A Case Report of Acute Motor and Sensory Polyneuropathy as the Presenting Symptom of SARS-CoV-2

Kopscik, Michael R; Giourgas, Barbra K.; Presley, Bradley C.

doi:10.5811/cpcem.2020.6.48683

Cited by 20 publications

(30 citation statements)

References 6 publications

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“…Other symptoms included abdominal pain, anorexia, arthralgia, chest pain, sore throat, low back pain, and sinus congestion, with one case for each. Three cases were asymptomatic for COVID-19 and presented with neurological symptoms [ 9 , 24 , 31 ]. Of the five cases that did not describe specific COVID-19 symptoms, three had respiratory symptoms or SARS-CoV-2 pneumonia without further details [ 16 , 28 , 32 ] and two were admitted to the intensive care unit (ICU) for mechanical ventilation without further details [ 18 ].…”

Section: Resultsmentioning

confidence: 99%

“…There were 33 cases of ataxia [ 9 – 16 , 24 – 40 ], including our case report, with a mean age of 56.9 ± 14.6 (SD) years and a median age of 58.5 years (IQR 47.75–71.25). Three cases were asymptomatic for COVID-19 and presented with ataxia and other neurological symptoms [ 9 , 24 , 31 ]. Other cases either developed ataxia concurrently with or after COVID-19 symptoms.…”

Section: Resultsmentioning

confidence: 99%

“…Generally, GBS is post-infectious and thought to be caused by molecular mimicry between infectious and nervous system antigens [ 61 ]. Specifically, Miller Fisher syndrome has a strong association with anti-ganglioside Q1b (anti-GQ1b) antibodies [ 60 , 61 ], which were found in two cases of ataxia associated with COVID-19 [ 31 , 34 ]. Miller Fisher syndrome and GBS associated with COVID-19 indicate that molecular mimicry between SARS-CoV-2 and the nervous system may play a role in pathogenesis.…”

Section: Discussionmentioning

confidence: 99%

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Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

2021

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Background Since the beginning of the coronavirus disease 2019 (COVID-19) pandemic in December 2019, neurological manifestations have been recognized as potential complications. Relatively rare movement disorders associated with COVID-19 are increasingly reported in case reports or case series. Here, we present a case and systematic review of myoclonus and cerebellar ataxia associated with COVID-19. Methods A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline using the PubMed and Ovid MEDLINE databases, from November 1, 2019 to December 6, 2020. Results 51 cases of myoclonus or ataxia associated with COVID-19, including our case, were identified from 32 publications. The mean age was 59.6 years, ranging from 26 to 88 years, and 21.6% were female. Myoclonus was multifocal or generalized and had an acute onset, usually within 1 month of COVID-19 symptoms. Myoclonus occurred in isolation (46.7%), or with ataxia (40.0%) or cognitive changes (30.0%). Most cases improved within 2 months, and treatment included anti-epileptic medications or immunotherapy. Ataxia had an acute onset, usually within 1 month of COVID-19 symptoms, but could be an initial symptom. Concurrent neurological symptoms included cognitive changes (45.5%), myoclonus (36.4%), or a Miller Fisher syndrome variant (21.2%). Most cases improved within 2 months, either spontaneously or with immunotherapy. Conclusions This systematic review highlights myoclonus and ataxia as rare and treatable post-infectious or para-infectious, immune-mediated phenomena associated with COVID-19. The natural history is unknown and future investigation is needed to further characterize these movement disorders and COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s00415-021-10458-0.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

2021

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“…Furthermore, polyneuropathies including Guillain–Barré syndrome, Miller Fisher syndrome and polyneuritis cranialis have also been reported in infected SARS-CoV-2 patients. 11–14 Two patients experienced symptoms of Guillain–Barré syndrome as the initial presentation of SARS-CoV-2, and had documented fever 7 days later. 5…”

Section: Discussionmentioning

confidence: 99%

A rise in facial nerve palsies during the coronavirus disease 2019 pandemic

2020

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Objective An increase in spontaneous lower motor neuron facial nerve (VIIth cranial nerve) palsies was seen during the severe acute respiratory syndrome coronavirus 2 outbreak in our emergency clinic. This led us to perform a single-centre cohort review. Methods A retrospective review was conducted of VIIth cranial nerve palsies from January to June 2020 and the findings were compared to those cases reviewed in the previous year. The severe acute respiratory syndrome coronavirus 2 incidence of the cohort was compared with that of the Liverpool population. Results Our VIIth cranial nerve palsy incidence in the 2020 period was 3.5 per cent (30 out of 852), 2.7 higher than last year's rate of 1.3 per cent (14 out of 1081), which was a statistically significant difference (p < 0.01). Two of the 17 patients in our cohort tested positive for severe acute respiratory syndrome coronavirus 2 (11.8 per cent), contrasting with Liverpool's severe acute respiratory syndrome coronavirus 2 incidence (0.5 per cent). Conclusion Severe acute respiratory syndrome coronavirus 2 may be responsible for an increased number of facial nerve palsies; it is important for clinicians to be aware that this may being an initial presentation of the disease.

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“…seizures in < 2% of patients and ataxia in < 1% of patients [2,3]. Cases with ataxia included acute cerebellar ataxia (2 cases during COVID-19, 1 case without typical COVID-19 symptoms) [5][6][7], acute cerebellar ataxia and myoclonus (1 case during COVID-19 and 8 cases after COVID-19) [8][9][10][11][12][13], opsoclonus myoclonus ataxia syndrome (2 cases during COVID-19 and 6 cases after COVID-19) [12][13][14][15][16][17], ataxia caused by Miller Fisher syndrome (8 cases during COVID-19 and 1 cases after COVID-19) [18][19][20][21] and ataxia associated with encephalopathy (8 cases during COVID-19) [22][23][24][25][26]. Here, we describe a case of a subacute cerebellar ataxia without myoclonus, opsoclonus, oculomotor deficits, sensory deficits or areflexia after recovery from SARS-CoV-2 infection of the upper airways.…”

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confidence: 99%

Subacute cerebellar ataxia following respiratory symptoms of COVID-19: a case report

et al. 2021

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Background Severe acute respiratory syndrome virus 2 (SARS-CoV-2) is spreading globally and causes most frequently fever and respiratory symptoms, i.e. Coronavirus disease 2019 (COVID-19), however, distinct neurological syndromes associated with SARS-CoV-2 infection have been described. Among SARS-CoV-2-infections-associated neurological symptoms fatigue, headache, dizziness, impaired consciousness and anosmia/ageusia are most frequent, but less frequent neurological deficits such as seizures, Guillain-Barré syndrome or ataxia may also occur. Case presentation Herein we present a case of a 62-year-old man who developed a subacute cerebellar syndrome with limb-, truncal- and gait ataxia and scanning speech 1 day after clinical resolution of symptomatic SARS-CoV-2 infection of the upper airways. Apart from ataxia, there were no signs indicative of opsoclonus myoclonus ataxia syndrome or Miller Fisher syndrome. Cerebral magnetic resonance imaging showed mild cerebellar atrophy. SARS-CoV-2 infection of the cerebellum was excluded by normal cerebrospinal fluid cell counts and, most importantly, absence of SARS-CoV-2 RNA or intrathecal SARS-CoV-2-specific antibody production. Other causes of ataxia such as other viral infections, other autoimmune and/or paraneoplastic diseases or intoxication were ruled out. The neurological deficits improved rapidly after high-dose methylprednisolone therapy. Conclusions The laboratory and clinical findings as well as the marked improvement after high-dose methylprednisolone therapy suggest a post-infectious, immune-mediated cause of ataxia. This report should make clinicians aware to consider SARS-CoV-2 infection as a potential cause of post-infectious neurological deficits with an atypical clinical presentation and to consider high-dose corticosteroid treatment in case that a post-infectious immune-mediated mechanism is assumed.

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A Case Report of Acute Motor and Sensory Polyneuropathy as the Presenting Symptom of SARS-CoV-2

Cited by 20 publications

References 6 publications

Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

A rise in facial nerve palsies during the coronavirus disease 2019 pandemic

Subacute cerebellar ataxia following respiratory symptoms of COVID-19: a case report

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