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Jumagaliyeva MB, Ayaganov DN, Abdelazim IA, Saparbayev SS, Tuychibaeva NM, Kurmambayev YJ. Relation between Guillain-Barré syndrome and Covid-19: Case-Series. J Med Life 2023; 16:1433-1435. [PMID: 38107719 PMCID: PMC10719799 DOI: 10.25122/jml-2023-0275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 08/27/2023] [Indexed: 12/19/2023] Open
Abstract
Approximately two-thirds of the Guillain-Barré syndrome (GBS) cases are preceded by upper respiratory tract infection or enteritis. There has been previous documentation of a clear association between Covid-19 and GBS. Covid-19 can affect the nervous tissue either through direct damage or through triggering a host immune response with subsequent development of autoimmune diseases such as GBS. Covid-19 can affect the host`s immune system through the activation and interaction of the T-and B-lymphocytes with subsequent production of antibodies that cross-react with the gangliosides. Depending on the nature of the neuronal autoimmune destruction, the affected individual may have either a demyelinating or axonal subtype of GBS. These subtypes differ not only in symptoms but also in the likelihood of recovery. This report presents two cases of GBS that developed after the respiratory symptoms of Covid-19. Their neurological features indicated demyelination, axonal damage, irritation of spinal nerve roots, and impaired sensory and motor transmission with additional facial nerve palsy in the second-studied case. This case report highlights the relationship between GBS and Covid-19 infection.
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Affiliation(s)
| | | | - Ibrahim Anwar Abdelazim
- Department of Obstetrics and Gynecology, Faculty of Medicine Ain Shams University, Cairo, Egypt
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2
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Gabr T, Kotait M, Moaty AS. Audiovestibular and vaccination complications of COVID-19. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2022. [PMCID: PMC9389503 DOI: 10.1186/s43163-022-00290-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Objectives
Since its first appearance in Wuhan December 2019, SARS-CoV2 virus received great attention due to its severe symptoms and high spread causing COVID-19 disease which spread all over the world like a pandemic. The causative virus is capable of human-to-human transmission via droplet and direct contact suggesting that upper respiratory tract is the main site to virus manifestations.
There is a great diversity in its clinical picture, although the severe respiratory and neurological symptoms are commonly present; however, other symptoms are present. Although otological manifestations are reported in many COVID-19 patients even in asymptomatic cases, they did not receive much attention compared with other critical manifestations. In this article, we paid our attention specifically to the otological manifestations of COVID-19 and their relevance either to the virus infection, treatment, or vaccination through literature review.
Conclusion
COVID-19 disease has a deleterious effect on the inner ear. This effect is not only due to SARS-Cov-2 infection, but it could be also due to the ototoxic drugs used for treatment. The COVID-19 vaccinations are found to be implicated in the otological symptoms in some cases.
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Kumar M, Dhar N, Madhaw G, Tiwari A, Kumar N. Guillain-Barre Syndrome Associated with Scrub Typhus Infection: Uncommon or Under-Reported! Ann Indian Acad Neurol 2022; 25:1231-1233. [PMID: 36911444 PMCID: PMC9996525 DOI: 10.4103/aian.aian_559_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 08/01/2022] [Accepted: 08/05/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Mritunjai Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nikita Dhar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Govind Madhaw
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ashutosh Tiwari
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Niraj Kumar
- Department of Neurology, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Parálisis facial aislada posterior a infección por virus de chikunguña: un nuevo diagnóstico diferencial. BIOMÉDICA 2022; 42:435-439. [PMID: 36122282 PMCID: PMC9534523 DOI: 10.7705/biomedica.6308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Indexed: 12/04/2022]
Abstract
En las últimas décadas, se ha incrementado el reporte de manifestaciones neurológicas asociadas con la infección por el virus de chikunguña. Se informa el caso de un adulto joven previamente sano que presentó parálisis facial izquierda aislada después de una infección reciente por el virus de chikunguña en el trópico colombiano. Se describen aspectos importantes de la fisiopatología del virus y su tropismo por el sistema nervioso central y periférico, y se sugiere considerar este virus en el diagnóstico diferencial de la parálisis facial en pacientes con infección confirmada por el virus de chikunguña en regiones tropicales endémicas o en aquellos con antecedente de viajes recientes a dichas regiones.
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Purja S, Oh S, Kim E. A Systematic Review on Neurological Aspects of COVID-19: Exploring the Relationship Between COVID-19-Related Olfactory Dysfunction and Neuroinvasion. Front Neurol 2022; 13:887164. [PMID: 35911902 PMCID: PMC9334857 DOI: 10.3389/fneur.2022.887164] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectivesTo identify neurological aspects of Coronavirus disease 2019 (COVID-19) and to investigate COVID-19 infected patients with and without olfactory dysfunction in relation to polymerase chain reaction (PCR) assay results for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) in the cerebrospinal fluid (CSF).MethodsPubMed and EMBASE databases were searched until March 26, 2021, for observational studies with COVID-19 patients that had performed CSF PCR assay due to the neurologic symptom and reported anosmia status.ResultsInitially, 2,387 studies were identified;167 studies performed SARS-CoV-2 CSF PCR assay, of which our review comprised 45 observational studies that conducted CSF PCR assay for SARS-CoV-2 in 101 patients and reported anosmia status in 55 of 101 patients. Central and peripheral neurological manifestations observed in COVID-19 patients were diverse. The most common neurological diagnoses were Guillain-Barré syndrome (GBS) and its variants (24%), followed by encephalopathy (21%). The SARS-CoV-2 PCR assay was positive in only four CSF samples, of which two patients had olfactory dysfunction while the others did not.ConclusionsThe neurological spectrum of COVID-19 is diverse, and direct neuroinvasion of SARS-CoV-2 is rare. The neuroprotection against SARS-CoV-2 in COVID-19 patients with anosmia is controversial, as an equal number of patients with and without olfactory dysfunction had positive CSF PCR results for SARS-CoV-2 in our study, and further studies are required to provide more insight into this topic.
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Affiliation(s)
- Sujata Purja
- Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - SuA Oh
- Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - EunYoung Kim
- Evidence-Based and Clinical Research Laboratory, Department of Health, Social and Clinical Pharmacy, College of Pharmacy, Chung-Ang University, Seoul, South Korea
- The Graduate School for Food and Drug Administration, The Graduate School for Pharmaceutical Industry Management, College of Pharmacy, Chung-Ang University, Seoul, South Korea
- *Correspondence: EunYoung Kim
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Wang Y, Wang Y, Li X, Wang H. Re: Towards a deeper understanding of the dynamics of COVID-19-associated Guillain-Barre syndrome. QJM 2022; 115:344-345. [PMID: 34240218 PMCID: PMC8344588 DOI: 10.1093/qjmed/hcab188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Indexed: 11/14/2022] Open
Affiliation(s)
- Yumin Wang
- Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine,No.15 Rd.Yuquan,Beijing 100049, PR China
| | - Yanchao Wang
- Department of Neurology, The Affiliated Hospital of Chifeng University, No.42 Street Wangfu, Chifeng 024005, PR China
| | - Xiujun Li
- Department of Nursing, School of Clinical Medicine, Chifeng University, No.1 Rd.Yingbin, Chifeng 024005, PR China
| | - Hongquan Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, No.15 Rd.Yuquan, Beijing 100049, PR China
- Address correspondence to Hongquan Wang, Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China. or
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Singh J, Kumar N, Dinkar A. Demographic, clinical, investigational characteristics of COVID-19 related Guillain-Barré syndrome with differences from typical and another virus-related Guillain-Barré syndrome. Infect Disord Drug Targets 2022; 22:IDDT-EPUB-123097. [PMID: 35507796 DOI: 10.2174/1871526522666220429134113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUNDS SARS-CoV-2 infection typically presents with fever and respiratory symptoms. Besides this, COVID-19 related central and peripheral nervous system manifestations are emerging. OBJECTIVES This study summarises the demographics, clinical profile, laboratory findings, management strategies, and outcomes in a large number of patients with COVID-19 related GBS and its variants. We also compared its clinical profile with Zika and dengue virus-related GBS. METHODS Authors carried out a literature search up to Dec 31, 2020, in MEDLINE, PubMed, SCOPUS, Cochrane database, and Google Scholar for all published articles. RESULTS The study identified 54 different types of articles consisting of 70 cases from 17 countries worldwide. Maximum cases 15 (21.4%) were identified from Italy, followed by USA 12 (17.1%), Spain 11 (15.7%), and Iran 10 (14.3%). The age group more than 60 years had most cases with 32 (45.7%) cases followed by age group 40-60 with cases 25 (35.7%) with male and female ratio 2. Maximum cases were treated with IVIG infusion 58 (82.9%), followed by Plasma exchange 13 (18.6%) cases. Out of 70 cases, 7 (10%) cases were manifested as Miller-Fisher syndrome. The most predominant electrodiagnostic variant was demyelinating neuropathy in 41 (73.21%) cases. The outcome reported in 67 cases was survival in 63 (90%) cases and the death of 4 (5.7%) cases. CONCLUSION Covid 19 related GBS were reported worldwide with a better outcome. Both postinfectious or parainfectious patterns were reported. Early recognition with prompt management of GBS can prevent further severe morbidity and mortality.
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Affiliation(s)
- Jitendra Singh
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
| | - Nilesh Kumar
- Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
| | - Anju Dinkar
- Department of Microbiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, U.P, India
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Nori S, Moran A, Franolich J, Patel J, Stern M. COVID-19 and Neurologic Manifestations: An Experience at Major New York City Hospitals. Cureus 2022; 14:e24049. [PMID: 35547415 PMCID: PMC9090219 DOI: 10.7759/cureus.24049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction: The exact incidence of neurologic manifestations in coronavirus disease 2019 (COVID-19) patients is not clear. The New York City Hospital system has been severely affected by the COVID-19 pandemic between December 2019 and 202. A large number of patients were treated at these centers. This study aims to investigate the incidence of such neurologic manifestations. Secondly, we wanted to find out if there is a correlation between comorbidities and neurologic manifestations in patients with COVID-19. Methodology: A retrospective analysis of 5,455 Electronic Medical Records of patients with a positive polymerase chain reaction (PCR) result admitted to Elmhurst Hospital, Queens Hospital Center, Jacobi Medical Center, and North Central Bronx Hospitals, four of the 11 teaching hospitals in the NYCHH (New York Health + Hospitals) between 3-1-2020 to 8-31-2020 was carried out. Comprehensive data were collected using medical documentation in five categories: demographic details, comorbidities, symptoms, laboratory findings, and radiologic examinations. All neurologic manifestation keywords were provided to the statisticians by two trained and board-certified physiatrists. Neurologic manifestations were categorized into central nervous system (CNS) manifestations and peripheral nervous system (PNS) manifestations. Results; Out of the 5,455 patients, 285 patients (5.2%) had central nervous system manifestations, a prevalence in people older than 50, and had a high incidence of comorbidities. We found increased D-dimer and high C reactive protein levels. Our findings agree with two of the three authors with significant case volume.
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Estakhr M, Tabrizi R, Ghotbi Z, Shahabi S, Habibzadeh A, Bashi A, Borhani-Haghighi A. Is facial nerve palsy an early manifestation of COVID-19? A literature review. Am J Med Sci 2022; 364:264-273. [PMID: 35429449 PMCID: PMC9007824 DOI: 10.1016/j.amjms.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 03/04/2022] [Accepted: 04/08/2022] [Indexed: 11/01/2022]
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10
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Galassi G, Marchioni A. Acute neuromuscular syndromes with respiratory failure during COVID-19 pandemic: where we stand and challenges ahead. J Clin Neurosci 2022; 101:264-275. [PMID: 35660960 PMCID: PMC9050587 DOI: 10.1016/j.jocn.2022.03.048] [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: 09/26/2021] [Revised: 03/15/2022] [Accepted: 03/29/2022] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19), a disease caused by the novel betacoronavirus SARS-COV-2, has become a global pandemic threat. SARS- COV-2 is structurally similar to SARS-COV, and both bind to the angiotensin-converting enzyme 2 (ACE2) receptor to enter human cells. While patients typically present with fever, shortness of breath, sore throat, and cough, in some cases neurologic manifestations occur due to both direct and indirect involvement of the nervous system. Case reports include anosmia, ageusia, central respiratory failure, stroke, acute necrotizing hemorrhagic encephalopathy, toxic-metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. Some patients with COVID-19 may present with concurrent acute neuromuscular syndromes such as myasthenic crisis (MC), Guillain–Barré syndrome (GBS) and idiopathic inflammatory myopathies (IIM); these conditions coupled with respiratory failure could trigger a life-threatening condition. Here, we review the current state of knowledge on acute neuromuscular syndromes with respiratory failure related to COVID-19 infection in an attempt to clarify and to manage the muscle dysfunction overlapping SARS-COV-2 infection.
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Taga A, Lauria G. COVID-19 and the Peripheral Nervous System. A 2-year review from the pandemic to the vaccine era. J Peripher Nerv Syst 2022; 27:4-30. [PMID: 35137496 PMCID: PMC9115278 DOI: 10.1111/jns.12482] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 11/29/2022]
Abstract
Increasing literature has linked COVID‐19 to peripheral nervous system (PNS) diseases. In addition, as we move from the pandemic to the vaccination era, literature interest is shifting towards the potential association between COVID‐19 vaccines and PNS manifestations. We reviewed published literature on COVID‐19, COVID‐19 vaccines and PNS manifestations between 1 January 2020 and 1 December 2021. For Guillain‐Barré syndrome (GBS), isolated cranial neuropathy (ICN) and myositis associated with COVID‐19, the demographic, clinical, laboratory, electrophysiological and imaging features were included in a narrative synthesis. We identified 169 studies on COVID‐19‐associated complications, including 63 papers (92 patients) on GBS, 29 papers (37 patients) on ICN and 11 papers (18 patients) on myositis. Additional clinical phenotypes included chronic inflammatory demyelinating polyneuropathy, vasculitic neuropathies, neuralgic amyotrophy, critical care‐related complications, and myasthenia gravis. PNS complications secondary to COVID‐19 vaccines have been reported during randomized clinical trials, in real‐world case reports, and during large‐scale surveillance programs. These mainly include cases of GBS, Bell's palsy, and cases of neuralgic amyotrophy. Based on our extensive review of the literature, any conclusion about a pathophysiological correlation between COVID‐19 and PNS disorders remains premature, and solely supported by their temporal association, while epidemiological and pathological data are insufficient. The occurrence of PNS complications after COVID‐19 vaccines seems limited to a possible higher risk of facial nerve palsy and GBS, to a degree that widespread access to the ongoing vaccination campaign should not be discouraged, while awaiting for more definitive data from large‐scale surveillance studies.
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Affiliation(s)
- Arens Taga
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Giuseppe Lauria
- Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico "Carlo Besta", Milan.,Department of Medical Biotechnology and Translational Medicine, University of Milan, Milan, Italy
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Aladawi M, Elfil M, Abu-Esheh B, Abu Jazar D, Armouti A, Bayoumi A, Piccione E. Guillain Barre Syndrome as a Complication of COVID-19: A Systematic Review. Can J Neurol Sci 2022; 49:38-48. [PMID: 33949300 PMCID: PMC8267336 DOI: 10.1017/cjn.2021.102] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/04/2021] [Accepted: 04/28/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND In January 2020, the first case of Guillain Barre syndrome (GBS) due to COVID-19 was documented in China. GBS is known to be postinfectious following several types of infections. Although causality can only be proven through large epidemiological studies, we intended to study this association by a thorough review of the literature. METHODS We searched PubMed, EMBASE, and Google scholar and included all papers with English or Spanish full text and original data of patients with GBS and recent COVID infection. Variables of interest were demographics, diagnostic investigations, and the latency between arboviral and neurological symptoms. Further variables were pooled to identify GBS clinical and electrophysiological variants, used treatments, and outcomes. The certainty of GBS diagnosis was verified using Brighton criteria. RESULTS We identified a total of 109 GBS cases. Ninety-nine cases had confirmed COVID-19 infection with an average age of 56.07 years. The average latency period between the arboviral symptoms and neurologic manifestations for confirmed COVID-19 cases was 12.2 d. The predominant GBS clinical and electromyography variants were the classical sensorimotor GBS and acute demyelinating polyneuropathy respectively. Forty cases required intensive care, 33 cases required mechanical ventilation, and 6 cases were complicated by death. CONCLUSIONS Studies on COVID-19-related GBS commonly reported sensorimotor demyelinating GBS with frequent facial palsy. The time between the onset of infectious and neurological symptoms suggests a postinfectious mechanism. Early diagnosis of GBS in COVID-19 patients is important as it might be associated with a severe disease course requiring intensive care and mechanical ventilation.
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Affiliation(s)
- Mohammad Aladawi
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Mohamed Elfil
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Baha Abu-Esheh
- Department of Neurology, Mercy Hospital, Oklahoma City, Oklahoma, USA
| | - Deaa Abu Jazar
- Department of Neurology, University of Texas Medical Branch – Galveston, Galveston, Texas, USA
| | - Ahmad Armouti
- Department of Neurology, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Ahmed Bayoumi
- Department of Neurology, Yale University, New Haven, Connecticut, USA
| | - Ezequiel Piccione
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, Nebraska, USA
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El-Abassi RN, Soliman M, Levy MH, England JD. Treatment and Management of Autoimmune Neuropathies. Neuromuscul Disord 2022. [DOI: 10.1016/b978-0-323-71317-7.00015-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Guillain-Barré Syndrome in the COVID-19 Pandemic. Neurol Int 2021; 14:34-48. [PMID: 35076589 PMCID: PMC8788454 DOI: 10.3390/neurolint14010003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 12/18/2022] Open
Abstract
There have been several reported cases of severe acute respiratory syndrome (SARS-CoV-2) infection that were associated with an increased incidence of neurological manifestations, including Guillain–Barré syndrome (GBS). This review aims to present information on the reports of GBS associated with coronavirus disease 2019 (COVID-19) infection. Our review is retrospective work examining articles published from the 1 April 2020 to the 8 May 2021 in the English language. We used the diagnostic criteria and classification published by the National Institute of Neurological Disorders and Stroke and Brighton Collaboration. GBS is usually a postinfectious syndrome, but GBS in the COVID-19 pandemic also takes on a para-infectious profile. In the reports, the genetic factor has a role in developing GBS in some patients. In conclusion, the association between COVID-19 and GBS is not very clear. Still, one mechanism is strongly associated with COVID-19 and immune-mediated neurological complications, which is molecular mimicry between SARS-CoV-2 and human autoantigens.
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Li X, Wang Y, Wang H, Wang Y. SARS-CoV-2-associated Guillain-Barré syndrome is a para-infectious disease. QJM 2021; 114:625-635. [PMID: 34043803 PMCID: PMC8195029 DOI: 10.1093/qjmed/hcab157] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 12/20/2022] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has been linked to the Guillain-Barré syndrome (GBS). The objective of the present study is to identify specific clinical features of cases of GBS reported in the literature associated with SARS-CoV-2 infection. We searched Pubmed, and included single case reports and case series with full text in English, reporting original data of patients with GBS and a confirmed recent SARS-CoV-2 infection. Clinical data were extracted. We identified 28 articles (22 single case reports and 6 case series), reporting on a total of 44 GBS patients with confirmed SARS-CoV-2 infection. SARS-CoV-2 infection was confirmed through serum reverse transcriptase-polymerase chain reaction in 72.7% of cases. A total of 40 patients (91%) had symptoms compatible with SARS-CoV-2 infection before the onset of the GBS. The median period between the onset of symptoms of SARS-CoV-2 infection and symptoms of the GBS was 11.2 days (range, 2-23). The most common clinical features were: leg weakness (61.4%), leg paresthesia (50%), arm weakness (50.4%), arm paresthesia (50.4%), hyporeflexia/areflexia (48%) and ataxia (22.7%). In total, 38.6% (n = 17) were found to have facial paralysis. Among 37 patients in whom nerve-conduction studies and electromyography were performed, of which 26 patients (59.1%) were consistent with the acute inflammatory demyelinating polyneuropathy subtype of the GBS. The present retrospective analysis support the role of the SARS-CoV-2 infection in the development of the GBS, may trigger GBS as para-infectious disease, and lead to SARS-CoV-2-associated GBS.
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Affiliation(s)
- Xiujun Li
- School of Clinical Medicine, Chifeng University, Chifeng 024005, PR China
- Corresponding author: Yumin Wang, Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China. E-mail:
| | - Yanchao Wang
- Department of Neurology, The Affiliated Hospital of Chifeng University, Chifeng 024005, PR China
| | - Hongquan Wang
- Department of Neurology, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China
| | - Yumin Wang
- Department of Respiratory and Critical Care Medicine, Aerospace Center Hospital, Peking University Aerospace School of Clinical Medicine, Beijing 100049, People's Republic of China
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Abstract
PURPOSE OF REVIEW Since its outbreak in Wuhan, China in late 2019, coronavirus disease-19 (COVID-19) has become a global pandemic. The number of affected cases and deaths continues to rise. Primarily a respiratory illness, COVID-19 is now known to affect various organ systems including peripheral nerve and skeletal muscle. The purpose of this review is to discuss the scope of neuromuscular manifestations and complications of COVID-19. RECENT FINDINGS Several neuromuscular conditions, including Guillain-Barré syndrome, rhabdomyolysis, and myositis, have been reported in patients infected with COVID-19, but even with a temporal association, a causal relationship remains unproven. Direct invasion of neurons or myocytes by the virus, and immune-mediated injury have been speculated but not consistently demonstrated. In addition to potentially causing the above conditions, COVID-19 can trigger exacerbations of preexisting neuromuscular conditions such as myasthenia gravis, and severe infections can lead to critical illness myopathy/polyneuropathy. SUMMARY COVID-19 appears to be potentially associated with a wide range of neuromuscular manifestations and complications. Further studies are needed to examine these possible associations, understand the pathogenesis, and develop preventive and treatment strategies.
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Affiliation(s)
- Joome Suh
- Department of Neurology, Brigham and Women's Hospital, Boston, Massachusetts, USA
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Goudarzi S, Esmaeeli S, Valencia JD, Lu ME, Hales RR, Fehnel CR, Conley CM, Quraishi SA, Nozari A. Treatment Options for COVID-19-Related Guillain-Barré Syndrome: A Systematic Review of Literature. Neurologist 2021; 26:196-224. [PMID: 34491938 PMCID: PMC8423032 DOI: 10.1097/nrl.0000000000000342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Central nervous system complications are reported in an increasing number of patients with Coronavirus Disease 2019 (COVID-19). COVID-19-related Guillain-Barré syndrome (GBS) is of particular importance given its association with higher mortality rates and prolonged respiratory failure. REVIEW SUMMARY We conducted a systematic review of published cases for COVID-19-related GBS, and provide a summary of clinical management strategies for these cases. Sixty-three studies, including 86 patients, were included. Seventy-six cases with reported outcome data were eligible for the outcome analysis. Ninety-nine percent of patients were diagnosed with COVID-19 before diagnosis of GBS (median: 14 d prior, interquartile range: 7 to 20). Intravenous immunotherapy (intravenous immunoglobulin: 0.4 g/kg/d for 5 d) was the most frequently used treatment approach. The review indicated that the outcome was not favorable in 26% of cases (persistent neurological deficits). A mortality rate of 3.5% was observed in patients with COVID-19-related GBS. CONCLUSIONS Although evidence to support specific treatments is lacking, clinicians should consider the benefits of immunotherapy and plasma exchange in addition to the standard antimicrobial and supportive therapies for patients who meet the diagnostic criteria for acute sensory and motor polyradiculoneuritis. Intravenous immunoglobulin treatment alone is not shown to result in improved outcomes or mortality. More extensive studies aimed at exploring the neurological manifestations and complications of COVID-19 and distinctive treatment options for COVID-19-related GBS are warranted.
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Affiliation(s)
| | - Shooka Esmaeeli
- Departments of Anesthesiology, Critical Care, and Pain Medicine
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | | | - Maegan E. Lu
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Riley R. Hales
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Corey R. Fehnel
- Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School
| | - Christopher M. Conley
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
| | - Sadeq A. Quraishi
- Department of Anesthesiology and Perioperative Medicine, Tufts Medical Center, Tufts University School of Medicine, Boston, MA
| | - Ala Nozari
- Department of Anesthesiology, Boston Medical Center, Boston University School of Medicine
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Fidan V, Akin O, Koyuncu H. Rised sudden sensorineural hearing loss during COVID-19 widespread. Am J Otolaryngol 2021; 42:102996. [PMID: 33831819 PMCID: PMC8011306 DOI: 10.1016/j.amjoto.2021.102996] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND Sudden sensorineural hearing loss (SSNHL) is commonly encountered in otolaryngologic practice. SARS-CoV-2 infection is typically marked by respiratory symptoms although neurologic manifestations of the disease have also been described. OBJECTIVE We want to measure the incidence and clinical aspects of persons exhibiting in otolaryngology clinic (OC) with SSNHL during the COVID-19 widespread and in the constant interval of previous year. METHODS We retrospectively inspected the medical information for admissions to OC in Eskisehir, Turkey, during the COVID-19 widespread to describe the patients SSNHL. Clinical knowledge was saved for each subject and corresponded with that of SSNHL subjects demonstrating in 2019. RESULT Between 1 April and 30 September 2020, 68 patients admitted to OC for SSNHL; in 2019, there were 41 subjects, for an incidence rate ratio of 8.5 per 100.000 (95% CI 1.02-2.92) for the 2020 cohort. Of the 2020 group, forty-one patients (60.3%) presented with active or recent symptoms consistent with COVID-19 infection, compared with four (9.8%) in 2019 (p < 0.001). Furthermore, subjects in 2020 group were younger (-15.5 years, p = 0.0141) than 2019 group and demonstrated prolonged interim (+1.7 days, p < 0.001) between SSNHL initiation and OC petition. CONCLUSION We detected increased incidence of SSNHL during the COVID-19 widespread compared to the same interval of the prior year; 60.3% of subjects confronting with SSNHL had signs that were harmonious with COVID-19.
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Affiliation(s)
- Vural Fidan
- Department of Otorhinolaryngology, Eskisehir City Hospital, Eskisehir, Turkey.
| | - Okan Akin
- Department of Otorhinolaryngology, Ortadogu Hospital, Ankara, Turkey
| | - Handan Koyuncu
- Department of Otorhinolaryngology, Yunus Emre Hospital, Eskisehir, Turkey
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Resuli AS, Salviz M, Oktem F. Evaluation of Acoustic Reflex Thresholds in COVID-19 Patients With Taste Disorders. EAR, NOSE & THROAT JOURNAL 2021; 101:514-517. [PMID: 34420420 DOI: 10.1177/01455613211039808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, can result in persistent loss of taste and smell. This study was performed to assess acoustic reflex threshold (ART) in patients with taste disorders caused by SARS-CoV-2. MATERIAL AND METHODS This retrospective study enrolled 11 patients (9 men, 2 women; average age = 22.3 years) with a history of COVID-19 and had complaints of taste disorder and sensitivity to loud sounds. The control group consisted of 13 healthy participants (10 men, 3 women; average age = 23.4 years). Anamnesis, neuro-otological, ear, nose and throat, and eye examinations, as well as a taste test, pure tone audiometry, speech discrimination test, and impedance audiometry were performed in all participants. RESULTS All participants in the study group had a negative taste test result. In addition, ART values were significantly higher in the study group than the control group at all frequencies. CONCLUSIONS SARS-CoV-2 could be a neurotropic virus that can cause facial nerve neuropathy.
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Affiliation(s)
- Ali Seyed Resuli
- Department of ENT, Faculty of Medicine, İstanbul Yeni Yüzyıl University, İstanbul, Turkey
| | - Mehdi Salviz
- Department of ENT, Faculty of Medicine, İstanbul Yeni Yüzyıl University, İstanbul, Turkey
| | - Fatih Oktem
- Department of ENT, Cerrahpaşa Faculty of Medicine, İstanbul University, İstanbul, Turkey
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20
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Medeiros KSD, Macêdo LTDA, Souza WFD, Sarmento AC, Costa APF, Gonçalves AK. Guillain-Barré syndrome associated with SARS-CoV-2 infection: a scoping review. Rev Assoc Med Bras (1992) 2021; 67:318-334. [PMID: 34406260 DOI: 10.1590/1806-9282.67.2.20200716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 08/30/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections can affect the nervous system, triggering problems such as the Guillain-Barre Syndrome (GBS), an association that can bring complications to the patient. OBJECTIVE This scoping review aimed to clarify the clinical features and analyze patients with GBS associated with SARS-CoV-2 infection, looking at morbidity, mortality, and neurological outcomes. SEARCH STRATEGY The search was conducted through Medline, Web of Science, Embase, CINAHAL, Latin-American and Caribbean Literature in Health Sciences (LILACS), clinicaltrials.gov, SCOPUS, and the Cochrane Central Register of Controlled Trials. SELECTION CRITERIA Observational studies, published after 2019, describe patients with GBS associated with SARS-CoV-2 infection. There were no language restrictions while selecting the studies. DATA COLLECTION AND ANALYSIS Three authors, Kleyton Santos de Medeiros, Luíza Thomé de Araújo Macêdo, and Wederson Farias de Souza, independently screened the search results using titles and abstracts. Duplicate studies were excluded. The same authors then went through the entire text to determine whether the studies met the inclusion criteria. Discrepancies were resolved by other reviewers, Ana Paula Ferreira Costa, Ayane Cristine Sarmento, and Ana Katherine Gonçalves. Finally, the selection of the studies was summarized in a PRISMA flow diagram. MAIN RESULTS Main manifestations were fever, coughing, dyspnea, sore throat, ageusia, anosmia, and respiratory failure, in addition to paresthesia of the upper and lower limbs, tetraparesis, facial diplegia, areflexia, asthenia, mastoid pain, acute ataxia, fatigue, numbness, swallowing disorder, and moderate low back pain. CONCLUSION Coronavirus disease 2019 (COVID-19) can trigger the GBS, despite the few studies on this topic. Patients had clinical manifestations of COVID-19 infection and neurological manifestations characterizing GBS.
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Affiliation(s)
| | | | | | - Ayane Cristine Sarmento
- Universidade Federal do Rio Grande do Norte, Pós-Graduação em Ciências da Saúde - Natal (RN), Brazil
| | - Ana Paula Ferreira Costa
- Universidade Federal do Rio Grande do Norte, Pós-Graduação em Ciências da Saúde - Natal (RN), Brazil
| | - Ana Katherine Gonçalves
- Universidade Federal do Rio Grande do Norte, Pós-Graduação em Ciências da Saúde - Natal (RN), Brazil.,Universidade Federal do Rio Grande do Norte, Departamento de Toco-Ginecologia - Natal (RN), Brazil
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21
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Johansson A, Mohamed MS, Moulin TC, Schiöth HB. Neurological manifestations of COVID-19: A comprehensive literature review and discussion of mechanisms. J Neuroimmunol 2021; 358:577658. [PMID: 34304141 PMCID: PMC8272134 DOI: 10.1016/j.jneuroim.2021.577658] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 07/08/2021] [Accepted: 07/08/2021] [Indexed: 01/08/2023]
Abstract
Several neurological symptoms and complications have been described in association with COVID-19, such as anosmia, ageusia, encephalitis and Guillain-Barré syndrome. Here, we review the literature describing SARS-CoV-2-induced neurological manifestations and provide a comprehensive discussion of proposed mechanisms underlying the neurological pathophysiology. First, we analyse the neuroinvasiveness potential of the coronavirus family based on previous SARS-CoV-1 studies. Then, we describe the current evidence on COVID-19-induced nervous tissue damage, including processes behind brain vasculopathy and cytokine storm. We also discuss in detail anosmia and Guillain-Barré syndrome. Finally, we provide a summarised timeline of the main findings in the field. Future perspectives are presented, and suggestions of further investigations to clarify how SARS-COV-2 can affect the CNS.
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Affiliation(s)
- Anton Johansson
- Functional Pharmacology Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Mohamed S Mohamed
- Functional Pharmacology Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Thiago C Moulin
- Functional Pharmacology Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | - Helgi B Schiöth
- Functional Pharmacology Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden; Institute for Translational Medicine and Biotechnology, Sechenov First Moscow State Medical University, Moscow, Russia.
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22
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Lewis A, Frontera J, Placantonakis DG, Galetta S, Balcer L, Melmed KR. Cerebrospinal fluid from COVID-19 patients with olfactory/gustatory dysfunction: A review. Clin Neurol Neurosurg 2021; 207:106760. [PMID: 34146842 PMCID: PMC8196517 DOI: 10.1016/j.clineuro.2021.106760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/09/2021] [Accepted: 06/10/2021] [Indexed: 12/31/2022]
Abstract
Objective We reviewed the literature on cerebrospinal fluid (CSF) testing in patients with altered olfactory/gustatory function due to COVID-19 for evidence of viral neuroinvasion. Methods We performed a systematic review of Medline and Embase to identify publications that described at least one patient with COVID-19 who had altered olfactory/gustatory function and had CSF testing performed. The search ranged from December 1, 2019 to November 18, 2020. Results We identified 51 publications that described 70 patients who met inclusion criteria. Of 51 patients who had CSF SARS-CoV-2 PCR testing, 3 (6%) patients had positive results and 1 (2%) patient had indeterminate results. Cycle threshold (Ct; the number of amplification cycles required for the target gene to exceed the threshold, which is inversely related to viral load) was not provided for the patients with a positive PCR. The patient with indeterminate results had a Ct of 37 initially, then no evidence of SARS-CoV-2 RNA on repeat testing. Of 6 patients who had CSF SARS-CoV-2 antibody testing, 3 (50%) were positive. Testing to distinguish intrathecal antibody synthesis from transudation of antibodies to the CSF via breakdown of the blood-brain barrier was performed in 1/3 (33%) patients; this demonstrated antibody transmission to the CSF via transudation. Conclusion Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare in patients with altered olfactory/gustatory function. While pathology studies are needed, our review suggests it is unlikely that these symptoms are related to viral neuroinvasion.
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Affiliation(s)
- Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA.
| | - Jennifer Frontera
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA
| | | | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Population Health, NYU Langone, Medical Center, New York, NY 10016, USA
| | - Kara R Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA
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23
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Freire M, Andrade A, Sopeña B, Lopez-Rodriguez M, Varela P, Cacabelos P, Esteban H, González-Quintela A. Guillain Barré syndrome associated with COVID-19- lessons learned about its pathogenesis during the first year of the pandemic, a systematic review. Autoimmun Rev 2021; 20:102875. [PMID: 34119673 PMCID: PMC8191287 DOI: 10.1016/j.autrev.2021.102875] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/11/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Mayka Freire
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain.
| | - Ariadna Andrade
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Bernardo Sopeña
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Maria Lopez-Rodriguez
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Pablo Varela
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | | | - Helena Esteban
- Servicio de Farmacia, Hospital Clínico Universitario de Santiago de Compostela, Spain
| | - Arturo González-Quintela
- Unidad de Enfermedades Sistémicas e Inmunopatología, Servicio de Medicina Interna, Hospital Clínico Universitario de Santiago de Compostela, Spain
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Neuro-COVID-19 is more than anosmia: clinical presentation, neurodiagnostics, therapies, and prognosis. Curr Opin Neurol 2021; 34:423-431. [PMID: 33709973 DOI: 10.1097/wco.0000000000000930] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW To provide an overview on current knowledge of neurological symptoms and complications of COVID-19, and to suggest management concepts. RECENT FINDINGS Headache, dizziness, excessive tiredness, myalgia, anosmia/hyposmia, and ageusia/dysgeusia are common nonspecific neurological manifestations during early COVID-19 disease found in the majority of patients. Less frequent but more severe and specific neurological manifestations include Guillain--Barré syndrome, encephalopathy, encephalitis/meningitis, epileptic seizures, and cerebrovascular events. Beyond standard neurological examination, these require a more extensive work-up, including cerebrospinal fluid assessment, neurophysiological evaluation, neuroimaging, and cognitive testing. Symptomatic treatment is advisable unless the neurological complication's immune pathogenesis is proven. SUMMARY Neurological manifestations of COVID-19 occur during the acute, para-infectious, and 'recovery' phase. Therapeutic management depends on the clinical presentation and neurological work-up.
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25
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Mahler M, Meroni PL, Infantino M, Buhler KA, Fritzler MJ. Circulating Calprotectin as a Biomarker of COVID-19 Severity. Expert Rev Clin Immunol 2021; 17:431-443. [PMID: 33750254 PMCID: PMC8054493 DOI: 10.1080/1744666x.2021.1905526] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/16/2021] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Although demographic and clinical parameters such as sex, age, comorbidities, genetic background and various biomarkers have been identified as risk factors, there is an unmet need to predict the risk and onset of severe inflammatory disease leading to poor clinical outcomes. In addition, very few mechanistic biomarkers are available to inform targeted treatment of severe (auto)-inflammatory conditions associated with COVID-19. Calprotectin, also known as S100A8/S100A9, MRP8/14 (Myeloid-Related Protein) or L1, is a heterodimer involved in neutrophil-related inflammatory processes. In COVID-19 patients, calprotectin levels were reported to be associated with poor clinical outcomes such as significantly reduced survival time, especially in patients with severe pulmonary disease. AREAS COVERED Pubmed was searched using the following keywords: Calprotectin + COVID19, S100A8/A9 + COVID19, S100A8 + COVID-19, S100A9 + COVID-19, MRP8/14 + COVID19; L1 + COVID-19 between May 2020 and 8 March 2021. The results summarized in this review provide supporting evidence and propose future directions that define calprotectin as an important biomarker in COVID-19. EXPERT OPINION Calprotectin represents a promising serological biomarker for the risk assessment of COVID-19 patients.
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Affiliation(s)
- Michael Mahler
- Research and Development, Inova Diagnostics, San Diego, CA, USA
| | - Pier-Luigi Meroni
- Allergy, Clinical Immunology and Rheumatology Unit, Immunorheumatology Research Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Maria Infantino
- Immunology and Allergology Laboratory Unit, Rheumatology Unit, S. Giovanni Di Dio Hospital, Florence, Italy
| | - Katherine A. Buhler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Marvin J. Fritzler
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Abu-Rumeileh S, Abdelhak A, Foschi M, Tumani H, Otto M. Guillain-Barré syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases. J Neurol 2021; 268:1133-1170. [PMID: 32840686 PMCID: PMC7445716 DOI: 10.1007/s00415-020-10124-x] [Citation(s) in RCA: 225] [Impact Index Per Article: 75.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/22/2020] [Accepted: 07/27/2020] [Indexed: 01/08/2023]
Abstract
Since coronavirus disease-2019 (COVID-19) outbreak in January 2020, several pieces of evidence suggested an association between the spectrum of Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). Most findings were reported in the form of case reports or case series, whereas a comprehensive overview is still lacking. We conducted a systematic review and searched for all published cases until July 20th 2020. We included 73 patients reported in 52 publications. A broad age range was affected (mean 55, min 11-max 94 years) with male predominance (68.5%). Most patients showed respiratory and/or systemic symptoms, and developed GBS manifestations after COVID-19. However, asymptomatic cases for COVID-19 were also described. The distributions of clinical variants and electrophysiological subtypes resemble those of classic GBS, with a higher prevalence of the classic sensorimotor form and the acute inflammatory demyelinating polyneuropathy, although rare variants like Miller Fisher syndrome were also reported. Cerebrospinal fluid (CSF) albuminocytological dissociation was present in around 71% cases, and CSF SARS-CoV-2 RNA was absent in all tested cases. More than 70% of patients showed a good prognosis, mostly after treatment with intravenous immunoglobulin. Patients with less favorable outcome were associated with a significantly older age in accordance with previous findings regarding both classic GBS and COVID-19. COVID-19-associated GBS seems to share most features of classic post-infectious GBS and possibly the same immune-mediated pathogenetic mechanisms. Nevertheless, more extensive epidemiological studies are needed to clarify these issues.
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Affiliation(s)
| | - Ahmed Abdelhak
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Department of Neurology and Stroke, University Hospital of Tübingen, 72076, Tübingen, Germany
- Hertie Institute of Clinical Brain Research, University of Tübingen, 72076, Tübingen, Germany
| | - Matteo Foschi
- Neurology Unit, S. Maria delle Croci Hospital-AUSL Romagna, ambito di Ravenna, 48121, Ravenna, Italy
| | - Hayrettin Tumani
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany
- Specialty Hospital of Neurology Dietenbronn, 88477, Schwendi, Germany
| | - Markus Otto
- Department of Neurology, Ulm University Hospital, 89070, Ulm, Germany.
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Rass V, Beer R, Schiefecker AJ, Kofler M, Lindner A, Mahlknecht P, Heim B, Limmert V, Sahanic S, Pizzini A, Sonnweber T, Tancevski I, Scherfler C, Zamarian L, Bellmann-Weiler R, Weiss G, Djamshidian A, Kiechl S, Seppi K, Loeffler-Ragg J, Pfausler B, Helbok R. Neurological outcome and quality of life 3 months after COVID-19: A prospective observational cohort study. Eur J Neurol 2021; 28:3348-3359. [PMID: 33682276 PMCID: PMC8250725 DOI: 10.1111/ene.14803] [Citation(s) in RCA: 102] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 03/02/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND PURPOSE To assess neurological manifestations and health-related quality of life (QoL) 3 months after COVID-19. METHODS In this prospective, multicenter, observational cohort study we systematically evaluated neurological signs and diseases by detailed neurological examination and a predefined test battery assessing smelling disorders (16-item Sniffin Sticks test), cognitive deficits (Montreal Cognitive Assessment), QoL (36-item Short Form), and mental health (Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist-5) 3 months after disease onset. RESULTS Of 135 consecutive COVID-19 patients, 31 (23%) required intensive care unit (ICU) care (severe), 72 (53%) were admitted to the regular ward (moderate), and 32 (24%) underwent outpatient care (mild) during acute disease. At the 3-month follow-up, 20 patients (15%) presented with one or more neurological syndromes that were not evident before COVID-19. These included polyneuro/myopathy (n = 17, 13%) with one patient presenting with Guillain-Barré syndrome, mild encephalopathy (n = 2, 2%), parkinsonism (n = 1, 1%), orthostatic hypotension (n = 1, 1%), and ischemic stroke (n = 1, 1%). Objective testing revealed hyposmia/anosmia in 57/127 (45%) patients at the 3-month follow-up. Self-reported hyposmia/anosmia was lower (17%) at 3 months, however, improved when compared to the acute disease phase (44%; p < 0.001). At follow-up, cognitive deficits were apparent in 23%, and QoL was impaired in 31%. Assessment of mental health revealed symptoms of depression, anxiety, and posttraumatic stress disorders in 11%, 25%, and 11%, respectively. CONCLUSIONS Despite recovery from the acute infection, neurological symptoms were prevalent at the 3-month follow-up. Above all, smelling disorders were persistent in a large proportion of patients.
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Affiliation(s)
- Verena Rass
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Ronny Beer
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Mario Kofler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Anna Lindner
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Philipp Mahlknecht
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Beatrice Heim
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Victoria Limmert
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Sabina Sahanic
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Alex Pizzini
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Thomas Sonnweber
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Scherfler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Laura Zamarian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Atbin Djamshidian
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Klaus Seppi
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Judith Loeffler-Ragg
- Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina Pfausler
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Lewis A, Frontera J, Placantonakis DG, Lighter J, Galetta S, Balcer L, Melmed KR. Cerebrospinal fluid in COVID-19: A systematic review of the literature. J Neurol Sci 2021; 421:117316. [PMID: 33561753 PMCID: PMC7833669 DOI: 10.1016/j.jns.2021.117316] [Citation(s) in RCA: 111] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 01/07/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. METHODS We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. RESULTS We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. CONCLUSION Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS- CoV-2 are unlikely to be related to direct viral neuroinvasion.
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Affiliation(s)
- Ariane Lewis
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA.
| | - Jennifer Frontera
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA
| | | | - Jennifer Lighter
- Department of Pediatrics, NYU Langone Medical Center, New York, NY 10016, USA
| | - Steven Galetta
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA
| | - Laura Balcer
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Ophthalmology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Population Health, NYU Langone Medical Center, New York, NY 10016, USA
| | - Kara R Melmed
- Department of Neurology, NYU Langone Medical Center, New York, NY 10016, USA; Department of Neurosurgery, NYU Langone Medical Center, New York, NY 10016, USA
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Sriwastava S, Kataria S, Tandon M, Patel J, Patel R, Jowkar A, Daimee M, Bernitsas E, Jaiswal P, Lisak RP. Guillain Barré Syndrome and its variants as a manifestation of COVID-19: A systematic review of case reports and case series. J Neurol Sci 2021; 420:117263. [PMID: 33321326 PMCID: PMC7725056 DOI: 10.1016/j.jns.2020.117263] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 01/01/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused by SARS-COV-2 began in Wuhan, China in December 2019. Reports of COVID-19 with central (CNS) and peripheral nervous (PNS) system manifestations are emerging. In this systematic review, we compared and summarized the demographics, clinical features, Brighton criteria, immunological and laboratory findings with a focus on modified Erasmus GBS Outcome Score (mEGOS) in SARS-CoV-2 patients with GBS and its variants. METHODS Based on PRISMA guidelines, we searched three databases (PubMed, Scopus, and Google Scholar) for studies on COVID-19 and GBS between December 1, 2019 to July 15, 2020. For descriptive analysis, we studied two groups with: 1) acute inflammatory demyelinating polyradiculoneuropathy (AIDP) variant, and 2) Non-AIDP/Other variants. We compared mEGOS scores for patients in both groups along with other key clinical features. RESULTS Of the 50 GBS cases identified from 37 studies, 33 (66%) had acute inflammatory demyelinating polyradiculopolyneuropathy (AIDP) while 17 (34%) were of other (non-AIDP) variants. There mEGOS scores did not differ between AIDP patients and AMAN/AMSAN patients. Majority of the AIDP (66.7%) and AMAN/AMSAN (57.2%) patients belonged to Brighton level 1 indicating maximum diagnostic certainty. CONCLUSION To our knowledge, this is among the first reviews that includes GBS variants and the clinical prediction tool mEGOS for prognostication in COVID-19 patients. Further research is needed to assess whether IVIG is preferable over plasmapheresis in this population of GBS patients. It would also be crucial to follow these patients over time to identify the long-term disability as well as treatment outcomes.
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Affiliation(s)
- Shitiz Sriwastava
- Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States of America.
| | - Saurabh Kataria
- Department of Neurology, University of Missouri Healthcare at Columbia, MO, United States of America
| | | | - Jenil Patel
- Department of Epidemiology, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Riddhi Patel
- Department of Epidemiology, Human Genetics & Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, TX, USA
| | - Abbas Jowkar
- Department of Neurology, Mercy Health, Michigan State University, Grand Rapids, MI, United States of America
| | - Maha Daimee
- Department of Neurology, MedStar Georgetown University, Washington, DC, United States of America
| | - Evanthia Bernitsas
- Department of Neurology, Wayne State University, Detroit, MI, United States of America
| | - Preeti Jaiswal
- Department of Public Health, Walden University, Minneapolis, MN, United States of America
| | - Robert P Lisak
- Department of Neurology, Wayne State University, Detroit, MI, United States of America; Department of Biochemistry, Microbiology and Immunology, Detroit, MI, United States of America
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Abdullahi A, Candan SA, Soysal Tomruk M, Elibol N, Dada O, Truijen S, Saeys W. Is Guillain-Barré Syndrome Associated With COVID-19 Infection? A Systemic Review of the Evidence. Front Neurol 2021; 11:566308. [PMID: 33519663 PMCID: PMC7838680 DOI: 10.3389/fneur.2020.566308] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background: There is emerging evidence that Guillain-Barré syndrome (GBS) may be associated with coronavirus disease 2019 (COVID-19) infection. The aim of this review was to investigate the strength of the evidence. Method: The review was registered in PROSPERO (CDR42020184822). Three electronic databases, MEDLINE, PubMed, and Web of Science, and three preprint servers, MedRvix, ChemRvix, and BioRvix, were searched from December 2019 to 24th September 2020. Studies were included if they were on COVID-19 and of any design. Articles that are reviews or opinion were excluded. The selection process was carried out using EndNote and Rayyan software. The main outcomes in the study were study design, sample size, sex, age, overall GBS symptoms, other COVID-19 symptoms, comorbidity, timing between infection and the onset of neurological symptoms, CT, MRI, and EMG results. Methodological quality of the studies was assessed using the McMaster Critical Review Form. The collected data was analyzed using qualitative synthesis. Findings: Fifty-one high-quality studies (mostly) consisting of 83 patients were included in the study. All of the patients (except in a very few) in the included studies had confirmed diagnosis of COVID-19. Similarly, the diagnosis of GBS was based on standard clinical, electrophysiological, and cerebrospinal fluid (CSF) criteria. Conclusion: GBS may be associated with COVID-19, and therefore, testing for COVID-19 is recommended in patients presenting with GBS during this pandemic.
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Affiliation(s)
- Auwal Abdullahi
- Department of Physiotherapy, Bayero University, Kano, Nigeria
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
| | - Sevim Acaroz Candan
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ordu University, Ordu, Turkey
| | - Melda Soysal Tomruk
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Mehmet Akif University, Burdur, Turkey
| | - Nuray Elibol
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Ege University, Izmir, Turkey
| | - Olumide Dada
- Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria
| | - Steven Truijen
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
| | - Wim Saeys
- Department of Physiotherapy and Rehabilitation Sciences, University of Antwerp, Antwerp, Belgium
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Codeluppi L, Venturelli F, Rossi J, Fasano A, Toschi G, Pacillo F, Cavallieri F, Giorgi Rossi P, Valzania F. Facial palsy during the COVID-19 pandemic. Brain Behav 2021; 11:e01939. [PMID: 33159420 PMCID: PMC7821573 DOI: 10.1002/brb3.1939] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/22/2020] [Accepted: 10/22/2020] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To compare the incidence and clinical features of individuals presenting in emergency rooms (ER) with facial palsy during the Italian COVID-19 outbreak and in the same period of 2019. METHODS We retrospectively reviewed the medical records for all accesses to the six ER in the province of Reggio Emilia, Italy, during the first phase of the COVID-19 pandemic (27 February-3 May 2020) to identify all cases of diagnosed facial palsy. Clinical information was retrieved for each patient and compared with that of facial palsy cases presenting in 2019. RESULT Between 27 February and 3 May 2020, 38 patients presented to provincial ERs for facial palsy; in 2019, there were 22 cases, for an incidence rate ratio of 1.73 (95% CI 1.02-2.92) for the 2020 cohort. Of the 2020 cohort, eight patients (21%) presented with active or recent symptoms consistent with COVID-19 infection, compared with 2 (9%) in 2019 (p = .299); one was tested and resulted positive for SARS-CoV-2. Moreover, patients were younger (-11 years, p = .037) than those of the previous year and manifested a longer lag (+1.1 days, p = .001) between symptoms onset and ER presentation. CONCLUSION We observed a higher occurrence of facial palsy during the COVID-19 outbreak compared to the same period of the previous year; 21% of patients presenting with facial palsy had active or recent symptoms consistent with SARS-CoV-2 infection, suggesting an excess risk of facial palsy during or after COVID-19. These patients searched for medical attention later, probably because of the fear of contracting COVID-19 during assistance.
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Affiliation(s)
- Luca Codeluppi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Jessica Rossi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Department of Biomedical, Metabolic and Neural Sciences, Center for Neuroscience and Neurotechnology, University of Modena and Reggio Emilia, Modena, Italy.,Neurology Department, OCB Hospital, AOU Modena, Modena, Italy
| | - Antonio Fasano
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giulia Toschi
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Pacillo
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Cavallieri
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Paolo Giorgi Rossi
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.,Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Franco Valzania
- Neurology Unit, Neuromotor & Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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COVID-19 infection presented as Guillain-Barre Syndrome: Report of two new cases and review of 116 reported cases and case series. Travel Med Infect Dis 2021; 44:102169. [PMID: 34624553 PMCID: PMC8492388 DOI: 10.1016/j.tmaid.2021.102169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND /Aims: Corona virus disease 2019 (COVID 19) is a pandemic infectious disease of 2020, which often presents with respiratory and gastrointestinal symptoms. The behavior of the virus and its full clinical picture has not been fully studied yet. Many case reports and case series have been running in order to elaborate different presentations and associations. Pulmonary and gastrointestinal features of COVID-19 infection are well outlined; however, neurological manifestations are less defined. CASE PRESENTATION We report two adult cases of COVID-19 infection presented with acute Guillain-Barre Syndrome (GBS), and a literature review on the causal association between COVID-19 and GBS. CONCLUSION Our two case reports in addition to literature review of 116 published cases may help offer insight into the clinical course of COVID-19 infection. Our two COVID-19 patients presented with neurological manifestations of GBS which were not preceded with any respiratory, gastrointestinal or other systemic infection. This leads us to raise the possibility of establish direct causal association between COVID-19 infection and GBS. Physicians should have high clinical suspicions when encounter GBS patient during the current COVID-19 pandemic and consider co-existence of COVID-19 infection that may warrant SARS-CoV-2 testing, isolation precautions, and specific treatment for Covid-19 infection.
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Novelli L, Motta F, De Santis M, Ansari AA, Gershwin ME, Selmi C. The JANUS of chronic inflammatory and autoimmune diseases onset during COVID-19 - A systematic review of the literature. J Autoimmun 2020; 117:102592. [PMID: 33401171 PMCID: PMC7833462 DOI: 10.1016/j.jaut.2020.102592] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/15/2022]
Abstract
The diverse clinical manifestations of COVID-19 is emerging as a hallmark of the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection. While the initial target of SARS-CoV-2 is the respiratory tract, it is becoming increasingly clear that there is a complex interaction between the virus and the immune system ranging from mild to controlling responses to exuberant and dysfunctional multi-tissue directed autoimmune responses. The immune system plays a dual role in COVID-19, being implicated in both the anti-viral response and in the acute progression of the disease, with a dysregulated response represented by the marked cytokine release syndrome, macrophage activation, and systemic hyperinflammation. It has been speculated that these immunological changes may induce the loss of tolerance and/or trigger chronic inflammation. In particular, molecular mimicry, bystander activation and epitope spreading are well-established proposed mechanisms to explain this correlation with the likely contribution of HLA alleles. We performed a systematic literature review to evaluate the COVID-19-related autoimmune/rheumatic disorders reported between January and September 2020. In particular, we investigated the cases of incident hematological autoimmune manifestations, connective tissue diseases, antiphospholipid syndrome/antibodies, vasculitis, Kawasaki-like syndromes, acute arthritis, autoimmune-like skin lesions, and neurologic autoimmune conditions such as Guillain–Barré syndrome. We screened 6263 articles and report herein the findings of 382 select reports which allow us to conclude that there are 2 faces of the immune response against SARS-CoV-2, that include a benign virus controlling immune response and a many faceted range of dysregulated multi-tissue and organ directed autoimmune responses that provides a major challenge in the management of this viral disease. The number of cases for each disease varied significantly while there were no reported cases of adult onset Still disease, systemic sclerosis, or inflammatory myositis. The immune system plays a major role in the acute progression of COVID-19. SARS-CoV-2 infection shares features with autoimmune diseases. SARS-CoV-2 can induce Guillain-Barré syndrome, arthritis, chilblain-like lesions.
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Affiliation(s)
- Lucia Novelli
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Francesca Motta
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy
| | - Aftab A Ansari
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - M Eric Gershwin
- Division of Rheumatology, Department of Medicine, Allergy and Clinical Immunology, University of California at Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Clinical and Research Center- IRCCS, Rozzano, MI, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, MI, Italy.
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Hasan I, Saif-Ur-Rahman KM, Hayat S, Papri N, Jahan I, Azam R, Ara G, Islam Z. Guillain-Barré syndrome associated with SARS-CoV-2 infection: A systematic review and individual participant data meta-analysis. J Peripher Nerv Syst 2020; 25:335-343. [PMID: 33112450 DOI: 10.1111/jns.12419] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/15/2022]
Abstract
Several published reports have described a possible association between Guillain-Barré syndrome (GBS) and severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection. This systematic review aimed to summarize and meta-analyze the salient features and prognosis of SARS-CoV-2-associated GBS. We searched the PubMed (Medline), Web of Science and Cochrane databases for articles published between 01 January 2020 and 05 August 2020 using SARS-CoV-2 and GBS-related keywords. Data on sociodemographic characteristics, antecedent symptoms, clinical, serological and electrophysiological features, and hospital outcomes were recorded. We included 45 articles from 16 countries reporting 61 patients with SARS-CoV-2-associated GBS. Most (97.7%) articles were from high- and upper-middle-income countries. Forty-two (68.9%) of the patients were male; median (interquartile range) age was 57 (49-70) years. Reverse transcriptase polymerase chain reaction for SARS-CoV-2 was positive in 90.2% of patients. One report of SARS-CoV-2-associated familial GBS was found which affected a father and daughter of a family. Albuminocytological dissociation in cerebrospinal fluid was found in 80.8% of patients. The majority of patients (75.5%) had a demyelinating subtype of GBS. Intravenous immunoglobulin and plasmapheresis were given to 92.7% and 7.3% of patients, respectively. Around two-thirds (65.3%) of patients had a good outcome (GBS-disability score ≤ 2) on discharge from hospital. Two patients died in hospital. SARS-CoV-2-associated GBS mostly resembles the classical presentations of GBS that respond to standard treatments. Extensive surveillance is required in low- and lower-middle-income countries to identify and report similar cases/series. Further large-scale case-control studies are warranted to strengthen the current evidence. PROSPERO Registration Number CRD42020201673.
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Affiliation(s)
- Imran Hasan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.,Department of Public Health and Health Systems, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Shoma Hayat
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Nowshin Papri
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh.,Department of Neurology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Israt Jahan
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Rufydha Azam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
| | - Gulshan Ara
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Zhahirul Islam
- Laboratory of Gut-Brain Signaling, Laboratory Sciences and Services Division, icddr,b, Dhaka, Bangladesh
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Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci 2020; 41:3437-3470. [PMID: 33089477 PMCID: PMC7577367 DOI: 10.1007/s10072-020-04801-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. METHODS We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. RESULTS Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4-50.2), taste disturbances (38.5%; 95%CI 24.0-53.0), myalgia (19.3%; 95% CI 15.1-23.6), headache (14.7%; 95% CI 10.4-18.9), dizziness (6.1%; 95% CI 3.1-9.2), and syncope (1.8%; 95% CI 0.9-4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0-3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9-3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2-0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1-0.6). CONCLUSIONS Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.
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36
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Neurological complications of coronavirus infection; a comparative review and lessons learned during the COVID-19 pandemic. J Neurol Sci 2020; 417:117085. [PMID: 32871412 PMCID: PMC7413162 DOI: 10.1016/j.jns.2020.117085] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. METHODS This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. RESULTS Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. CONCLUSION There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.
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Uncini A, Vallat JM, Jacobs BC. Guillain-Barré syndrome in SARS-CoV-2 infection: an instant systematic review of the first six months of pandemic. J Neurol Neurosurg Psychiatry 2020; 91:1105-1110. [PMID: 32855289 DOI: 10.1136/jnnp-2020-324491] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 08/10/2020] [Accepted: 08/10/2020] [Indexed: 12/30/2022]
Abstract
A systematic review from 1 January to 30 June 2020 revealed 42 patients with Guillain-Barré syndrome (GBS) associated with SARS-CoV-2 infection. Single cases and small series were reported from 13 countries, the majority from Europe (79.4%) and especially from Italy (30.9%). SARS-CoV-2 infection was demonstrated by nasopharyngeal swab (85.7%) and serology (14.3%). Median time between COVID-19 and GBS onset in 36 patients was 11.5 days (IQR: 7.7-16). The most common clinical features were: limb weakness (76.2%), hypoareflexia (80.9 %), sensory disturbances (66.7 %) and facial palsy (38.1%). Dysautonomia occurred in 19%, respiratory failure in 33.3% and 40.5% of patients were admitted in intensive care unit. Most patients (71.4%) had the classical clinical presentation but virtually all GBS variants and subtypes were reported. Cerebrospinal fluid (CSF) albumin-cytological dissociation was found in 28/36 (77.8%) and PCR for SARS-CoV-2 was negative in 25/25 patients. Electrodiagnosis was demyelinating in 80.5% and levels 1 and 2 of Brighton criteria of diagnostic certainty, when applicable, were fulfilled in 94.5% patients. Antiganglioside antibodies were positive in only 1/22 patients. Treatments were intravenous immunoglobulin and/or plasma exchange (92.8%) with, at short-time follow-up, definite improvement or recovery in 62.1% of patients. One patient died. In conclusion, the most frequent phenotype of GBS in SARS-CoV-2 infection is the classical sensorimotor demyelinating GBS responding to the usual treatments. The time interval between infectious and neuropathic symptoms, absence of CSF pleocytosis and negative PCR support a postinfectious mechanism. The abundance of reports suggests a pathogenic link between SARS-CoV-2 infection and GBS but a case-control study is greatly needed.
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Affiliation(s)
- Antonino Uncini
- Department of Neuroscience, Imaging and Clinical Sciences, University "G. d'Annunzio" Chieti-Pescara, Chieti, Italy
| | - Jean-Michel Vallat
- Department of Neurology, National Reference Center for "Rare Peripheral Neuropathies", CHU Dupuytren, Limoges, France
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus MC, Rotterdam, The Netherlands
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Pitscheider L, Karolyi M, Burkert FR, Helbok R, Wanschitz JV, Horlings C, Pawelka E, Omid S, Traugott M, Seitz T, Zoufaly A, Lindeck-Pozza E, Wöll E, Beer R, Seiwald S, Bellmann-Weiler R, Hegen H, Löscher WN. Muscle involvement in SARS-CoV-2 infection. Eur J Neurol 2020; 28:3411-3417. [PMID: 32997370 PMCID: PMC7537196 DOI: 10.1111/ene.14564] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/09/2020] [Accepted: 09/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE Since the outbreak of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic, several reports indicated neurological involvement in COVID-19 disease. Muscle involvement has also been reported as evidenced by creatine kinase (CK) elevations and reports of myalgia. METHODS Creatine kinase, markers of inflammation, pre-existing diseases and statin use were extracted from records of Austrian hospitalised COVID-19 patients. Disease severity was classified as severe in case of intensive care unit (ICU) admission or mortality. COVID-19 patients were additionally compared to an historical group of hospitalised influenza patients. RESULTS Three hundred fifty-one patients with SARS-CoV-2 and 258 with influenza were included in the final analysis. CK was elevated in 27% of COVID-19 and in 28% of influenza patients. CK was higher in severe COVID-19 as were markers of inflammation. CK correlated significantly with inflammation markers, which had an independent impact on CK when adjusted for demographic variables and disease severity. Compared to influenza patients, COVID-19 patients were older, more frequently male, had more comorbidities, and more frequently had a severe disease course. Nevertheless, influenza patients had higher baseline CK than COVID-19, and 35.7% of intensive care unit (ICU)-admitted patients had CK levels >1,000 U/L compared to only 4.7% of ICU-admitted COVID-19 patients. CONCLUSIONS HyperCKemia occurs in a similar frequency in COVID-19 and influenza infection. CK levels were lower in COVID-19 than in influenza in mild and severe disease. CK levels strongly correlate with disease severity and markers of inflammation. To date, it remains unclear whether hyperCKemia is due to a virus-triggered inflammatory response or direct muscle toxicity.
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Affiliation(s)
- Lea Pitscheider
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Mario Karolyi
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Francesco R Burkert
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Raimund Helbok
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Julia V Wanschitz
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Corinne Horlings
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Erich Pawelka
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Sara Omid
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Marianna Traugott
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Tamara Seitz
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - Alexander Zoufaly
- 4th Medical Department with Infectious Diseases and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | | | - Ewald Wöll
- Department of Internal Medicine, St. Vinzenz Hospital, Zams, Austria
| | - Ronny Beer
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Stefanie Seiwald
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Rosa Bellmann-Weiler
- Department of Internal Medicine II, Infectious Diseases, Pneumology, Rheumatology, Medical University of Innsbruck, Innsbruck, Austria
| | - Harald Hegen
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Wolfgang N Löscher
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
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Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci 2020; 41:3039-3056. [PMID: 32935156 PMCID: PMC7491599 DOI: 10.1007/s10072-020-04708-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.
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Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | | | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
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Zito A, Alfonsi E, Franciotta D, Todisco M, Gastaldi M, Cotta Ramusino M, Ceroni M, Costa A. COVID-19 and Guillain-Barré Syndrome: A Case Report and Review of Literature. Front Neurol 2020; 11:909. [PMID: 32973665 PMCID: PMC7471770 DOI: 10.3389/fneur.2020.00909] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/14/2020] [Indexed: 12/17/2022] Open
Abstract
During the recent coronavirus disease 2019 (COVID-19) outbreak in Northern Italy, we observed a 57-year-old man developing acute motor-sensory axonal neuropathy, a variant of Guillain-Barré syndrome (GBS), 12 days after severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) infection. Similarly to other bacterial and viral infections, dysregulation of the immune system due to post-infectious mechanisms, such as the molecular mimicry, could lead to an indirect damage of the peripheral nervous system related to SARS-CoV-2. GBS causes motor dysfunctions that are not easily recognizable in non-neurological settings or in patients requiring ventilatory assistance. Several reports also suggested that GBS and Miller Fisher syndrome (MFS) could be neurological complications of COVID-19. Therefore, we performed a review of the 29 articles so far published, describing 33 GBS cases and five MFS cases associated with SARS-CoV-2 infection. We recommend awareness of this rare, but treatable, neurological syndrome, which may also determine a sudden and otherwise unexplained respiratory deterioration in COVID-19 patients.
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Affiliation(s)
- Antonio Zito
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Enrico Alfonsi
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Diego Franciotta
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, Pavia, Italy
| | - Massimiliano Todisco
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Clinical Neurophysiology Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Gastaldi
- Laboratory of Neuroimmunology, IRCCS Mondino Foundation, Pavia, Italy
| | - Matteo Cotta Ramusino
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Mauro Ceroni
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Pavia, Italy
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Diez-Porras L, Vergés E, Gil F, Vidal MJ, Massons J, Arboix A. Guillain-Barré-Strohl syndrome and COVID-19: Case report and literature review. Neuromuscul Disord 2020; 30:859-861. [PMID: 32912716 PMCID: PMC7420397 DOI: 10.1016/j.nmd.2020.08.354] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 12/23/2022]
Abstract
A case of an acute demyelinating polyneuropathy during infection by SARS-CoV-2. SARS-CoV-2 has also been shown to affect the peripheral nervous system. Guillain-Barré syndrome (GBS) due to SARS-CoV-2 is a rare complication. Some GBS have led to hypothesize a possible parainfectious pathogenesis.
In recent months, the new beta-coronavirus has caused a pandemic with symptoms affecting mainly the respiratory system. It is established that the virus may play a neurotropic role and in recent months several cases of Guillain-Barré-Strohl syndrome (GBS) have been reported in patients infected with COVID-19. We report the case of a 54-year-old patient with acute demyelinating polyneuropathy during infection by SARS-CoV-2 who progressed clinically to require assisted ventilation. After several weeks of specific symptomatic treatment, the patient had a favorable outcome. In conclusion, despite being a rare complication, we think it is important to consider the possibility of diffuse involvement of the peripheral nervous system in patients with COVID-19 to adjust clinical monitoring and treatment in these cases.
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Affiliation(s)
- Laura Diez-Porras
- Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain.
| | - Enric Vergés
- Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
| | - Francisco Gil
- Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
| | - M José Vidal
- Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
| | - Joan Massons
- Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
| | - Adrià Arboix
- Department of Neurology, Hospital Universitari del Sagrat Cor, Universitat de Barcelona, Barcelona, Spain
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Caress JB, Castoro RJ, Simmons Z, Scelsa SN, Lewis RA, Ahlawat A, Narayanaswami P. COVID-19-associated Guillain-Barré syndrome: The early pandemic experience. Muscle Nerve 2020; 62:485-491. [PMID: 32678460 PMCID: PMC7405390 DOI: 10.1002/mus.27024] [Citation(s) in RCA: 176] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 07/14/2020] [Indexed: 12/27/2022]
Abstract
Guillain-Barré syndrome (GBS) is an inflammatory polyradiculoneuropathy associated with numerous viral infections. Recently, there have been many case reports describing the association between coronavirus disease-2019 (COVID-19) and GBS, but much remains unknown about the strength of the association and the features of GBS in this setting. We reviewed 37 published cases of GBS associated with COVID-19 to summarize this information for clinicians and to determine whether a specific clinical or electrodiagnostic (EDx) pattern is emerging. The mean age (59 years), gender (65% male), and COVID-19 features appeared to reflect those of hospitalized COVID-19 patients early in the pandemic. The mean time from COVID-19 symptoms to GBS symptoms was 11 days. The clinical presentation and severity of these GBS cases was similar to those with non-COVID-19 GBS. The EDx pattern was considered demyelinating in approximately half of the cases. Cerebrospinal fluid, when assessed, demonstrated albuminocytologic dissociation in 76% of patients and was negative for severe acute respiratory distress syndrome-coronavirus-2 (SARS-CoV-2) in all cases. Serum antiganglioside antibodies were absent in 15 of 17 patients tested. Most patients were treated with a single course of intravenous immunoglobulin, and improvement was noted within 8 weeks in most cases. GBS-associated COVID-19 appears to be an uncommon condition with similar clinical and EDx patterns to GBS before the pandemic. Future studies should compare patients with COVID-19-associated GBS to those with contemporaneous non-COVID-19 GBS and determine whether the incidence of GBS is elevated in those with COVID-19.
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Affiliation(s)
- James B Caress
- Department of Neurology, Wake Forest School of Medicine, North Carolina, USA
| | - Ryan J Castoro
- Department of Neurology, Wake Forest School of Medicine, North Carolina, USA
| | - Zachary Simmons
- Department of Neurology, Penn State Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Stephen N Scelsa
- Department of Neurology, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Richard A Lewis
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Aditi Ahlawat
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
| | - Pushpa Narayanaswami
- Department of Neurology, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts, USA
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