SARS-CoV-2 Transmission and Outcome in Neuro-rehabilitation Patients Hospitalized at Neuroscience Hospital in Italy

ABSTRACT Introduction:  Patients admitted to intensive neurorehabilitation facilities following neurological damage who developed SARS-CoV-2 infection during hospitalization have not yet been reported. Such patients are elderly, with severe disabling neurological syndromes, more likely have significant underlying comorbidities and develop fatal complications during the disease. We reported clinical features, underlying comorbidities, laboratory and radiological findings, treatment and outcome of severely disabled neurological patients with SARS-CoV-2 infection. Methods:  We retrospectively analyzed a group of 14 patients affected by severe neurological damage previously admitted to the Neurorehabilitation Unit of Neuromed Research Institute in Pozzilli, Italy, who developed confirmed COVID-19 during a SARS-CoV-2 outbreak occurred on March, 2020. Results:  One out of 14 patients (7%) died after developing a severe acute respiratory distress. The remaining patients did not present any symptom or laboratory or radiological signs of the disease; neither new neurological deficit nor worsening of the pre-existing clinical manifestations were observed. Thirtheen patients had underlying comorbitidies (93%), the most frequent being hypertension (11 patients, 78.5%) and diabetes mellitus type II (7 patients, 50%). Long before infection, all patients were already under anticoagulant therapy with enoxaparin. Conclusions:  In 13 out of 14 patients, the infection was asymptomatic; this is particularly intriguing considering their severe neurological clinical profile. According to the pivotal role played by inflammation and activation of blood coagulation in the pathogenesis of COVID-19, the anti-inflammatory and anticoagulant properties of enoxaparin, administered much earlier and during infection, could have favored an extremely benign disease course in these patients at high risk of poor outcome. Keywords: SARS CoV 2, neurological patients, neurological damage, Infection, Coronavirus    

Effects of hypertension on balance assessed by computerized posturography in the elderly

Unsteadiness, dizziness and vertigo occur more frequently in hypertensive subjects, compared to the normal ones. This study evaluated the influence of hypertension on balance tests, performed on posturographic platform. The study pool consisted of 112 persons aged 65 and older (65 hypertensives), their mean age was 72.9+/-0.5, scored on the Mini Mental State Examination (MMSE) greater than 24, were able to perform self-care activities, to walk independently for at least 400 m and were free from major diseases. Subjective dizziness and vertigo were assessed by means of Sickness-Impact-Profile-Questionnaire (SIPQ). The static posturographic tests were performed on a vertical force platform, from which the center of foot pressure (COP) positions and displacements were recorded. In balance tests three standardized positions were utilized: feet 30 degrees apart, semitandem and tandem. Subjects with hypertension complained more frequently dizziness and vertigo (41.5% vs. 21.3%). The track-length and COP-velocity were associated with age in all the balance tests. In semitandem and tandem positions, the medio-lateral sway distance significantly increased in elderly subjects compared to young controls. No difference, however, was found in balance tests between normotensive and hypertensive subjects. Those with uncomplicated hypertension compared with normo-tensive subjects, although complaining more frequently symptoms of postural instability, did not show worse performances in static posturographic tests.