Mixed central and peripheral nervous system disorders in severe SARS-CoV-2 infection

Chaumont, Hugo; San-Galli, Aurore; Martino, Frédéric; Couratier, C.; Joguet, Guillaume; Carlès, Michel; Roze, Emmanuel; Lannuzel, Annie

doi:10.1007/s00415-020-09986-y

Cited by 54 publications

(70 citation statements)

References 9 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In addition to GBS and MFS, we also included three reports of six patients who developed symmetrical or asymmetrical neuropathy (Table 5) [66][67][68].…”

Section: Search Resultsmentioning

confidence: 99%

“…Three reports of 6 patients with COVID-19-related neuropathy were published [66][67][68]. Authors claimed that the neuropathy in their patients was different from GBS.…”

Section: Neuropathymentioning

confidence: 99%

“…In absence of nerve conduction tests, type of neuropathy could not be determined in both cases [67]. Chaumont et al presented four patients (age range 52 to 72 years, all males), who presented with CNS symptoms along with quadriparesis after or during the weaning stage from the mechanical ventilator [68]. All patients had ARDS secondary to COVID-19 infection, and they developed neurological features after an interval of 12 to 20 days of initial COVID-19 symptoms.…”

Section: Neuropathymentioning

confidence: 99%

See 2 more Smart Citations

Neuromuscular presentations in patients with COVID-19

et al. 2020

View full text Add to dashboard Cite

COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.

show abstract

“…In addition to GBS and MFS, we also included three reports of six patients who developed symmetrical or asymmetrical neuropathy (Table 5) [66][67][68].…”

Section: Search Resultsmentioning

confidence: 99%

“…Three reports of 6 patients with COVID-19-related neuropathy were published [66][67][68]. Authors claimed that the neuropathy in their patients was different from GBS.…”

Section: Neuropathymentioning

confidence: 99%

Section: Neuropathymentioning

confidence: 99%

See 1 more Smart Citation

Neuromuscular presentations in patients with COVID-19

et al. 2020

View full text Add to dashboard Cite

show abstract

“…In this sense, in an observational study in France, over one third (15/45) of patients showed evidence of cognitive impairment at discharge from ICU, especially in the form of dysexecutive syndrome characterized by inattention, disorientation and poorly organized movements in response to commands (Helms et al, 2020). In a case series of 4 severe COVID-19 patients who required ICU admission, cognitive impairment, identified as memory deficit and frontal syndrome, was detected after discharged but remitted after 5 days of immunoglobulin therapy (Chaumont et al, 2020). Besides, in a sample of 71 COVID-19 hospitalized patients, those who were diagnosed with delirium during their hospitalization (42%) had lower cognitive scores on a telephone screening interview after 4 weeks of discharge, although the betweengroup comparison did not reach statistical significance (p = 0.06) (McLoughlin et al, 2020).…”

Section: Cognitive Manifestations Of Covid-19mentioning

confidence: 99%

“…To date there is little evidence of direct brain infection related to COVID-19. Results from reverse transcription polymerase chain reaction (RT-PCR) assays of cerebrospinal fluid (CSF) samples carried out in a few COVID-19 cases with neurological manifestations have been negative for SARS-CoV-2 (Chaumont et al, 2020;Helms et al, 2020).…”

Section: Mechanisms Involved In Cognitive and Neuropsychiatric Manifementioning

confidence: 99%

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Alonso‐Lana

Marquié

Ruiz

et al. 2020

Front. Aging Neurosci.

150

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread worldwide and has had unprecedented effects in healthcare systems, economies and society. COVID-19 clinical presentation primarily affects the respiratory system causing bilateral pneumonia, but it is increasingly being recognized as a systemic disease, with neurologic manifestations reported in patients with mild symptoms but, most frequently, in those in a severe condition. Elderly individuals are at high risk of developing severe forms of COVID-19 due to factors associated with aging and a higher prevalence of medical comorbidities and, therefore, they are more vulnerable to possible lasting neuropsychiatric and cognitive impairments. Several reports have described insomnia, depressed mood, anxiety, post-traumatic stress disorder and cognitive impairment in a proportion of patients after discharge from the hospital. The potential mechanisms underlying these symptoms are not fully understood but are probably multifactorial, involving direct neurotrophic effect of SARS-CoV-2, consequences of long intensive care unit stays, the use of mechanical ventilation and sedative drugs, brain hypoxia, systemic inflammation, secondary effects of medications used to treat COVID-19 and dysfunction of peripheral organs. Chronic diseases such as dementia are a particular concern not only because they are associated with higher rates of hospitalization and mortality but also because COVID-19 further exacerbates the vulnerability of those with cognitive impairment. In patients with dementia, COVID-19 frequently has an atypical presentation with mental status changes complicating the early identification of cases. COVID-19 has had a dramatical impact in long-term care facilities, where rates of infection and mortality have been very high. Community measures implemented to slow the spread of the virus have forced to social distancing and cancelation of cognitive stimulation programs, which may have contributed to generate loneliness, behavioral symptoms and worsening of cognition in patients with dementia. COVID-19 has impacted the functioning of Memory Clinics, research programs and clinical trials in the Alzheimer's field, triggering the

show abstract

Brain dysfunction in COVID‐19 and CAR‐T therapy: cytokine storm‐associated encephalopathy

Pensato

Muccioli

Cani

et al. 2021

Ann Clin Transl Neurol

View full text Add to dashboard Cite

Objective Many neurological manifestations are associated with COVID‐19, including a distinct form of encephalopathy related to cytokine storm, the acute systemic inflammatory syndrome present in a subgroup of COVID‐19 patients. Cytokine storm is also associated with immune effector cell‐associated neurotoxicity syndrome (ICANS), a complication of chimeric antigen receptor T‐cell (CAR‐T) therapy, a highly effective treatment for refractory hematological malignancies. We investigated whether COVID‐19‐related encephalopathy, ICANS, and other encephalopathies associated with cytokine storm, share clinical and investigative findings. Methods Narrative literature review. Results Comparisons between COVID‐19‐related encephalopathy and ICANS revealed several overlapping features. Clinically, these included dysexecutive syndrome, language disturbances, akinetic mutism and delirium. EEG showed a prevalence of frontal abnormalities. Brain MRI was often unrevealing. CSF elevated cytokine levels have been reported. A direct correlation between cytokine storm intensity and severity of neurological manifestations has been shown for both conditions. Clinical recovery occurred spontaneously or following immunotherapies in most of the patients. Similar clinical and investigative features were also reported in other encephalopathies associated with cytokine storm, such as hemophagocytic lymphohistiocytosis, sepsis, and febrile infection‐associated encephalopathies. Interpretation COVID‐19‐related encephalopathy and ICANS are characterized by a predominant electro‐clinical frontal lobe dysfunction and share several features with other encephalopathies associated with cytokine storm, which may represent the common denominator of a clinical spectrum of neurological disorders. Therefore, we propose a unifying definition of cytokine storm‐associated encephalopathy (CySE), and its diagnostic criteria.

show abstract

Mixed central and peripheral nervous system disorders in severe SARS-CoV-2 infection

Cited by 54 publications

References 9 publications

Neuromuscular presentations in patients with COVID-19

Neuromuscular presentations in patients with COVID-19

Cognitive and Neuropsychiatric Manifestations of COVID-19 and Effects on Elderly Individuals With Dementia

Brain dysfunction in COVID‐19 and CAR‐T therapy: cytokine storm‐associated encephalopathy

Contact Info

Product

Resources

About