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Neurological Involvement in Covid-19 Infections; Pathophysiology, Presentation and Outcome

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Neurological Involvement in Covid-19 Infections; Pathophysiology, Presentation and Outcome CORE Metadata, citation and similar papers at core.ac.uk Provided by eCommons@AKU Pakistan Journal of Neurological Sciences (PJNS) Volume 15 Issue 1 Article 2 3-2020 NEUROLOGICAL INVOLVEMENT IN COVID-19 INFECTIONS; PATHOPHYSIOLOGY, PRESENTATION AND OUTCOME. Dureshahwar Kanwar Aga Khan University, Karachi Muhammad Imran Aga Khan University, Karachi Mohammad Wasay Aga Khan University, Karachi Follow this and additional works at: https://ecommons.aku.edu/pjns Part of the Neurology Commons Recommended Citation Kanwar, Dureshahwar; Imran, Muhammad; and Wasay, Mohammad (2020) "NEUROLOGICAL INVOLVEMENT IN COVID-19 INFECTIONS; PATHOPHYSIOLOGY, PRESENTATION AND OUTCOME.," Pakistan Journal of Neurological Sciences (PJNS): Vol. 15 : Iss. 1 , Article 2. Available at: https://ecommons.aku.edu/pjns/vol15/iss1/2 REVIEW ARTICLE identified as SARS CoV 2. Most of the patients in the Data from the largest case series in China found that demyelination. Infection with COVID 19 promotes hyposmia, and dysgeusia should be added to the list effectiveness of routine brain MRI to guide treatment COVID 19 is still unknown. The risk of contamination children.31 The EEG findings although are non-specific but this remains to be seen in COVID-19. NEUROLOGICAL INVOLVEMENT IN COVID-19 outbreak reported a link to the Huanan South China 87% of confirmed cases were aged 30 to 79 years, 1% atherosclerosis, inflammation and local thrombosis in of COVID-19 screening symptoms and urged selection is uncertain.22 remains high. A non-contrast CT Head to exclude acute may show diffuse or bifrontal slowing consistent with Prognosis: Seafood and live animal Market. Rapid spread occurred were aged 9 years or younger, 1% were aged 10 to 19 the presence of systemic inflammation the resultant precautionary isolation for individuals with these stroke in patients with possible or confirmed COVID 19 encephalopathy.28 INFECTIONS; PATHOPHYSIOLOGY, PRESENTATION AND COVID-19 and Seizures Neurological manifestations may have a variable throughout China and within one month several other years, and 3% were aged 80 years or older. elevation in C reactive protein and D dimer increases symptoms, even in the absence of respiratory should be reserved for times when actionable Metabolic derangements may be common in Nerve conduction studies and electromyography: prognosis. Patients with milder disease or isolated countries, including Italy, the United States and Approximately 51% of patients were male and 49% the risk of acute cerebrovascular disease.14 Molecular disease.16 information is likely to be obtained, or when a OUTCOME. SARS-CoV2 infected patients and these should be Nerve conduction studies (NCS) and symptoms such as anosmia, ageusia, isolated Germany. Since then, the outbreak has escalated were female.8 In the US, older patients (aged ≥65 mimicry between specific viral proteins and proteins significant change in the neurological examination is Neurological syndromes: evaluated for possibly causing seizures. Severely electromyography (EMG) may be necessary with headaches or myalgias suggest a relatively better rapidly, with the WHO first declaring this as a public years) accounted for 31% of all cases, 45% of on peripheral nerves (gangliosides) leads to an seen. A CT angiogram of the head and neck may be Dureshahwar Kanwar, Muhammad Imran, Mohammad Wasay Isolated new cases of COVID 19 with neurological affected have compromised renal and hepatic systems patient acute flaccid paralysis or myositis. Reports of outcome. However, those with more severe systemic 1. Department of Medicine Aga Khan University, 2,3 Section of Neurology, Department of Medicine, Aga Khan University, Karachi health emergency of international concern on 30 hospitalizations, 53% of intensive care unit admissions, innocent bystander attack against the myelin or axon, required in cases of subarachnoid hemorrhage. syndromes are emerging every day from all around and appropriate antiseizure medication should be GBS in association with COVID-19 have recently been disease and extensive neurological involvement like January 2020 and then formally declaring it a and 80% of deaths, with the highest incidence of the most likely mechanism behind peripheral nerve Additional studies including MRI with gadolinium may the world. Ischemic strokes have been reported in 5% carefully selected. Brivaracetam, lacosamide, seen.32 An over-emphasis on the fact that NCS and strokes, encephalitis or Guillain Barre syndrome may Correspondence to: Dureshahwar Kanwar Email: [email protected] pandemic on 11 March 2020. Difficulty controlling severe outcomes in patients aged ≥85 years.9 Infection injury. There is no current evidence of direct viral be required in patients with a history of seizures or of patients with severe COVID -19 infections and in Levetiracetam, Zonisamide is advised with abnormal EMG are within normal limits in the first 1-2 weeks in have a graver outcome. such an aggressive spread resulted partly due to the in children is reported much less commonly than invasion with inflammation and degeneration of motor unexplained encephalopathy. In one recently published 1% of non-severe infections due to the COVID 19 liver tests.23 diseases of the muscle and nerves cannot be made. Date of submission: April 22. 2020 Date of revision: April 27,2020 Date of acceptance: April 30,2020 extensive size of Wuhan; Central China’s transportation amongst adults. neurons and peripheral nerves as seen in some other study from Strasbourg, France, between March 3 and Future directions for research: from recent data considering the patients are in a pro Unnecessary procedures should be avoided as the hub, which has a full-time population of more than 9 viral infections like poliovirus, West Nile, Herpes COVID19 and Headache April 3, 2020 in patients with confirmed COVID 19 with Understanding the full spectrum of the neurotropic Pathophysiology: thrombotic state.3 There was also one patient with machines may serve as fomites. ABSTRACT million and a transient population of an additional 5.10 Zoster, or Cytomegalovirus etc. Headache appears to be the most common encephalopathy. MRI Brain showed leptomeningeal effects of COVID 19 is still in its maiden stages. SARS CoV2 is an enveloped, positive sense, single spontaneous intra cerebral hemorrhage and cerebral million. In an attempt to reduce virus transmission, on neurological complaint with COVID-19. The putative enhancement predominately in occipital lobe in eight Laboratory evaluation: Neurological manifestations until now have depicted Severe acute respiratory syndrome corona virus 2 (SARS CoV 2) seems to display an increasing affinity for the nervous stranded RNA virus with a diameter of approximately Neurological symptoms: venous sinus thrombosis each in the same study. January 23, 2020, authorities locked down Wuhan, but role of ACE2 in the pathophysiology has recently fueled out of 13 patients. Small diffusion abnormalities Laboratory findings in patients with COVID -19 include the entire neuroaxis is prone to disease. system. The ongoing pandemic has made evident that diverse neurological manifestations may occur with COVID 19. 60-140 nanometers. The viral envelope consists of a Neurological signs and symptoms fall into three main Encephalopathy and acute hemorrhagic necrotizing by that time approximately 5 million persons had concerns regarding the use of non- steroidal indicating asymptomatic acute ischemic stroke were high white blood cell counts, lower lymphocyte count, Pharmaceutical research needs to change directions Headache and dizziness remain the most common symptoms however stroke, seizures, encephalopathy, neuropathy lipid bilayer with four structural proteins known as S categories; central nervous symptoms (CNS), encephalopathy have recently been reported with already left.4 The WHO COVID-19 Situation Report for anti-inflammatory drugs (NSAIDs) such as ibuprofen, seen in two patients. Bilateral frontotemporal and increased C-reactive protein. Severe infection to expedite the development of a possible vaccine and skeletal muscle injury may be seen. An increasing number of patients report initial anosmia and ageusia. (spike (E (envelope), M (membrane) and N peripheral nervous symptoms (PNS) and skeletal COVID19 which are rare complications of influenza April 21,2020 reports 2.4 million confirmed cases of commonly used for headache. These are known to hypo-perfusion was noted in all 11 of these patients has corresponding higher D-dimer levels, increased and also accelerate in the quest for newer antiviral Tendency for serious illness is believed to be in the elderly or people with a history of diabetes, high blood pressure and (nucleocapsid). Interaction between the spike protein muscular symptoms.3 These clinical features may be and other viral infections.17 Myopathies, COVID 19 and 162,956 deaths.5 In Pakistan alone at induce up-regulation of ACE2 and, in theory, may who underwent perfusion imaging.28 Hemorrhagic ring lactate dehydrogenase, alanine aminotransferase, agents. More extensive neurological workup or heart disease. Many patients on immunosuppressive therapies such as multiple sclerosis, myasthenia gravis or and host cell receptor is essential for virulence and the presenting complaints or as more commonly seen rhabdomyolyis, viral myositis, critical illness myopathy the writing of this manuscript the affected number was facilitate infection with COVID-19.24 Sodium valproate enhancing lesions within the bilateral thalami and and aspartate aminotransferase
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