, 3 had new onset seizures without underlying pathology (0.68 % out of the total 439 patients); 2 others (0.46 %) had previously diagnosed controlled epilepsy with breakthrough seizures. The majority of cases (14 patients, 3.19 %) had primary pathology that could explain the occurrence of seizures: 5 suffered a post COVID-19 stroke (3 ischemic and 2 hemorrhagic stroke); 6 patients had COVID-related encephalitis; 2 patients were old ischemic stroke patients; 1 patient had a brain tumor and developed seizures post COVID-19. Conclusion acute symptomatic seizure is not a rare complication of post COVID-19 infection. Both new onset seizures and seizures secondary to primary brain insult (post COVID encephalitis or recent stroke) were observed.
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Affiliation(s)
- Eman M Khedr
- Department of Neuropsychiatry, Faculty of Medicine, Assiut University, Egypt.
| | - Ahmed Shoyb
- Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Egypt
| | - Mahmoud Mohammaden
- Department of Neuropsychiatry, Faculty of Medicine, South Valley University, Egypt
| | - Mostafa Saber
- Department of Neuropsychiatry, Faculty of Medicine, Aswan University, Egypt
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Duan K, Premi E, Pilotto A, Cristillo V, Benussi A, Libri I, Giunta M, Bockholt HJ, Liu J, Campora R, Pezzini A, Gasparotti R, Magoni M, Padovani A, Calhoun VD. Alterations of frontal-temporal gray matter volume associate with clinical measures of older adults with COVID-19. Neurobiol Stress 2021; 14:100326. [PMID: 33869679 PMCID: PMC8041745 DOI: 10.1016/j.ynstr.2021.100326] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 04/03/2021] [Accepted: 04/05/2021] [Indexed: 12/19/2022] Open
Abstract
COVID-19, the infectious disease caused by the most recently discovered severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), has become a global pandemic. It dramatically affects people's health and daily life. Neurological complications are increasingly documented for patients with COVID-19. However, the effect of COVID-19 on the brain is less studied, and existing quantitative neuroimaging analyses of COVID-19 were mainly based on the univariate voxel-based morphometry analysis (VBM) that requires corrections for a large number of tests for statistical significance, multivariate approaches that can reduce the number of tests to be corrected have not been applied to study COVID-19 effect on the brain yet. In this study, we leveraged source-based morphometry (SBM) analysis, a multivariate extension of VBM, to identify changes derived from computed tomography scans in covarying gray matter volume patterns underlying COVID-19 in 120 neurological patients (including 58 cases with COVID-19 and 62 patients without COVID-19 matched for age, gender and diseases). SBM identified that lower gray matter volume (GMV) in superior/medial/middle frontal gyri was significantly associated with a higher level of disability (modified Rankin Scale) at both discharge and six months follow-up phases even when controlling for cerebrovascular diseases. GMV in superior/medial/middle frontal gyri was also significantly reduced in patients receiving oxygen therapy compared to patients not receiving oxygen therapy. Patients with fever presented significant GMV reduction in inferior/middle temporal gyri and fusiform gyrus compared to patients without fever. Patients with agitation showed GMV reduction in superior/medial/middle frontal gyri compared to patients without agitation. Patients with COVID-19 showed no significant GMV differences from patients without COVID-19 in any brain region. Results suggest that COVID-19 may affect the frontal-temporal network in a secondary manner through fever or lack of oxygen.
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Affiliation(s)
- Kuaikuai Duan
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
| | - Enrico Premi
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Andrea Pilotto
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Viviana Cristillo
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Alberto Benussi
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Ilenia Libri
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Marcello Giunta
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - H. Jeremy Bockholt
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
| | - Jingyu Liu
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
- Department of Computer Science, Georgia State University, Atlanta, USA
| | - Riccardo Campora
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Pezzini
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Roberto Gasparotti
- Neuroradiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Mauro Magoni
- Stroke Unit, Azienda Socio Sanitaria Territoriale Spedali Civili, Spedali Civili Hospital, Brescia, Italy
| | - Alessandro Padovani
- Neurology Unit, Department of Clinical and Experimental Sciences, University of Brescia, Italy
| | - Vince D. Calhoun
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, USA
- Tri-Institutional Center for Translational Research in Neuroimaging and Data Science (TReNDS), Georgia Institute of Technology, Georgia State University, Emory University, Atlanta, USA
- Department of Computer Science, Georgia State University, Atlanta, USA
- Department of Psychology, Computer Science, Neurosciences, Mathematics & Statistics, Georgia State University, Atlanta, USA
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Post-COVID seizure: A new feature of "long-COVID". eNeurologicalSci 2021; 23:100340. [PMID: 33898792 PMCID: PMC8053221 DOI: 10.1016/j.ensci.2021.100340] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 12/19/2022] Open
Abstract
Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or “long-COVID” complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence. Patients with COVID-19 can develop multiple neurologic disorders. Seizure can be a manifestation of the “Long-COVID” syndrome. Longitudinal studies of neurologic disease in COVID-19 survivors are needed.
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43
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Karvigh SA, Vahabizad F, Mirhadi MS, Banihashemi G, Montazeri M. COVID-19-related refractory status epilepticus with the presence of SARS-CoV-2 (RNA) in the CSF: a case report. Neurol Sci 2021; 42:2611-2614. [PMID: 33860395 PMCID: PMC8049392 DOI: 10.1007/s10072-021-05239-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 04/08/2021] [Indexed: 12/04/2022]
Abstract
Amongst the neurologic complications of COVID-19 disease, very few reports have shown the presence of the virus in the cerebrospinal fluid (CSF). Seizure and rarely status epilepticus can be associated with COVID-19 disease. Here we present a 73-year-old male with prior history of stroke who has never experienced seizure before. He had no systemic presentation of COVID-19 disease. The presenting symptoms were two consecutive generalized tonic-clonic seizures that after initial resolution turned into a nonconvulsive status epilepticus despite antiepileptic treatment (a presentation similar to NORSE (new-onset refractory status epilepticus)). There was no new lesion in the brain magnetic resonance imaging (MRI). The CSF analysis only showed an increased protein levels and positive reverse transcription polymerase chain reaction (RT-PCR) of 2019-nCoV. Patient recovered partially after anesthetic, IVIG, steroid, and remdesivir. To our knowledge, this is the first report of a refractory status epilepticus with the presence of SARS-CoV-2 ribonucleic acid (RNA) in the CSF.
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Affiliation(s)
- Sanaz Ahmadi Karvigh
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Fahimeh Vahabizad
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Imam Street, Tehran, Iran.
| | - Maryam Sadat Mirhadi
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Gelareh Banihashemi
- Department of Neurology, Sina Hospital, Tehran University of Medical Sciences, Imam Street, Tehran, Iran
| | - Mahnaz Montazeri
- Department of Infectious Disease, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Yassin A, Nawaiseh M, Shaban A, Alsherbini K, El-Salem K, Soudah O, Abu-Rub M. Neurological manifestations and complications of coronavirus disease 2019 (COVID-19): a systematic review and meta-analysis. BMC Neurol 2021; 21:138. [PMID: 33784985 PMCID: PMC8007661 DOI: 10.1186/s12883-021-02161-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 03/17/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The spectrum of neurological involvement in COVID-19 is not thoroughly understood. To the best of our knowledge, no systematic review with meta-analysis and a sub-group comparison between severe and non-severe cases has been published. The aim of this study is to assess the frequency of neurological manifestations and complications, identify the neurodiagnostic findings, and compare these aspects between severe and non-severe COVID-19 cases. METHODS A systematic search of PubMed, Scopus, EBSCO, Web of Science, and Google Scholar databases was conducted for studies published between the 1st of January 2020 and 22nd of April 2020. In addition, we scanned the bibliography of included studies to identify other potentially eligible studies. The criteria for eligibility included studies published in English language (or translated to English), those involving patients with COVID-19 of all age groups, and reporting neurological findings. Data were extracted from eligible studies. Meta-analyses were conducted using comprehensive meta-analysis software. Random-effects model was used to calculate the pooled percentages and means with their 95% confidence intervals (CIs). Sensitivity analysis was performed to assess the effect of individual studies on the summary estimate. A subgroup analysis was conducted according to severity. The main outcomes of the study were to identify the frequency and nature of neurological manifestations and complications, and the neuro-diagnostic findings in COVID-19 patients. RESULTS 44 articles were included with a pooled sample size of 13,480 patients. The mean age was 50.3 years and 53% were males. The most common neurological manifestations were: Myalgia (22.2, 95% CI, 17.2 to 28.1%), taste impairment (19.6, 95% CI, 3.8 to 60.1%), smell impairment (18.3, 95% CI, 15.4 to 76.2%), headache (12.1, 95% CI, 9.1 to 15.8%), dizziness (11.3, 95% CI, 8.5 to 15.0%), and encephalopathy (9.4, 95% CI, 2.8 to 26.6%). Nearly 2.5% (95% CI, 1 to 6.1%) of patients had acute cerebrovascular diseases (CVD). Myalgia, elevated CK and LDH, and acute CVD were significantly more common in severe cases. Moreover, 20 case reports were assessed qualitatively, and their data presented separately. CONCLUSIONS Neurological involvement is common in COVID-19 patients. Early recognition and vigilance of such involvement might impact their overall outcomes.
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Affiliation(s)
- Ahmed Yassin
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 630001, Irbid, 22110, Jordan.
| | - Mohammed Nawaiseh
- Graduate of The University of Jordan, Amman, Jordan
- Intern at Jordanian Royal Medical Services, Amman, Jordan
| | - Ala Shaban
- Graduate of The University of Jordan, Amman, Jordan
- Researcher, King Hussein Cancer Center, Amman, Jordan
| | - Khalid Alsherbini
- Department of Neurology, University of Tennessee Health Science Center, Methodist University Hospital, Memphis, TN, USA
| | - Khalid El-Salem
- Division of Neurology, Department of Neurosciences, Faculty of Medicine, Jordan University of Science and Technology, P.O.Box 630001, Irbid, 22110, Jordan
| | - Ola Soudah
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk University, Irbid, Jordan
| | - Mohammad Abu-Rub
- Department of Neurology, The George Washington University, Washington, DC, USA
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45
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Shulman JG, Ford T, Cervantes-Arslanian AM. Neurologic Emergencies during the Coronavirus Disease 2019 Pandemic. Neurol Clin 2021; 39:671-687. [PMID: 33896538 PMCID: PMC7995638 DOI: 10.1016/j.ncl.2021.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Julie G Shulman
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA.
| | - Thomas Ford
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA
| | - Anna M Cervantes-Arslanian
- Department of Neurology, Boston University School of Medicine, 72 East Concord Street, Suite C3, Boston, MA 02118, USA; Department of Neurosurgery, Boston University School of Medicine, 725 Albany St, Suite 7C, Boston, MA 02118, USA; Department of Medicine (Infectious Diseases), Boston University School of Medicine, 801 Massachusetts Avenue, Crosstown, 2nd floor, Boston MA 02118, USA
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46
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Jalil BA, Ijaz M, Khan AM, Ledbetter TG. A young man presenting with encephalopathy and seizures secondary to SARS-CoV-2. BMJ Case Rep 2021; 14:14/3/e240576. [PMID: 33762283 PMCID: PMC7993329 DOI: 10.1136/bcr-2020-240576] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has now emerged from a respiratory illness to a systemic viral illness with multisystem involvement. There is still a lot to learn about this illness as new disease associations with COVID-19 emerge consistently. We present a unique case of a neurological manifestation of a patient with structural brain disease who was COVID-19 positive and developed mental status changes, new-onset seizures and findings suggestive of viral meningitis on lumbar puncture. We also review the literature and discuss our case in the context of the other cases reported. We highlight the value of considering seizures and encephalopathy as one of the presenting features of COVID-19 disease.
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Affiliation(s)
- Bilal Athar Jalil
- Pulmonary and Critical Care Medicine, Baylor Scott and White Medical Center, Waxahachie, Texas, USA
| | - Mohsin Ijaz
- Pulmonary and Critical Care Medicine, Baylor Scott and White Medical Center, Waxahachie, Texas, USA
| | - Amir Maqbul Khan
- Pulmonary and Critical Care Medicine, Baylor Scott and White Medical Center, Waxahachie, Texas, USA
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47
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Sharma S, Batra S, Gupta S, Sharma VK, Rahman MH, Kamal MA. Persons with co-existing neurological disorders: Risk analysis, considerations and management in COVID-19 pandemic. CNS & NEUROLOGICAL DISORDERS-DRUG TARGETS 2021; 21:228-234. [PMID: 33687889 DOI: 10.2174/1871527320666210308113457] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 01/08/2023]
Abstract
Increasing reports of neurological symptoms in COVID-19 patient's warrant clinicians to adopt and define the standardized diagnostic and managing protocols in order to investigate the linkage of neurological symptoms in COVID-19. Encephalitis, anosmia, acute cerebrovascular disease and ageusia are some of the emerging neurological manifestations which are reported in several cohort studies on hospitalized patients with COVID-19. Although the COVID-19 pandemic is primarily associated with respiratory tract system but measures like lockdown and restricted physical movements to control the spread of this infection will certainly have neurobehavioural implications. Additionally, some of the patients with pre-existing neurological manifestations like epilepsy, Parkinson's and Alzheimer's disease are more prone to infection and demands extra as well as improvisation in their treatment therapy. In this review we have focused on the neurovirological clinical manifestations associated with COVID-19 pandemic. Although the prevalence of neurovirological manifestations is rare but increasing reports cannot be ignored and needs to be discussed thoroughly with respect to risk analysis and considerations for developing management strategy. This also helps in defining the burden of neurological disorders associated with COVID-19 patients.
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Affiliation(s)
- Sumit Sharma
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | - Sonali Batra
- Department of Pharmaceutical Sciences, Guru Jambheshwar University of Science and Technology, Hisar, Haryana. India
| | - Saurabh Gupta
- Chitkara College of Pharmacy, Chitkara University, Punjab. India
| | | | - Md Habibur Rahman
- Department of Pharmacy, South East University, Banani, Dhaka-1213. Bangladesh
| | - Mohammad Amjad Kamal
- Enzymoics, 7 Peterlee place, Hebersham, NSW 2770, Novel Global Community Educational Foundation. Australia
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48
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Srivastava A, Gupta RC, Doss RB, Lall R. Trace Minerals, Vitamins and Nutraceuticals in Prevention and Treatment of COVID-19. J Diet Suppl 2021; 19:395-429. [PMID: 33682615 DOI: 10.1080/19390211.2021.1890662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Coronavirus disease 2019 (COVID-19) was first officially diagnosed in the city of Wuhan, China in January 2020. In reality, the disease was identified in December 2019 in the same city where patients began showing symptoms of pneumonia of unidentified origin. Very soon the disease became a global pandemic due to the suppression of information in the country of origin and inadequate testing for the COVID-19 virus. Currently, > 101 million people have been found positive for this virus and > 2.17 million people have died. There are no signs that COVID-19 is slowing down. This deadly virus affects multiple vital organs (lungs, heart, nervous system, blood, and immune system), yet its exact mechanism of pathophysiology remains obscure. Depending on the viral load, sick people often show symptoms of fever, cough, shortness of breath, coagulopathy, cardiac abnormalities, fatigue, and death. Great strides have been made in COVID-19 testing, thereby allowing timely therapeutic intervention. Currently, vaccines are on the market from Pfizer, Moderna and Astra Zeneca with limited supply. Phase III clinical trials are also underway from other manufacturers. In the current scenario, nutraceuticals and other phyto-mineral supplements appear to be promising alternative solutions for the prevention and treatment of COVID-19.
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Affiliation(s)
| | - Ramesh C Gupta
- Breathitt Veterinary Center, Toxicology Department, Murray State University, Hopkinsville, KY, USA
| | - Robin B Doss
- Breathitt Veterinary Center, Toxicology Department, Murray State University, Hopkinsville, KY, USA
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49
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Bhagat R, Kwiecinska B, Smith N, Peters M, Shafer C, Palade A, Sagi V. New-Onset Seizure With Possible Limbic Encephalitis in a Patient With COVID-19 Infection: A Case Report and Review. J Investig Med High Impact Case Rep 2021; 9:2324709620986302. [PMID: 33648382 PMCID: PMC7930644 DOI: 10.1177/2324709620986302] [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] [Indexed: 01/08/2023] Open
Abstract
With the outbreak of COVID-19 (coronavirus disease 2019) as a global pandemic, various of its neurological manifestations have been reported. We report a case of a 54-year-old male with new-onset seizure who tested positive for severe acute respiratory syndrome coronavirus 2 from a nasopharyngeal swab sample. Investigative findings, which included contrast-enhancing right posterior temporal lobe T2-hyperintensity on brain magnetic resonance imaging, right-sided lateralized periodic discharges on the electroencephalogram, and elevated protein level on cerebrospinal fluid analysis, supported the diagnosis of possible encephalitis from COVID-19 infection. The findings in this case are placed in the context of the existing literature.
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Affiliation(s)
| | | | - Nolan Smith
- University of Louisville, Louisville, KY, USA
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50
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Vellieux G, Sonneville R, Vledouts S, Jaquet P, Rouvel-Tallec A, d’Ortho MP. COVID-19-Associated Neurological Manifestations: An Emerging Electroencephalographic Literature. Front Physiol 2021; 11:622466. [PMID: 33679425 PMCID: PMC7933549 DOI: 10.3389/fphys.2020.622466] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/29/2020] [Indexed: 02/02/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide since the end of year 2019 and is currently responsive for coronavirus infectious disease 2019 (COVID-19). The first reports considered COVID-19 as a respiratory tract disease responsible for pneumonia, but numerous studies rapidly emerged to warn the medical community of COVID-19-associated neurological manifestations, including encephalopathy at the acute phase and other postinfectious manifestations. Using standard visual analysis or spectral analysis, recent studies reported electroencephalographic (EEG) findings of COVID-19 patients with various neurological symptoms. Most EEG recordings were normal or revealed non-specific abnormalities, such as focal or generalized slowing, interictal epileptic figures, seizures, or status epilepticus. Interestingly, novel EEG abnormalities over frontal areas were also described at the acute phase. Underlying mechanisms leading to brain injury in COVID-19 are still unknown and matters of debate. These frontal EEG abnormalities could emphasize the hypothesis whereby SARS-CoV-2 enters the central nervous system (CNS) through olfactory structures and then spreads in CNS via frontal lobes. This hypothesis is reinforced by the presence of anosmia in a significant proportion of COVID-19 patients and by neuroimaging studies confirming orbitofrontal abnormalities. COVID-19 represents a new viral disease characterized by not only respiratory symptoms but also a systemic invasion associated with extra-respiratory signs. Neurological symptoms must be the focus of our attention, and functional brain evaluation with EEG is crucial, in combination with anatomical and functional brain imaging, to better understand its pathophysiology. Evolution of symptoms together with EEG patterns at the distance of the acute episode should also be scrutinized.
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Affiliation(s)
- Geoffroy Vellieux
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Romain Sonneville
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Sérafima Vledouts
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Pierre Jaquet
- Médecine Intensive-Réanimation, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
- Université de Paris, UMR 1148, LVTS, Paris, France
| | - Anny Rouvel-Tallec
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
| | - Marie-Pia d’Ortho
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- Neurophysiologie clinique, Service de Physiologie – Explorations Fonctionnelles, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France
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