Six years before the present study we performed a retrospective study of 114 subjects presenting with asymptomatic / oligosymptomatic hyperckemia (raised creatine kinase blood levels), a diagnosis being made in 21 of them. We now present the results of a long-term follow-up in 55 of the still undiagnosed 93 individuals. Most of them have remained asymptomatic and did not develop specific neuromuscular disorders. One subject became frankly symptomatic manifesting limb-girdle weakness. A diagnosis of dystrophinopathy carrier and one of possible type I SMA carrier were indirectly made in another two subjects. Almost all subjects still have hyperckemia, though the mean creatine kinase (CK) value is lower than before. CK levels have become normal in 12 subjects. Two died of neoplasia, and six developed non-neuromuscular disorders. We noted no follow-up differences in terms of CK modifications between subjects with pathological EMG and/or muscle biopsy findings and those with normal findings at first examination.

Objective To estimate the incidence and describe clinical characteristics and outcome of GBS in COVID-19 patients (COVID19-GBS) in one of the most hit regions during the first pandemic wave, Lombardia. Methods Adult patients admitted to 20 Neurological Units between 1/3–30/4/2020 with COVID19-GBS were included as part of a multi-center study organized by the Italian society of Hospital Neuroscience (SNO). Results Thirty-eight COVID19-GBS patients had a mean age of 60.7 years and male frequency of 86.8%. CSF albuminocytological dissociation was detected in 71.4%, and PCR for SARS-CoV-2 was negative in 19 tested patients. Based on neurophysiology, 81.8% of patients had a diagnosis of AIDP, 12.1% of AMSAN, and 6.1% of AMAN. The course was favorable in 76.3% of patients, stable in 10.5%, while 13.2% worsened, of which 3 died. The estimated occurrence rate in Lombardia ranges from 0.5 to 0.05 GBS cases per 1000 COVID-19 infections depending on whether you consider positive cases or estimated seropositive cases. When we compared GBS cases with the pre-pandemic period, we found a reduction of cases from 165 to 135 cases in the 2-month study period in Lombardia. Conclusions We detected an increased incidence of GBS in COVID-19 patients which can reflect a higher risk of GBS in COVID-19 patients and a reduction of GBS events during the pandemic period possibly due to a lower spread of more common respiratory infectious diseases determined by an increased use of preventive measures.

Background and aimsThe COVID 19 pandemic is impacting on acute ischemic stroke (AIS) care: fewer patients reach the hospital within the therapeutic time-window. We aim at describing and quantifying this impact in terms of number of stroke hospital admissions and treatments across the Tuscany Stroke Network (TSN) in 2020. MethodsThe TSN was implemented in 2015 and it is structured as three hub-and-spoke systems throughout Tuscany. We retrospectively included all AIS patients admitted and those treated in each of the 22 TSN hospitals during 2020, using the 2019 as a comparator. ResultsFrom January 1 through December 312,020, a total of 1388 treatments were administered to AIS patients, being 1536 during the same period of 2019. Compared with 2019, AIS hospital admissions in 2020 decreased by 11.7% while reperfusion treatments only by 9.5%. In particular, thrombolysis decreased by 10% but endovascular tratments increased by 11.7%. Single month as well as single hospital performances varied a lot. ConclusionsDuring 2020, secondary to stay-at-home orders and possibly patients wanting to avoid healthcare facilities, stroke volumes decreased significantly across Tuscany. In addition, many patients reached hospitals beyond thrombolysis therapeutic window and were transferred to the hub for endovascular treatment. The logistic interventions provided by the TSN counterbalanced the deleterious effects of the COVID 19 outbreak on AIS care. Our data suggest both the need and the benefit of organized stroke systems. Only a wellestablished hospital network can adjust its organization and logistics to quickly and effectively deal with an unexpected health problem.

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