Brachial plexopathy as a complication of COVID-19

Han, Catherine Y.; Tarr, Andrew M; Gewirtz, Alexandra N.; Kaunzner, Ulrike W.; Roy-Burman, Paula; Cutler, Todd; MacGowan, Daniel

doi:10.1136/bcr-2020-237459

Cited by 17 publications

(16 citation statements)

References 33 publications

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“…Very few case reports/series have been published in the literature describing PTS as a sequelae of COVID-19 infection or vaccination (Table 2 ) [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 , 18 , 19 , 20 ]. In 5 of these articles, patients had contracted COVID-19, after which they developed shoulder and/or arm pain followed subsequently by arm/hand paresthesia and weakness [ 2 , 7 , 9 , 11 , 12 ]. Five case reports/series featured similar presenting symptoms after receiving the COVID-19 vaccine [ 3 , 10 , 18 , 19 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

“…The safety profile of this vaccine specified short-term, mild-to-moderate pain at the injection site, fatigue, and headaches. Numerous short- and long-term side effects of the peripheral nervous system from the COVID-19 infection have been reported, including nerve pain and skeletal muscle injury, Guillain-Barrė syndrome, Bell's palsy, tinnitus, cranial polyneuritis, neuro-ophthalmological disorders, neurosensory hearing loss, neuromuscular junction disorders, and dysautonomia [ 7 ]. Rare cases of PTS following COVID-19 infection or vaccination have been described [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…Numerous short- and long-term side effects of the peripheral nervous system from the COVID-19 infection have been reported, including nerve pain and skeletal muscle injury, Guillain-Barrė syndrome, Bell's palsy, tinnitus, cranial polyneuritis, neuro-ophthalmological disorders, neurosensory hearing loss, neuromuscular junction disorders, and dysautonomia [ 7 ]. Rare cases of PTS following COVID-19 infection or vaccination have been described [ 2 , 3 , 7 , 8 , 9 , 10 , 11 , 12 ]. It has been suggested that peripheral nervous system abnormalities may be attributed to dysregulation of the systemic immune response due to COVID-19 [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Parsonage-Turner Syndrome Following COVID-19 Vaccination: Clinical and Electromyographic Findings in 6 Patients

Shields

Iyer²,

Burger

et al. 2022

Case Rep Neurol

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Parsonage-Turner syndrome (PTS) following COVID-19 infection or vaccination is rare. The pathophysiology may involve an immune-mediated inflammatory reaction against brachial plexus nerve fibers in a genetically predisposed individual. We describe the clinical and electromyographic features of 6 patients presenting with the clinical picture of PTS following COVID-19 vaccination. All patients were referred for electromyographic studies to evaluate the acute onset of pain in the shoulder girdle/upper limb accompanied by muscle weakness in the distribution of one or more branches of the brachial plexus. Each patient had received the COVID-19 vaccine within a few weeks prior to the onset of symptoms. Patients underwent detailed neurological examinations followed by nerve conduction and EMG studies. The patients developed symptoms after a mean duration of 17 days (5 days–8 weeks) after receiving the COVID-19 vaccine. The initial symptom was pain in the shoulder girdle/upper limb, followed within days by muscle weakness. Physical examinations and EMG studies showed upper trunk brachial plexopathy in 2 patients, lower trunk plexopathy in 1 patient, posterior cord brachial plexopathy in 1 patient, and anterior/posterior interosseous nerve involvement in 2 patients. All patients either improved or attained complete resolution of the arm pain at follow-up. Three (50%) patients did not have any improvement in the arm/hand weakness, while 3 (50%) patients had some recovery in strength. PTS may occur after the COVID-19 vaccine and should be suspected in patients with symptoms and signs suggestive of acute brachial plexopathy. Studies of a larger series may provide insight into predisposing factors.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Parsonage-Turner Syndrome Following COVID-19 Vaccination: Clinical and Electromyographic Findings in 6 Patients

Shields

Iyer²,

Burger

et al. 2022

Case Rep Neurol

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“…Vasculitis 13 and the hypercoagulable state seen in COVID-19 14 leading to thrombosis within the vasa nervorum and resulting in peripheral neuropathy have been described. Proposed mechanisms relate to immune dysregulation, complement activation, clotting pathway activation or viral dissemination with direct systemic endothelial infection.…”

Section: Differential Diagnosismentioning

confidence: 99%

Polyneuropathy following COVID-19 infection: the rehabilitation approach

Saif

Pick²

2021

BMJ Case Rep

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A range of neurological manifestations associated with COVID-19 have been reported in the literature, but the pathogenesis of these have yet to be fully explained. The majority of cases of peripheral nervous system disease published thus far have shown a symmetrical pattern. In contrast, we describe the case of a patient with asymmetrical predominantly upper-limb sensorimotor polyneuropathy following COVID-19 infection, likely due to a multifactorial pathological process involving critical illness neuropathy, mechanical injury and inflammatory disease. His presentation, management and recovery contribute to the understanding of this complex condition and informs rehabilitation approaches.

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“…Previously published reports demonstrate that the condition can be triggered by surgery, infection, autoimmune diseases, strenuous exercise, trauma, radiation, and vaccination. Recently, brachial neuritis has been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as well [ 3 , 4 ]. Diagnosis is made based on the clinical history, physical examination, and electroneuromyography.…”

Section: Introductionmentioning

confidence: 99%

Parsonage–Turner syndrome following coronavirus disease 2019 immunization with ChAdOx1-S vaccine: a case report and review of the literature

et al. 2021

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Background Parsonage–Turner syndrome is an acute peripheral neuropathy that affects the upper brachial plexus region. Previously published reports demonstrate that the condition can be triggered by surgery, infection, autoimmune diseases, strenuous exercise, trauma, radiation, and vaccination. Parsonage–Turner syndrome has already been reported in three other patients who were vaccinated against coronavirus disease 2019. Case presentation We report the case of a 51-year-old Caucasian man without comorbidities who received the first dose of the ChAdOx1-S recombinant vaccine (Vaxzevria, AstraZeneca, Oxford, UK) against coronavirus disease 2019 and was diagnosed with Parsonage–Turner syndrome. A few days after getting vaccinated, the patient reported a progressive increase in pain in the region of vaccine administration. One month later, the shoulder pain was followed by symptoms of hypoesthesia and muscle weakness on abduction and elevation of the left upper limb. Neurological examination revealed an atrophy of the proximal muscles of the left upper limb, accompanied by paresis of the left deltoid, biceps brachii, triceps brachii, and infraspinatus muscles. Electroneuromyography carried out 3 months after the onset of symptoms showed signs consistent with brachial plexus neuritis. The adverse reaction has been properly reported to the Italian Pharmacovigilance System (Italian Medicines Agency—Agenzia Italiana del Farmaco. Conclusion The increased awareness of such association is essential for early identification and diagnosis and, thus, better clinical outcomes.

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Brachial plexopathy as a complication of COVID-19

Cited by 17 publications

References 33 publications

Parsonage-Turner Syndrome Following COVID-19 Vaccination: Clinical and Electromyographic Findings in 6 Patients

Parsonage-Turner Syndrome Following COVID-19 Vaccination: Clinical and Electromyographic Findings in 6 Patients

Polyneuropathy following COVID-19 infection: the rehabilitation approach

Parsonage–Turner syndrome following coronavirus disease 2019 immunization with ChAdOx1-S vaccine: a case report and review of the literature

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