Neuromuscular presentations in patients with COVID-19
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COVID-19
Neuromuscular presentations in patients with COVID-19 Vimal Kumar Paliwal 1
&
Ravindra Kumar Garg 2
&
Ankit Gupta 1 & Nidhi Tejan 3
Received: 7 July 2020 / Accepted: 1 September 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract 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. Keywords SARS-CoV-2 . COVID-19 . Coronavirus . Anosmia . Ageusia . Guillain-Barrè syndrome . Myositis . Rhabdomyolysis
The COVID-19 pandemic is caused by SARS-CoV-2, a member of the Coronavirinae subfamily. The coronaviruses are classified in four genera: alpha, beta, gamma, and delta coronaviruses [1]. The world has seen three large pandemics * Vimal Kumar Paliwal [email protected] Ravindra Kumar Garg [email protected] Ankit Gupta [email protected] Nidhi Tejan [email protected] 1
Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014, India
2
Department of Neurology, King George Medical University, Lucknow, UP, India
3
Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014, India
in the last 2 decades. The first pandemic originated in Guangdong, China (2002–2003) caused by SARS-CoV-1, and the second pandemic originated in Saudi Arabia (2012), caused by MERS CoV [2–4]. Both pandemics produced severe acute respiratory syndrome (SARS) in thousands of people an
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