Intensive Care Unit-Acquired Weakness and Positioning-Related Peripheral Nerve Injuries in COVID-19: A Case Series of Three Patients and the Latest Literature Review

Hokkoku, Keiichi; Erra, Carmen; Cuccagna, Cristina; Coraci, Daniele; Gatto, Dario Mattia; Glorioso, Davide; Padua, Luca

doi:10.3390/brainsci11091177

Cited by 10 publications

(8 citation statements)

References 49 publications

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“…The frequency of non-vascular neurologic manifestations as encephalopathic, epileptic or neuromuscular disorders shows a large variability in the preexisting literature, depending on timepoint of assessment, qualification of the investigator, definitions of disorders and control for confounders. According to our data and in line with previous reports, no specific direct pathomechanism between those manifestations and COVID-19 became obvious [ 19 , 38 ]. The number of patients with positive PCR detection of the virus in CSF or brain tissue was negligible which supports previous results arguing against SARS-CoV-2-associated meningoencephalitis [ 7 , 39 , 40 ].…”

Section: Discussionsupporting

confidence: 91%

“…Several pathophysiological mechanisms have been proposed to explain neurological manifestations in COVID-19 [ 5 , 13 – 15 ]. However, as ICU patients not suffering from COVID-19 also frequently exhibit neurologic complications like encephalopathy, critical illness polyneuropathy/myopathy (CIP/CIM) or cerebrovascular disorders, the evaluation of a direct pathophysiological link between the virus and neurologic complications is challenging [ 16 – 19 ]. Furthermore, studies on neurologic manifestations of COVID-19 in- and outside the ICU are largely hampered by their retrospective design and its inherent biases, discrepancies in methodology, differences in definitions of neurologic disorders, sample size and reporting bias.…”

Section: Introductionmentioning

confidence: 99%

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Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

Dimitriadis

Meis²,

Neugebauer³

et al. 2022

Crit Care

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Background Neurologic manifestations are increasingly reported in patients with coronavirus disease 2019 (COVID-19). Yet, data on prevalence, predictors and relevance for outcome of neurological manifestations in patients requiring intensive care are scarce. We aimed to characterize prevalence, risk factors and impact on outcome of neurologic manifestations in critically ill COVID-19 patients. Methods In the prospective, multicenter, observational registry study PANDEMIC (Pooled Analysis of Neurologic DisordErs Manifesting in Intensive care of COVID-19), we enrolled COVID-19 patients with neurologic manifestations admitted to 19 German intensive care units (ICU) between April 2020 and September 2021. We performed descriptive and explorative statistical analyses. Multivariable models were used to investigate factors associated with disorder categories and their underlying diagnoses as well as to identify predictors of outcome. Results Of the 392 patients included in the analysis, 70.7% (277/392) were male and the mean age was 65.3 (SD ± 3.1) years. During the study period, a total of 2681 patients with COVID-19 were treated at the ICUs of 15 participating centers. New neurologic disorders were identified in 350 patients, reported by these centers, suggesting a prevalence of COVID-19-associated neurologic disorders of 12.7% among COVID-19 ICU patients. Encephalopathy (46.2%; 181/392), cerebrovascular (41.0%; 161/392) and neuromuscular disorders (20.4%; 80/392) were the most frequent categories identified. Out of 35 cerebrospinal fluid analyses with reverse transcriptase PCR for SARS-COV-2, only 3 were positive. In-hospital mortality was 36.0% (140/389), and functional outcome (mRS 3 to 5) of surviving patients was poor at hospital discharge in 70.9% (161/227). Intracerebral hemorrhage (OR 6.2, 95% CI 2.5–14.9, p < 0.001) and acute ischemic stroke (OR 3.9, 95% CI 1.9–8.2, p < 0.001) were the strongest predictors of poor outcome among the included patients. Conclusions Based on this well-characterized COVID-19 ICU cohort, that comprised 12.7% of all severe ill COVID-19 patients, neurologic manifestations increase mortality and morbidity. Since no reliable evidence of direct viral affection of the nervous system by COVID-19 could be found, these neurologic manifestations may for a great part be indirect para- or postinfectious sequelae of the infection or severe critical illness. Neurologic ICU complications should be actively searched for and treated.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

Dimitriadis

Meis²,

Neugebauer³

et al. 2022

Crit Care

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“…Although a significant improvement in prevalence rates of neurological diseases could not be shown, individual patients recovered, especially those with CIP/CIM, underlining the importance of neuro‐rehabilitation in severe COVID‐19 patients. Similarly, positioning‐related peripheral nerve injury was alleviated in one patient [ 39 ]. There are insufficient data of other infectious diseases to be compared to long‐term neurological deficits as described in our study.…”

Section: Discussionmentioning

confidence: 99%

Neurological outcomes 1 year after COVID‐19 diagnosis: A prospective longitudinal cohort study

Rass

Beer

Schiefecker

et al. 2022

Euro J of Neurology

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Background and purpose Neurological sequelae from coronavirus disease 2019 (COVID‐19) may persist after recovery from acute infection. Here, the aim was to describe the natural history of neurological manifestations over 1 year after COVID‐19. Methods A prospective, multicentre, longitudinal cohort study in COVID‐19 survivors was performed. At a 3‐month and 1‐year follow‐up, patients were assessed for neurological impairments by a neurological examination and a standardized test battery including the assessment of hyposmia (16‐item Sniffin' Sticks test), cognitive deficits (Montreal Cognitive Assessment < 26) and mental health (Hospital Anxiety and Depression Scale and Post‐traumatic Stress Disorder Checklist 5). Results Eighty‐one patients were evaluated 1 year after COVID‐19, out of which 76 (94%) patients completed a 3‐month and 1‐year follow‐up. Patients were 54 (47–64) years old and 59% were male. New and persistent neurological disorders were found in 15% (3 months) and 12% (10/81; 1 year). Symptoms at 1‐year follow‐up were reported by 48/81 (59%) patients, including fatigue (38%), concentration difficulties (25%), forgetfulness (25%), sleep disturbances (22%), myalgia (17%), limb weakness (17%), headache (16%), impaired sensation (16%) and hyposmia (15%). Neurological examination revealed findings in 52/81 (64%) patients without improvement over time (3 months, 61%, p = 0.230) including objective hyposmia (Sniffin' Sticks test <13; 51%). Cognitive deficits were apparent in 18%, whereas signs of depression, anxiety and post‐traumatic stress disorders were found in 6%, 29% and 10% respectively 1 year after infection. These mental and cognitive disorders had not improved after the 3‐month follow‐up (all p > 0.05). Conclusion Our data indicate that a significant patient number still suffer from neurological sequelae including neuropsychiatric symptoms 1 year after COVID‐19 calling for interdisciplinary management of these patients.

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“…Of the 54 studies, 11 studies reported on ischemic strokes and 41 studies reported on ICHs. There were two case reports on mononeuritis multiplex (10,11), one case report on brachial plexopathy (12), three case reports on critical illness myopathy or neuropathy (12)(13)(14), five studies on cerebral microbleeds (12,(15)(16)(17)(18), and one case report of posterior reversible encephalopathy syndrome (18). Lastly, there were two studies that reported venous causes for neurovascular complications (19,20) and two studies that used electroencephalogram to investigate the electrophysiologic changes of patients with COVID-19 on ECMO (21,22).…”

Section: Resultsmentioning

confidence: 99%

Neurologic Complications of Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

Deng

et al. 2023

Critical Care Explorations

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OBJECTIVES:In COVID-19 patients requiring extracorporeal membrane oxygenation (ECMO), our primary objective was to determine the frequency of intracranial hemorrhage (ICH). Secondary objectives were to estimate the frequency of ischemic stroke, to explore association between higher anticoagulation targets and ICH, and to estimate the association between neurologic complications and in-hospital mortality.

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Intensive Care Unit-Acquired Weakness and Positioning-Related Peripheral Nerve Injuries in COVID-19: A Case Series of Three Patients and the Latest Literature Review

Cited by 10 publications

References 49 publications

Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

Neurologic manifestations of COVID-19 in critically ill patients: results of the prospective multicenter registry PANDEMIC

Neurological outcomes 1 year after COVID‐19 diagnosis: A prospective longitudinal cohort study

Neurologic Complications of Patients With COVID-19 Requiring Extracorporeal Membrane Oxygenation: A Systematic Review and Meta-Analysis

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