Peripheral neuropathy associated with SARS-CoV-2 infection

Abstract

Introduction. Coronavirus disease 2019 (COVID-19) is a contagious disease caused by SARS-CoV-2. Symptoms of COVID-19 include fever, cough, headache, fatigue, breathing difficulties, and loss of smell or taste. Neurological complications have been reported in the context of COVID19 infection both in the acute and subacute phase, as part of the post-COVID syndrome. To the best of current knowledge, observational investigations reported peripheral nervous system involvement in up to 8.9 % of people. Material and methods. Anamnesis, clinical and paraclinical data were taken from medical records in Institute of Emergency Medicine. Patients were investigated by RT-PCR, lung radiography, brain and lung computed tomography (CT), electrophysiological examen. The literature on similar cases has been studied. The exclusion criteria were: diabetes; presence of premorbid neuropathy or premorbid symptoms compatible with diagnosis of neuropathy; alcohol abuse; cancer; family history of genetic neuropathy; CPK values beyond the normal range. Purpose. Description of 9 patients with peripheral polyneuropathy, as a secondary neurological complication associated with SARS-CoV-2. Results. Peripheral nerve conduction examination was performed using a Synergy on Nicolet®EDX, by Natus Neurology. All patients had a standard battery of nerve conduction motor and sensory studies, including median, ulnar, peroneal, sural and tibial nerves on both sides, using both recording and stimulating surface electrode. Following electrical stimuli of the different nerves, motor nerve conduction was examined by recording the compound muscle action potential (CMAP) from surface electrodes overlying the muscle supplied by each motor nerve. The patients presented at different intervals after suffering the infection, evidenced by 2 negative nasopharyngeal tests with 48 hours between them and discharged from the hospital with progressive muscle weakness in the limbs, especially the involvement of the proximal muscles mainly in the lower limbs with areflexia. Electrophysiological examination were performed which confirmed the diagnosis of demyelinating polyneuropathy in 3 patients, axonal multiple mononeuropathy in 5 patients and axonal mononeuropathy in 1 patients, meeting the electrophysiological criteria 2. 5 patients received corticosteroids with marked improvement in two of them, and minimal improvement in the other three patients. The other 4 patients did not receive specific treatment. Conclusions. This case series describes a variety of unique presentations of peripheral neuropathies after mild-severe COVID-19 infection. - Neurological manifestations appear to be more frequent in patients who have developed severe disease and in the elderly. - Peripheral neuropathies in patients with COVID-19 are frequent result from immune mechanisms and neurotoxic side effects of drugs applied to treat COVID-19 and, from the compression of peripheral nerves after prolonged bedding on the ICU, but we must not exclude the neurotropism of the SARS-CoV2 virus. 3 - Management of peripheral nerve injury in COVID-19 survivors should be included in future COVID-19-specific rehabilitation programs in order to prevent long-term sequelae.