Diaphragmatic myoclonus due to SARS-CoV-2 infection
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COVID-19
Diaphragmatic myoclonus due to SARS-CoV-2 infection Barbara Borroni 1,2 & Stefano Gazzina 1 & Fedele Dono 3 & Valentina Mazzoleni 1 & Paolo Liberini 1 & Claudia Carrarini 3 & Mirella Russo 3 & Michela Pontolillo 4 & Jacopo Vecchiet 4 & M. Onofrj 3 & Laura Bonanni 3 Received: 12 July 2020 / Accepted: 24 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract A wide range of neurological signs and symptoms have been associated with SARS-CoV-2 infection. In the present report, we described two Italian patients diagnosed with diaphragmatic myoclonus after COVID-19. In both cases, mild lymphocytosis at cerebrospinal fluid analysis and no structural brain changes were reported. The pathophysiological origin of the myoclonus in the two cases was different. In case 1, electroencephalogram did not reveal any cortical correlates and brain imaging of the spine was unremarkable, while in case 2, cortical origin of myoclonus was demonstrated. With the present two cases, we confirm and extend the neurological manifestations of SARS-CoV-2 infection. Keywords Myoclonus . Diaphragmatic . SARS-CoV-2 . COVID-19 . Neurology
Introduction The 2019 new coronavirus (SARS-CoV-2) is a respiratory virus which has become increasingly prevalent worldwide, reaching a pandemic stage on March 2020 according to WHO, with more than 6 million people affected at 1st June, according to WHO data. The clinical manifestations of SARS-CoV-2 include fever, dry cough, fatigue, headache, gastrointestinal discomfort, dyspnea, muscle ache, and a severe pneumonia causing respiratory distress [1]. Neurological signs in patients with SARS-CoV-2 have been widely reported, suggesting a neuroinvasive nature of virus [2, 3]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10072-020-04766-y) contains supplementary material, which is available to authorized users. * Barbara Borroni [email protected] 1
Neurology, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
2
Clinica Neurologica, Università degli Studi di Brescia, P.le Spedali Civili 1, 25123 Brescia, Italy
3
Department of Neuroscience, Imaging and Clinical Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
4
Department of Medicine and Aging Sciences, University G. d’Annunzio of Chieti-Pescara, Chieti, Italy
With the present observation, we report two cases of diaphragmatic myoclonus as neurological subacute manifestation of SARS-CoV-2 infection. Case 1 A 54-year-old woman with SARS-CoV-2 presented on March 16, 2020, to the emergency room in Brescia, one of the epicenter of SARS-CoV-2 infection in Italy [4], with fever, dry cough, and dyspnea. Thoracic ultrasound was consistent with the suspicion of viral pneumonia, but the nasopharyngeal swab resulted negative. The initial treatment was supportive, and azithromycin was added as empirical therapy. However, in the following 2 weeks, fever and dry cough persisted and she started complaining episodic chest pain, associated with in
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