Mixed central and peripheral nervous system disorders in severe SARS-CoV-2 infection
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LETTER TO THE EDITORS
Mixed central and peripheral nervous system disorders in severe SARS‑CoV‑2 infection H. Chaumont1,2,3 · A. San‑Galli1 · F. Martino2,4 · C. Couratier1 · G. Joguet5 · M. Carles2,4 · E. Roze3,6 · A. Lannuzel1,2,3,7 Received: 3 June 2020 / Revised: 5 June 2020 / Accepted: 8 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Sirs, We report four cases of severe COVID-19 in male patients aged 50–70 with the combination of central and peripheral nervous system disorders occurring unexpectedly late after the first symptoms. Patients had comorbidities and were admitted for acute respiratory distress syndrome due to a proven SARS-CoV-2 infection. All required mechanical ventilation, among whom one needed an extracorporeal membrane oxygenation support. Several acute neurological syndromes have been associated with SARS-CoV-2 infection, including anosmia and ageusia [1, 2], meningoencephalitis [3, 4], acute hemorrhagic necrotizing encephalopathy [5], axonal or demyelinating polyradiculoneuropathy [6–8], polyneuritis cranialis Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00415-020-09986-y) contains supplementary material, which is available to authorized users. * H. Chaumont hugo.chaumont@chu‑guadeloupe.fr 1
Centre Hospitalier Universitaire de la Guadeloupe, Service de Neurologie, 97139 Pointe‑à‑Pitre/Abymes, France
2
Faculté de Médecine, Université Des Antilles, Pointe‑à‑Pitre, France
3
Institut National de La Santé Et de La Recherche Médicale, CNRS, Unité Mixte de Recherche (UMR) 7225, Institut du Cerveau Et de La Moelle épinière, ICM, Faculté de Médecine de Sorbonne Université, U 1127, Paris, France
4
Centre Hospitalier Universitaire de La Guadeloupe, Service de Réanimation, Pointe‑à‑Pitre/Abymes, France
5
Laboratoire de Biologie de La Reproduction, Centre Hospitalier Universitaire de La Guadeloupe, Pointe‑à‑Pitre/Abymes, France
6
AP‑HP, Hôpital de La Pitié‑Salpêtrière, Département de Neurologie, Paris, France
7
Centre D’investigation Clinique Antilles Guyane, Inserm CIC 1424, Pointe‑à‑Pitre, France
[8]. Like in most of the viral infections that involve nervous system, these manifestations occurred within the first ten days after infectious symptoms. Further away from the onset of the disease, when sedation and neuromuscular blocker were withheld, 67% of the patients with severe COVID-19 develop encephalopathy including prominent agitation, confusion and corticospinal tract signs [9]. In our cases neurological manifestations were detected after mechanical ventilation weaning and extubation (Fig. 1). They consisted of miscellaneous symptoms such as confusion, cognitive dysfunction (memory deficit, frontal syndrome), psychiatric disorders (paranoid delusion, hallucinations), weakness, pyramidal signs, dysautonomia, swallowing dysfunction, vertical supranuclear eye palsy, upper limbs myoclonus, fasciculation and focal muscle atrophy (Table 1). To note, before admission to intensive care unit, pat
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