COVID-19-associated polyneuritis cranialis

Jump to navigation Jump to search

WikiDoc Resources for COVID-19-associated polyneuritis cranialis

Articles

Most recent articles on COVID-19-associated polyneuritis cranialis

Most cited articles on COVID-19-associated polyneuritis cranialis

Review articles on COVID-19-associated polyneuritis cranialis

Articles on COVID-19-associated polyneuritis cranialis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated polyneuritis cranialis

Images of COVID-19-associated polyneuritis cranialis

Photos of COVID-19-associated polyneuritis cranialis

Podcasts & MP3s on COVID-19-associated polyneuritis cranialis

Videos on COVID-19-associated polyneuritis cranialis

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated polyneuritis cranialis

Bandolier on COVID-19-associated polyneuritis cranialis

TRIP on COVID-19-associated polyneuritis cranialis

Clinical Trials

Ongoing Trials on COVID-19-associated polyneuritis cranialis at Clinical Trials.gov

Trial results on COVID-19-associated polyneuritis cranialis

Clinical Trials on COVID-19-associated polyneuritis cranialis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated polyneuritis cranialis

NICE Guidance on COVID-19-associated polyneuritis cranialis

NHS PRODIGY Guidance

FDA on COVID-19-associated polyneuritis cranialis

CDC on COVID-19-associated polyneuritis cranialis

Books

Books on COVID-19-associated polyneuritis cranialis

News

COVID-19-associated polyneuritis cranialis in the news

Be alerted to news on COVID-19-associated polyneuritis cranialis

News trends on COVID-19-associated polyneuritis cranialis

Commentary

Blogs on COVID-19-associated polyneuritis cranialis

Definitions

Definitions of COVID-19-associated polyneuritis cranialis

Patient Resources / Community

Patient resources on COVID-19-associated polyneuritis cranialis

Discussion groups on COVID-19-associated polyneuritis cranialis

Patient Handouts on COVID-19-associated polyneuritis cranialis

Directions to Hospitals Treating COVID-19-associated polyneuritis cranialis

Risk calculators and risk factors for COVID-19-associated polyneuritis cranialis

Healthcare Provider Resources

Symptoms of COVID-19-associated polyneuritis cranialis

Causes & Risk Factors for COVID-19-associated polyneuritis cranialis

Diagnostic studies for COVID-19-associated polyneuritis cranialis

Treatment of COVID-19-associated polyneuritis cranialis

Continuing Medical Education (CME)

CME Programs on COVID-19-associated polyneuritis cranialis

International

COVID-19-associated polyneuritis cranialis en Espanol

COVID-19-associated polyneuritis cranialis en Francais

Business

COVID-19-associated polyneuritis cranialis in the Marketplace

Patents on COVID-19-associated polyneuritis cranialis

Experimental / Informatics

List of terms related to COVID-19-associated polyneuritis cranialis

For COVID-19 frequently asked outpatient questions, click here
For COVID-19 frequently asked inpatient questions, click here

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]

Synonyms and keywords: covid19 associated polyneuritis cranialis, SARS Cov2 associated polyneuritis cranialis, nCOV associated polyneuritis cranialis, coronavirus linked polyneuritis cranialis, covid linked polyneuritis cranialis, polyneuritis cranialis and coronavirus, polyneuritis cranialis and covid19, COVID-19 linked PNC.

Overview

Polyneuritis cranialis (PNC) literally means inflammation of the cranial nerves. It is a rare neurological disorder characterized by multiple cranial nerve palsies sparing the spinal cord. The disease is a Guillain-Barré syndrome-Miller Fisher syndrome interface. SARS-CoV-2 virus which causes COVID-19 is emerging as a neurotropic virus. The pathogenesis of polyneuritis cranials is characterized by the demyelination of lower cranial nerves. COVID-19-associated PNC must be differentiated from other diseases that cause bulbar weakness, facial weakness, and ophthalmoparesis. The diagnosis of PNC is clinical and confirmed by Nerve Conduction Studies (NCS). There is only one case of COVID-19 associated PNC reported so far (first six months of the COVID-19 pandemic). Fixation nystagmus, bilateral abducens palsy, impaired visual acuity, gaze palsy and loss of deep tendon reflexes has been observed with no gait pathology. Treatment with acetaminophen caused complete recovery within 2 weeks. As the disease is believed to be an immune response to COVID-19 infection, the prevention of COVID-19 itself is the most promising primary prevention strategy.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating COVID-19-associated polyneuritis cranialis from other Diseases

  • For further information about the differential diagnosis, click here.
  • To view the differential diagnosis of COVID-19, click here.

Epidemiology and Demographics

Incidence

  • Till date (July 25th, 2020) as the first six months of the COVID-19 pandemic pass, a single case report of COVID-19 associated PNC narrates the rarity of the disease.[17]

Age

  • The only case of COVID-19 associated PNC was reported in a 39-year-old patient.[5]
  • In general the age of patients reported of having PNC due to other reasons ranges from 10 - 40 years.[6][18][19]

Race

  • The only case of COVID-19 associated PNC was reported from Madrid, Spain. The race of the patient has not been mentioned clearly in the report.[5]
  • Having a single case reported to date makes it difficult to comment on the racial predilection.

Gender

  • The only case of COVID-19 associated PNC was reported in a male.[5]
  • Data regarding gender distribution for PNC, in general, is not available. Most of the cases of PNC that have been reported clearly show a predilection for male gender.[6][18][19]

Risk Factors

  • In general more severe patients are likely to have neurologic symptoms.[3]
  • There are no established risk factors for COVID-19-associated polyneuritis cranials (PNC).

Screening

  • Currently, there are no recommended guidelines for the routine screening for COVID-19-associated polyneuritis cranials or COVID-19. Some countries use temperature monitoring as a screening tool. Certain companies have launched the Screening Tool but there are no formal guidelines. Click here for more information on COVID-19 screening. [20]

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

  • The diagnosis of GBS and MFS is confirmed by Nerve conduction studies (NCS).
  • A decreased amplitude shows nerve conduction pathology.
  • Although other reports mention decreased nerve conduction in PNC patients, COVID-19 associated PNC report did not show NCS studies. The report considers not having done NCS due to the pandemic, a limitation.[5][1]

History and Symptoms

Common Symptoms

Less Common Symptoms

Physical Examination

Neuromuscular exam

Laboratory Findings

  • A positive qualitative real-time oropharyngeal swab RT PCR COVID-19 test confirmed COVID-19 infection in the COVID-19 associated PNC case.[5]
  • The cerebrospinal fluid (CSF) examination of COVID-19 associated PNC case revealed:[5][22]
    1. Opening pressure was normal (normal range 8-15 mm Hg).
    2. WBC count was reported normal with all monocytes (normal range 0 - 5 WBCs all monocytes).
    3. CSF protein was a little high i.e, 62 mg/dl (normal range 15 to 60 mg/dl). CSF protein can also be normal.[15][16] A high CSF protein and normal cell counts can be described as albumino-cytologic dissociation and is seen in 67% PNC cases.[6][1]
    4. CSF glucose was normal (normal range 50-80 mg/dl). CSF glucose is normal in PNC cases.
    5. CSF cytology was normal. Cytology is normal in PNC cases.
    6. CSF cultures and serology were sterile and negative respectively as occurs in other PNC cases.
    7. CSF RT PCR for COVID-19 was found negative in the patient.
  • Anti-ganglioside GM-1 IgM and IgG antibody levels ( antiganglioside GQ1b and GD1b) should be checked.[5] The COVID-19 associated PNC patient reported could not get the planned laboratory tests done due to hospital saturation.
  • CBC and differential, ESR, CRP, BMP, cardiac enzymes were all normal expect leukopenia was observed.[16]
  • Serum electrolytes: Retrospective studies from Italy and China demonstrated an assocition between hypokalemia, hypomagnesemia and COVID-19 due to degradation of ACE 2 loss, diuretic and corticosteroid use. Hypokalemia may lead to life-threatening arrhythmias. Close monitoring of serum electrolyte levels is essential specially in ICU patients.[23][24]

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

Axial postcontrast T1 weighted MRI sequence, with yellow arrow showing contrast enhancement of CN VI - Case courtesy of Dr Bruno Di Muzio, Radiopaedia.org, rID: 37607
  • There are no CT scan findings associated with COVID-19-associated polyneuritis cranialis.[5]
  • Chest CT scan may be helpful in suggesting other organ involvement in the COVID-19 which is a multi-organ disease.
  • The CT scan findings in COVID-19 can be viewed by clicking here.

MRI

  • There are no MRI findings reported in COVID-19-associated polyneuritis cranialis but the writer consider it a limitation to the study.[6]
  • MRI in such neuropathies demonstrates nerve enhancement.[25][26] The MRI shown is not a case of COVID-19 related PNC but is to give an example of nerve enhancement.
  • MRI may be helpful in suggesting other organ involvement in the COVID-19 which is a multi-organ disease.
  • The MRI findings in COVID-19 can be viewed by clicking here.

Other Imaging Findings

There are no other imaging findings associated with COVID-19-associated polyneuritis cranialis.

Other Diagnostic Studies

There diagnostic studies associated with COVID-19-associated polyneuritis cranialis (PNC) that can help in the diagnosis include:

Treatment

Medical Therapy

Surgery

  • Surgical intervention is not recommended for the management of COVID-19-associated polyneuritis cranialis.

Primary Prevention

  • As the disease is believed to be an immune response to COVID-19 infection, the prevention of COVID-19 itself is the most promising primary prevention strategy.
  • There have been rigorous efforts in order to develop a vaccine for novel coronavirus and several vaccines are in the later phases of trials.[30]
  • The only prevention for COVID-19 associated PNC is the prevention and early diagnosis of COVID-19 infection itself. According to the CDC, the measures include:[31]
    • Frequent hand-washing with soap and water for at least 20 seconds or using a alcohol based hand sanitizer with at least 60% alcohol. Alcohol here refers to ethanol, not methanol/ wood alcohol, as FDA warns against the use of methanol containing hand-wash.[32]
    • Staying at least 6 feet (about 2 arms’ length) from other people who do not live with you.
    • Covering your mouth and nose with a cloth face cover when around others and covering sneezes and coughs.
    • Cleaning and disinfecting.

Secondary Prevention

  • Contact tracing helps reduce the spread of the disease.[33]

References

  1. 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 Wakerley, Benjamin R.; Yuki, Nobuhiro (2015). "Polyneuritis cranialis—subtype of Guillain–Barré syndrome?". Nature Reviews Neurology. 11 (11): 664–664. doi:10.1038/nrneurol.2015.115. ISSN 1759-4758.
  2. "WHO Timeline - COVID-19".
  3. 3.0 3.1 Mao, Ling; Wang, Mengdie; Chen, Shanghai; He, Quanwei; Chang, Jiang; Hong, Candong; Zhou, Yifan; Wang, David; Li, Yanan; Jin, Huijuan; Hu, Bo (2020). doi:10.1101/2020.02.22.20026500. Missing or empty |title= (help)
  4. "WHO Director-General's opening remarks at the media briefing on COVID-19 - 11 March 2020".
  5. 5.00 5.01 5.02 5.03 5.04 5.05 5.06 5.07 5.08 5.09 5.10 5.11 5.12 5.13 5.14 5.15 5.16 5.17 5.18 5.19 5.20 5.21 5.22 5.23 5.24 5.25 Gutiérrez-Ortiz, Consuelo; Méndez, Antonio; Rodrigo-Rey, Sara; San Pedro-Murillo, Eduardo; Bermejo-Guerrero, Laura; Gordo-Mañas, Ricardo; de Aragón-Gómez, Fernando; Benito-León, Julián (2020). "Miller Fisher Syndrome and polyneuritis cranialis in COVID-19". Neurology: 10.1212/WNL.0000000000009619. doi:10.1212/WNL.0000000000009619. ISSN 0028-3878.
  6. 6.0 6.1 6.2 6.3 6.4 6.5 Polo A, Manganotti P, Zanette G, De Grandis D (May 1992). "Polyneuritis cranialis: clinical and electrophysiological findings". J. Neurol. Neurosurg. Psychiatry. 55 (5): 398–400. doi:10.1136/jnnp.55.5.398. PMC 489084. PMID 1318358.
  7. "www.who.int" (PDF).
  8. Vavougios GD (July 2020). "Potentially irreversible olfactory and gustatory impairments in COVID-19: Indolent vs. fulminant SARS-CoV-2 neuroinfection". Brain Behav. Immun. 87: 107–108. doi:10.1016/j.bbi.2020.04.071. PMC 7185018 Check |pmc= value (help). PMID 32353521 Check |pmid= value (help).
  9. Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L, Liu C, Yang C (July 2020). "Nervous system involvement after infection with COVID-19 and other coronaviruses". Brain Behav. Immun. 87: 18–22. doi:10.1016/j.bbi.2020.03.031. PMC 7146689 Check |pmc= value (help). PMID 32240762 Check |pmid= value (help).
  10. Bohmwald, Karen; Gálvez, Nicolás M. S.; Ríos, Mariana; Kalergis, Alexis M. (2018). "Neurologic Alterations Due to Respiratory Virus Infections". Frontiers in Cellular Neuroscience. 12. doi:10.3389/fncel.2018.00386. ISSN 1662-5102.
  11. 11.0 11.1 Bohmwald K, Gálvez N, Ríos M, Kalergis AM (2018). "Neurologic Alterations Due to Respiratory Virus Infections". Front Cell Neurosci. 12: 386. doi:10.3389/fncel.2018.00386. PMC 6212673. PMID 30416428. Vancouver style error: initials (help)
  12. 12.0 12.1 Schmutzhard E, Stanek G, Pohl P (November 1985). "Polyneuritis cranialis associated with Borrelia burgdorferi". J. Neurol. Neurosurg. Psychiatry. 48 (11): 1182–4. doi:10.1136/jnnp.48.11.1182. PMC 1028583. PMID 4078585.
  13. 13.0 13.1 Yagnik, P M; Dhaduk, V (1986). "Polyneuritis cranialis in Lyme disease". Journal of Neurology, Neurosurgery & Psychiatry. 49 (8): 963–964. doi:10.1136/jnnp.49.8.963. ISSN 0022-3050.
  14. Nagel MA, Gilden D (August 2013). "Complications of varicella zoster virus reactivation". Curr Treat Options Neurol. 15 (4): 439–53. doi:10.1007/s11940-013-0246-5. PMC 3752706. PMID 23794213.
  15. 15.0 15.1 15.2 15.3 15.4 15.5 15.6 Kasundra GM, Bhargava AN, Bhushan B, Shubhakaran K, Sood I (2015). "Polyneuritis cranialis with generalized hyperreflexia as a presenting manifestation of thyrotoxicosis". Ann Indian Acad Neurol. 18 (2): 240–2. doi:10.4103/0972-2327.150625. PMC 4445207. PMID 26019429.
  16. 16.0 16.1 16.2 Torres, Alcy R; Salvador, Carla; Mora, Mauricio; Mirchandani, Sharam; Chavez, Wilson (2019). "Idiopathic Recurrent Polyneuritis Cranialis: A Rare Entity". Cureus. doi:10.7759/cureus.4488. ISSN 2168-8184.
  17. Román, Gustavo C.; Spencer, Peter S.; Reis, Jacques; Buguet, Alain; Faris, Mostafa El Alaoui; Katrak, Sarosh M.; Láinez, Miguel; Medina, Marco Tulio; Meshram, Chandrashekhar; Mizusawa, Hidehiro; Öztürk, Serefnur; Wasay, Mohammad (2020). "The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries". Journal of the Neurological Sciences. 414: 116884. doi:10.1016/j.jns.2020.116884. ISSN 0022-510X.
  18. 18.0 18.1 Pavone, Piero; Incorpora, Gemma; Romantshika, Olga; Ruggieri, Martino (2007). "Polyneuritis Cranialis: Full Recovery after Intravenous Immunoglobulins". Pediatric Neurology. 37 (3): 209–211. doi:10.1016/j.pediatrneurol.2007.05.002. ISSN 0887-8994.
  19. 19.0 19.1 Torres AR, Salvador C, Mora M, Mirchandani S, Chavez W (April 2019). "Idiopathic Recurrent Polyneuritis Cranialis: A Rare Entity". Cureus. 11 (4): e4488. doi:10.7759/cureus.4488. PMC 6581414 Check |pmc= value (help). PMID 31259106.
  20. "Coronavirus (COVID-19) - Apple and CDC".
  21. Wakerley BR, Yuki N (September 2015). "Polyneuritis cranialis: oculopharyngeal subtype of Guillain-Barré syndrome". J. Neurol. 262 (9): 2001–12. doi:10.1007/s00415-015-7678-7. PMID 25712542.
  22. "Cerebral spinal fluid (CSF) collection: MedlinePlus Medical Encyclopedia".
  23. Chen D, Li X, Song Q, Hu C, Su F, Dai J, Ye Y, Huang J, Zhang X (June 2020). "Assessment of Hypokalemia and Clinical Characteristics in Patients With Coronavirus Disease 2019 in Wenzhou, China". JAMA Netw Open. 3 (6): e2011122. doi:10.1001/jamanetworkopen.2020.11122. PMC 7290402 Check |pmc= value (help). PMID 32525548 Check |pmid= value (help).
  24. Alfano, Gaetano; Ferrari, Annachiara; Fontana, Francesco; Perrone, Rossella; Mori, Giacomo; Ascione, Elisabetta; Riccardo, Magistroni; Venturi, Giulia; Pederzoli, Simone; Margiotta, Gianluca; Romeo, Marilina; Piccinini, Francesca; Franceschi, Giacomo; Volpi, Sara; Faltoni, Matteo; Ciusa, Giacomo; Bacca, Erica; Tutone, Marco; Raimondi, Alessandro; menozzi, marianna; Franceschini, Erica; Cuomo, Gianluca; Orlando, Gabriella; Santoro, Antonella; Di Gaetano, Margherita; Puzzolante, Cinzia; Carli, Federica; Bedini, Andrea; Milic, Jovana; Meschiari, Marianna; Mussini, Cristina; Cappelli, Gianni; Guaraldi, Giovanni (2020). doi:10.1101/2020.06.14.20131169. Missing or empty |title= (help)
  25. Lavi ES, Sklar EM (August 2001). "Enhancement of the eighth cranial nerve and labyrinth on MR imaging in sudden sensorineural hearing loss associated with human herpesvirus 1 infection: case report". AJNR Am J Neuroradiol. 22 (7): 1380–2. PMID 11498431.
  26. Aho TR, Wallace RC, Pitt AM, Sivakumar K (March 2004). "Charcot-Marie-Tooth disease: extensive cranial nerve involvement on CT and MR imaging". AJNR Am J Neuroradiol. 25 (3): 494–7. PMID 15037479.
  27. Capuano A, Scavone C, Racagni G, Scaglione F (July 2020). "NSAIDs in patients with viral infections, including Covid-19: Victims or perpetrators?". Pharmacol. Res. 157: 104849. doi:10.1016/j.phrs.2020.104849. PMC 7189871 Check |pmc= value (help). PMID 32360482 Check |pmid= value (help).
  28. Toro, Jaime; Millán, Carlos; Díaz, Camilo; Reyes, Saúl (2013). "Multiple Cranial Neuropathy (A Teaching Case)". Multiple Sclerosis and Related Disorders. 2 (4): 395–398. doi:10.1016/j.msard.2013.03.003. ISSN 2211-0348.
  29. Wiles CM, Brown P, Chapel H, Guerrini R, Hughes RA, Martin TD, McCrone P, Newsom-Davis J, Palace J, Rees JH, Rose MR, Scolding N, Webster AD (April 2002). "Intravenous immunoglobulin in neurological disease: a specialist review". J. Neurol. Neurosurg. Psychiatry. 72 (4): 440–8. doi:10.1136/jnnp.72.4.440. PMC 1737833. PMID 11909900.
  30. "NIH clinical trial of investigational vaccine for COVID-19 begins | National Institutes of Health (NIH)".
  31. "How to Protect Yourself & Others | CDC".
  32. "Coronavirus (COVID-19) Update: FDA Takes Action to Warn, Protect Consumers from Dangerous Alcohol-Based Hand Sanitizers Containing Methanol | FDA".
  33. "Contact Tracing for COVID-19 | CDC".


Template:WikiDoc Sources