Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19
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Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID‑19 Edward Needham1,3 · Virginia Newcombe1,2 · Andrew Michell1 · Rachel Thornton1 · Andrew Grainger1 · Fahim Anwar1 · Elizabeth Warburton1,3 · David Menon1,2,3 · Monica Trivedi1 · Stephen Sawcer1,3 Received: 1 October 2020 / Revised: 2 November 2020 / Accepted: 15 November 2020 © The Author(s) 2020
Abstract The prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant intensive care unit-acquired weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow-up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to “critical illness neuromyopathy”. While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19. Keywords COVID-19 · Neuropathy · Nerve injury · Mononeuritis multiplex
Introduction and case series The respiratory manifestations of the COVID-19 pandemic have strained health-care systems around the world [1]. Thousands of patients have required prolonged periods of mechanical ventilation and many are inevitably emerging with significant “intensive care unit-acquired weakness” (ICUAW) [2, 3]. Amongst the COVID-19 survivors attending our ICU follow-up clinic we have noticed that, in addition to the anticipated symmetrical weakness related to sarcopaenia [4], a significant number of these patients also have marked focal neurological deficits related to superimposed mononeuropathies. Here we present the findings in the first 11 such patients that we have seen (Fig. 1 and * Stephen Sawcer [email protected] 1
Cambridge University Hospital NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
2
University Division of Anaesthesia, Department of Medicine, University of Cambridge, Cambridge CB2 0QQ, UK
3
Department of Clinical Neurosciences, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
Table 1), many of whom are significantly disabled by their neuropathies. All these patients had severe COVID-19 necessitating mechanical ventilation for an average of 36 days (range 16–73), five required periods of prone positioning, and one required extra-corporeal membrane oxygenation (ECMO). Eight of the 11 were men (representative of the known sex difference for severe disease), and the median age was 58 years (range 50–77). Four of
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