#Myasthenia Gravis Associated With #SARS-CoV-2 Infection (Ann Intern Med., summary)

[Source: Annals of Internal Medicine, full page: (LINK). Summary, edited.]

Myasthenia Gravis Associated With SARS-CoV-2 Infection

Domenico A. Restivo, MD, PhD, Diego Centonze, MD, Alessandro Alesina, MD, Rosario Marchese-Ragona, MD

DOI: https://doi.org/10.7326/L20-0845

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Background: Some patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have neurologic symptoms (1–3). Some observers propose that these symptoms are caused by viral infection of nerve cells (4), but the possibility exists that these symptoms might be produced by autoimmune mechanisms (1–4). Myasthenia gravis is an autoimmune disease in which antibodies bind to acetylcholine receptors (AChRs) or to functionally related molecules in the postsynaptic membrane at the neuromuscular junction (5).

(…)

Keywords: SARS-CoV-2; COVID-19; Immunopathology; Neurology.

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Case Report: #COVID19 Patient With Chief Complaint of #Anosmia and #Ageusia; a Unique Perspective on #Atypical #Symptomatology and #Management in the #Military (Mil Med., abstract)

[Source: Military Medicine, full page: (LINK). Abstract, edited.]

Case Report: COVID-19 Patient With Chief Complaint of Anosmia and Ageusia; a Unique Perspective on Atypical Symptomatology and Management in the Military

L T Alicia C Smith, MC USN, C D R James Hodges, MC USN, Molly Pratt, USN, L C D R Ian M Porter, MC USN

Military Medicine, usaa196, https://doi.org/10.1093/milmed/usaa196

Published: 10 August 2020

 

ABSTRACT

A novel corona virus, severe acute respiratory syndrome coronavirus-2, found in Wuhan, China in December 2019 has since spread to multiple continents and has been implicated in thousands of deaths. This pandemic—causing virus has been initially described (corona virus disease 2019 [COVID-19]) with the presentation of fever, cough, and shortness of breath. The majority of studies published have been conducted on inpatient cases and a shortage of tests has encouraged screening only of patients with classic presentation. A positive COVID-19 case of a healthy military male, with the chief complaint of anosmia and ageusia, instigated local re-evaluation of the screening protocol for possible COVID-19 patients. Multiple studies in Europe have implicated anosmia and ageusia as symptoms associated with COVID-19, and subsequently, anosmia and ageusia have been added to Centers for Disease Control and Prevention screening guidelines as well. There should be a higher index of suspicion when evaluating a patient with high-risk activities, travel, and atypical symptoms. More studies need to be conducted with a healthy outpatient population to further understand this disease and decrease its impact.

Issue Section:  Case Report

Keywords: SARS-CoV-2; COVID-19; Anosmia; Otolaryngology; Neurology.

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#Delirium and #encephalopathy in severe #COVID19: a cohort analysis of #ICU patients (Crit Care, abstract)

[Source: Critical Care, full page: (LINK). Abstract, edited.]

Delirium and encephalopathy in severe COVID-19: a cohort analysis of ICU patients

Julie Helms, Stéphane Kremer, Hamid Merdji, Malika Schenck, François Severac, Raphaël Clere-Jehl, Antoine Studer, Mirjana Radosavljevic, Christine Kummerlen, Alexandra Monnier, Clotilde Boulay, Samira Fafi-Kremer, Vincent Castelain, Mickaël Ohana, Mathieu Anheim, Francis Schneider & Ferhat Meziani

Critical Care volume 24, Article number: 491 (2020)

 

Abstract

Background

Neurotropism of SARS-CoV-2 and its neurological manifestations have now been confirmed. We aimed at describing delirium and neurological symptoms of COVID-19 in ICU patients.

Methods

We conducted a bicentric cohort study in two French ICUs of Strasbourg University Hospital.

All the 150 patients referred for acute respiratory distress syndrome due to SARS-CoV-2 between March 3 and May 5, 2020, were included at their admission. Ten patients (6.7%) were excluded because they remained under neuromuscular blockers during their entire ICU stay. Neurological examination, including CAM-ICU, and cerebrospinal fluid analysis, electroencephalography, and magnetic resonance imaging (MRI) were performed in some of the patients with delirium and/or abnormal neurological examination. The primary endpoint was to describe the incidence of delirium and/or abnormal neurological examination. The secondary endpoints were to describe the characteristics of delirium, to compare the duration of invasive mechanical ventilation and ICU length of stay in patients with and without delirium and/or abnormal neurological symptoms.

Results

The 140 patients were aged in median of 62 [IQR 52; 70] years old, with a median SAPSII of 49 [IQR 37; 64] points. Neurological examination was normal in 22 patients (15.7%). One hundred eighteen patients (84.3%) developed a delirium with a combination of acute attention, awareness, and cognition disturbances. Eighty-eight patients (69.3%) presented an unexpected state of agitation despite high infusion rates of sedative treatments and neuroleptics, and 89 (63.6%) patients had corticospinal tract signs. Brain MRI performed in 28 patients demonstrated enhancement of subarachnoid spaces in 17/28 patients (60.7%), intraparenchymal, predominantly white matter abnormalities in 8 patients, and perfusion abnormalities in 17/26 patients (65.4%). The 42 electroencephalograms mostly revealed unspecific abnormalities or diffuse, especially bifrontal, slow activity. Cerebrospinal fluid examination revealed inflammatory disturbances in 18/28 patients, including oligoclonal bands with mirror pattern and elevated IL-6. The CSF RT-PCR SARS-CoV-2 was positive in one patient. The delirium/neurological symptoms in COVID-19 patients were responsible for longer mechanical ventilation compared to the patients without delirium/neurological symptoms. Delirium/neurological symptoms could be secondary to systemic inflammatory reaction to SARS-CoV-2.

Conclusions and relevance

Delirium/neurological symptoms in COVID-19 patients are a major issue in ICUs, especially in the context of insufficient human and material resources.

Trial registration

NA.

Keywords: SARS-CoV-2; COVID-19; Intensive Care; Encephalopathy; Neurology.

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A Case of #Coronavirus Disease 2019 Presenting with #Seizures Secondary to #Cerebral Venous Sinus #Thrombosis (Case Rep Neurol., abstract)

[Source: Case Reports in Neurology, full page: (LINK). Abstract, edited.]

A Case of Coronavirus Disease 2019 Presenting with Seizures Secondary to Cerebral Venous Sinus Thrombosis

Hussain S.a · Vattoth S.c · Haroon K.H.a · Muhammad A.a,b

Author affiliations: a Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar; b Weill Cornell Medicine-Qatar, Doha, Qatar; c University of Arkansas for Medical Sciences, Little Rock, AR, USA

Case Rep Neurol 2020;12:260–265 | DOI: https://doi.org/10.1159/000509505

 

Abstract

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2. COVID-19-associated thrombotic events are recognized. A wide variety of neurological presentations have been recently documented. We report the first case of COVID-19 presenting with generalized seizure secondary to cerebral venous sinus thrombosis.

© 2020 The Author(s). Published by S. Karger AG, Basel

Keywords: SARS-CoV-2; COVID-19; Neurology.

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Vital Signs: #Clinical Characteristics of Patients with Confirmed Acute Flaccid #Myelitis [#AFM], #USA, 2018 (MMWR Morb Mortal Wkly Rep., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), MMWR Morbidity and Mortality Weekly Report, full page: (LINK). Abstract, edited.]

Vital Signs: Clinical Characteristics of Patients with Confirmed Acute Flaccid Myelitis, United States, 2018

Early Release / August 4, 2020 / 69

Sarah Kidd, MD1; Adriana Lopez, MHS1; W. Allan Nix1; Gloria Anyalechi, MD2; Megumi Itoh, MD3; Eileen Yee, MD1; M. Steven Oberste, PhD1; Janell Routh, MD1

 

Summary

  • What is already known about this topic?
    • Since U.S. surveillance for acute flaccid myelitis (AFM) began in 2014, reported cases have peaked biennially. Most cases occur in children during late summer and early fall.
  • What is added by this report?
    • Among 238 patients with confirmed AFM during 2018, most (92%) had prodromal fever, respiratory illness, or both. In addition to weakness, common symptoms were gait difficulty (52%), neck or back pain (47%), fever (35%), and limb pain (34%). Among 211 who were outpatients when weakness began, 64% sought treatment at an emergency department. Overall, 23% required endotracheal intubation and mechanical ventilation.
  • What are the implications for public health practice?
    • Clinicians should suspect AFM in children with acute flaccid limb weakness, especially when accompanied by neck or back pain and a recent history of febrile respiratory illness. Increasing awareness in frontline settings such as emergency departments should aid rapid recognition and hospitalization for AFM.

 

Abstract

Background:

Acute flaccid myelitis (AFM) is a serious neurologic syndrome that affects mostly children and is characterized by the acute onset of limb weakness or paralysis. Since U.S. surveillance for AFM began in 2014, reported cases have peaked biennially. This report describes the clinical characteristics of AFM patients during 2018, the most recent peak year.

Methods:

Medical records from persons meeting AFM clinical criterion (acute onset of flaccid limb weakness) were submitted to CDC. Patients with confirmed AFM met the clinical criterion and had magnetic resonance imaging indicating spinal cord lesions largely restricted to gray matter and spanning one or more vertebral segments. Symptoms, physical findings, test and imaging results, and hospitalization data were abstracted and described.

Results:

Among 238 patients with confirmed AFM during 2018, median age was 5.3 years. Among the 238 patients, 205 (86%) had onset during August–November. Most (92%) had prodromal fever, respiratory illness, or both beginning a median of 6 days before weakness onset. In addition to weakness, common symptoms at clinical evaluation were gait difficulty (52%), neck or back pain (47%), fever (35%), and limb pain (34%). Among 211 who were outpatients when weakness began, most (76%) sought medical care within 1 day, and 64% first sought treatment at an emergency department. Overall, 98% of patients were hospitalized, 54% were admitted to an intensive care unit, and 23% required endotracheal intubation and mechanical ventilation.

Conclusion:

Clinicians should suspect AFM in children with acute flaccid limb weakness, especially during August–November and when accompanied by neck or back pain and a recent history of febrile respiratory illness. Increasing awareness in frontline settings such as emergency departments should aid rapid recognition and hospitalization for AFM.

Keywords: Acute Flaccid Myelitis; Pediatrics; USA.

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#Patterns of #Gustatory #Recovery in Patients Affected by the #COVID19 Outbreak (Virol Sin., summary)

[Source: Virologica Sinica, full page: (LINK). Summary, edited.]

Patterns of Gustatory Recovery in Patients Affected by the COVID-19 Outbreak

Carlos M. Chiesa-Estomba, Jerome R. Lechien, Maria R. Barillari & Sven Saussez

Virologica Sinica (2020)

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Dear Editor, Coronavirus disease 2019 (COVID-19) is a viral infection caused by severe  acute respiratory syndrome coronavirus 2 (SARS-CoV-2). From March 2020, several  studies indicate that many subjects affected by mild-to-moderate COVID-19 presented  olfactory/gustatory dysfunction (OD/GD) that appeared strongly correlated between them  but not with the other symptoms suggestive of upper airway infection (Lechien et  al.2020a, b; Hopkins et al.2020; Paderno et al.2020). Isolated OD and GD, without any other general or otolaryngologycal complaints like rhinorrhea or nasal obstruction, were also described as the main or unique symptoms of the infection in a variable percentage of cases; these patients, not initially identified as infected, could have represented a potential way to rapidly spread the infection among the population (Lechien et al.2020b; Vaira et al.2020).

(…)

Keywords: SARS-CoV-2; COVID-19; Anosmia; Neurology; Otolaryngology.

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#Mechanisms of #Stroke in #COVID19 (Cerebrovasc Dis., summary)

[Source: Cerebrovascular Diseases, full page: (LINK). Summary, edited.]

Mechanisms of Stroke in COVID-19

Spence J.D.a · de Freitas G.R.b · Pettigrew L.C.c · Ay H.d · Liebeskind D.S.e · Kase C.S.f · Del Brutto O.H.g · Hankey G.J.h · Venketasubramanian N.i

Author affiliations: a Stroke Prevention & Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, ON, Canada; b Department of Neurology, Universidade Federal Fluminense and Instituto D’Or de Pesquisa e Ensino, Rio de Janeiro, Brazil; c Department of Neurology, University of Kentucky School of Medicine, Lexington, KY, USA; d Department of Neurology and Radiology, Harvard School of Medicine and Takeda Pharmaceutical Company Limited, Cambridge, MA, USA; e Neurovascular Imaging Research Core and UCLA Stroke Center, Department of Neurology, University of California, Los Angeles, CA, USA; f Department of Neurology, Emory University, Atlanta, GA, USA; g School of Medicine, Universidad Espíritu Santo, Samborondón, Ecuador; h Medical School, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA, Australia; i Raffles Neuroscience Centre, Raffles Hospital, Singapore, Singapore

Cerebrovasc Dis | DOI: https://doi.org/10.1159/000509581

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In this Commentary, we address mechanisms of stroke in patients with coronavirus disease 2019 (COVID-19) due to infection with the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It should be noted that given the recency of the pandemic, most studies are small case series, so this evaluation should be regarded as preliminary.

(…)

Keywords: SARS-CoV-2; COVID-19; Stroke; Neurology.

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#Outcomes and #Spectrum of Major #Neurovascular Events Among #COVID19 Patients: A 3-Center Experience (Neurosurg Open, abstract)

[Source: Neurosurgery Open, full page: (LINK). Abstract, edited.]

Outcomes and Spectrum of Major Neurovascular Events Among COVID-19 Patients: A 3-Center Experience

Blake E S Taylor, MD, Priyank Khandelwal, MD, Michael S Rallo, BS, Purvee Patel, MD, Lindsey Smith, BSN, RN, SCRN, Hai Sun, MD, PhD, Anil Nanda, MD, MPH, Amit Singla, MD, Sudipta Roychowdhury, MD, Roger C Cheng, MD, Kiwon Lee, MD, Gaurav Gupta, MD, Stephen A Johnson, MD

Neurosurgery Open, Volume 1, Issue 3, September 2020,  okaa008, https://doi.org/10.1093/neuopn/okaa008

Published: 17 July 2020

 

ABSTRACT

BACKGROUND

Preliminary data suggest that Coronavirus Disease-2019 (COVID-19) is associated with hypercoagulability and neurovascular events, but data on outcomes is limited.

OBJECTIVE

To report the clinical course and outcomes of a case series of COVID-19 patients with a variety of cerebrovascular events.

METHODS

We performed a multicentric, retrospective chart review at our three academic tertiary care hospitals, and identified all COVID-19 patients with cerebrovascular events requiring neuro-intensive care and/or neurosurgical consultation.

RESULTS

We identified 26 patients between March 1 and May 24, 2020, of whom 12 (46%) died. The most common event was a large-vessel occlusion (LVO) in 15 patients (58%), among whom 8 died (8/15, 53%). A total of 9 LVO patients underwent mechanical thrombectomy, of whom 5 died (5/9, 56%). A total of 7 patients (27%) presented with intracranial hemorrhage. Of the remaining patients, 2 had small-vessel occlusions, 1 had cerebral venous sinus thrombosis, and another had a vertebral artery dissection. Acute Respiratory Distress Syndrome occurred in 8 patients, of whom 7 died. Mortalities had a higher D-dimer on admission (mean 20 963 ng/mL) than survivors (mean 3172 ng/mL). Admission Glasgow Coma Scale (GCS) score was poor among mortalities (median 7), whereas survivors had a favorable GCS at presentation (median 14) and at discharge (median 14).

CONCLUSION

COVID-19 may be associated with hemorrhage as well as ischemia, and prognosis appears poorer than expected—particularly among LVO cases, where outcome remained poor despite mechanical thrombectomy. However, a favorable neurological condition on admission and lower D-dimer may indicate a better outcome.

COVID-19, Large-vessel occlusion (LVO), Intracranial hemorrhage, Cerebral venous sinus thrombosis

Subject Cerebrovascular

Issue Section: Case Series

Keywords: SARS-CoV-2; COVID-19; Neurosurgery; Neurology; Stroke.

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#Encephalitic #syndrome and #anosmia in #COVID19: do these clinical presentations really reflect #SARS‐CoV‐2 #neurotropism? A theory based on the review of 25 COVID‐19 cases (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Encephalitic syndrome and anosmia in COVID‐19: do these clinical presentations really reflect SARS‐CoV‐2 neurotropism? A theory based on the review of 25 COVID‐19 cases

Lydia Pouga MD Virology PhD Neurosciences

First published: 16 July 2020 | DOI:  https://doi.org/10.1002/jmv.26309

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26309

 

Abstract

Since the discovery of COVID‐19, a disease caused by the new coronavirus SARS‐CoV‐2, the pathology showed different faces. There is an increasing number of cases described as (meningo)encephalitis although evidence often lacks. Anosmia, another atypical form of COVID‐19, has been considered as testimony of the potential of neuroinvasiveness of SARS‐CoV‐2, though this hypothesis remains highly speculative. We did a review of the cases reported as brain injury caused by SARS‐CoV‐2. Over 98 papers found, 21 were analyzed. Only four publications provided evidence of the presence of SARS‐CoV‐2 within the CNS. When facing acute neurological abnormalities during an infectious episode it is often difficult to disentangle neurological symptoms induced by the brain infection and those due to the impact of host immune response on the CNS. Cytokines release can disturb neural cells functioning and can have in the most severe cases vascular and cytotoxic effects. An inappropriate immune response can lead to the production of auto‐antibodies directed toward CNS components. In the case of proven SARS‐CoV‐2 brain invasion, the main hypothesis found in the literature focus on a neural pathway, especially the direct route via the nasal cavity, although the virus is likely to reach the CNS using other routes. Our ability to come up with hypotheses about the mechanisms by which the virus might interact with the CNS may help to keep in mind that all neurological symptoms observed during COVID‐19 do not always rely on CNS viral invasion.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; Neuroinvasion; Encephalitis; Anosmia; Neurology.

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#Clinical #neurophysiology and #CSF analysis to detect #GBS and #polyneuritis cranialis in #COVID19 patients: a case series (J Med Virol., abstract)

[Source: Journal of Medical Virology, full page: (LINK). Abstract, edited.]

Clinical neurophysiology and cerebrospinal liquor analysis to detect Guillain Barré syndrome and polyneuritis cranialis in COVID‐19 patients: a case series

Paolo Manganotti MD PhD,  Giulia Bellavita MD,  Laura D’Acunto MD,  Valentina Tommasini MD,  Martina Fabris MD,  Arianna Sartori MD,  Lucia Bonzi MD,  Alex Buoite Stella PhD,  Valentina Pesavento MD

First published: 14 July 2020 | DOI:  https://doi.org/10.1002/jmv.26289

This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/jmv.26289

 

ABSTRACT

We report a case series of 5 patients affected by SARS‐CoV‐2 who developed neurological symptoms, mainly expressing as polyradiculoneuritis and cranial polyneuritis in the two months of COVID‐19 pandemic in a city in the north east of Italy. A diagnosis of Guillain Barré syndrome was made on the basis of clinical presentation, cerebrospinal fluid analysis and electroneurography (ENG). In four of them therapeutic approach included the administration of intravenous immunoglobulin (0.4 gr/kg for 5 days), which resulted in the improvement of neurological symptoms. Clinical neurophysiology revealed the presence of conduction block, absence of F waves, and in two cases significant decrease in amplitude of compound motor action potential cMAP. Four patients presented a mild facial nerve involvement limited to the muscles of the lower face, with sparing of the forehead muscles associated to ageusia. In one patient, taste assessment showed right‐sided ageusia of the tongue, ipsilateral to the mild facial palsy. In three patients we observed albuminocytological dissociation in the cerebrospinal fluid, and notably we found an increase of inflammatory mediators such as the interleukin‐8. Peripheral nervous system involvement after infection with COVID‐19 is possible and may include several signs that may be successfully treated with immunoglobulin therapy.

This article is protected by copyright. All rights reserved.

Keywords: SARS-CoV-2; COVID-19; GBS; Neurology; Italy.

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