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Critical illness neuropathy in severe COVID-19: a case series

INTRODUCTION: Neurological complications of SARS-CoV-2 disease have received growing attention, but only few studies have described to date clinical and neurophysiological findings in COVID patients during their stay in intensive care units (ICUs). Here, we neurophysiologically assessed the presence...

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Autores principales: Bocci, Tommaso, Campiglio, Laura, Zardoni, Manuela, Botta, Stefano, Coppola, Silvia, Groppo, Elisabetta, Chiumello, Davide, Priori, Alberto
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414960/
https://www.ncbi.nlm.nih.gov/pubmed/34477990
http://dx.doi.org/10.1007/s10072-021-05471-0
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author Bocci, Tommaso
Campiglio, Laura
Zardoni, Manuela
Botta, Stefano
Coppola, Silvia
Groppo, Elisabetta
Chiumello, Davide
Priori, Alberto
author_facet Bocci, Tommaso
Campiglio, Laura
Zardoni, Manuela
Botta, Stefano
Coppola, Silvia
Groppo, Elisabetta
Chiumello, Davide
Priori, Alberto
author_sort Bocci, Tommaso
collection PubMed
description INTRODUCTION: Neurological complications of SARS-CoV-2 disease have received growing attention, but only few studies have described to date clinical and neurophysiological findings in COVID patients during their stay in intensive care units (ICUs). Here, we neurophysiologically assessed the presence of either critical illness neuropathy (CIP) or myopathy (CIM) in ICU patients. MATERIALS AND METHODS: Patients underwent a neurophysiological assessment, including bilateral examination of the median, ulnar, deep peroneal and tibial motor nerves and of the median, ulnar, radial and sural sensory nerves. Needle electromyography (EMG) was performed for both distal and proximal muscles of the lower and upper limbs. In order to differentiate CIP from CIM, Direct Muscle Stimulation (DMS) was applied either to the deltoid or tibialis anterior muscles. Peak to peak amplitudes and onset latencies of the responses evoked by DMS (DMS(amp), DMS(lat)) or by motor nerve stimulation (MNS(amp), MNS(lat)) were compared. The ratio MNS(amp) to DMS(amp) (NMR) and the MNS(lat) to DMS(lat) difference (NMD: MNS(lat) − DMS(lat)) were also evaluated. RESULTS: Nerve conduction studies showed a sensory-motor polyneuropathy with axonal neurogenic pattern, as confirmed by needle EMG. Both MNS(amp) and NMR were significantly reduced when compared to controls (p < 0.0001), whereas MNS(lat) and NMD were markedly increased (p = 0.0049). CONCLUSIONS: We have described COVID patients in the ICU with critical illness neuropathy (CIP). COVID-related CIP could have implications for the functional recovery and rehabilitation strategies.
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spelling pubmed-84149602021-09-03 Critical illness neuropathy in severe COVID-19: a case series Bocci, Tommaso Campiglio, Laura Zardoni, Manuela Botta, Stefano Coppola, Silvia Groppo, Elisabetta Chiumello, Davide Priori, Alberto Neurol Sci Covid-19 INTRODUCTION: Neurological complications of SARS-CoV-2 disease have received growing attention, but only few studies have described to date clinical and neurophysiological findings in COVID patients during their stay in intensive care units (ICUs). Here, we neurophysiologically assessed the presence of either critical illness neuropathy (CIP) or myopathy (CIM) in ICU patients. MATERIALS AND METHODS: Patients underwent a neurophysiological assessment, including bilateral examination of the median, ulnar, deep peroneal and tibial motor nerves and of the median, ulnar, radial and sural sensory nerves. Needle electromyography (EMG) was performed for both distal and proximal muscles of the lower and upper limbs. In order to differentiate CIP from CIM, Direct Muscle Stimulation (DMS) was applied either to the deltoid or tibialis anterior muscles. Peak to peak amplitudes and onset latencies of the responses evoked by DMS (DMS(amp), DMS(lat)) or by motor nerve stimulation (MNS(amp), MNS(lat)) were compared. The ratio MNS(amp) to DMS(amp) (NMR) and the MNS(lat) to DMS(lat) difference (NMD: MNS(lat) − DMS(lat)) were also evaluated. RESULTS: Nerve conduction studies showed a sensory-motor polyneuropathy with axonal neurogenic pattern, as confirmed by needle EMG. Both MNS(amp) and NMR were significantly reduced when compared to controls (p < 0.0001), whereas MNS(lat) and NMD were markedly increased (p = 0.0049). CONCLUSIONS: We have described COVID patients in the ICU with critical illness neuropathy (CIP). COVID-related CIP could have implications for the functional recovery and rehabilitation strategies. Springer International Publishing 2021-09-03 2021 /pmc/articles/PMC8414960/ /pubmed/34477990 http://dx.doi.org/10.1007/s10072-021-05471-0 Text en © Fondazione Società Italiana di Neurologia 2021 This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Covid-19
Bocci, Tommaso
Campiglio, Laura
Zardoni, Manuela
Botta, Stefano
Coppola, Silvia
Groppo, Elisabetta
Chiumello, Davide
Priori, Alberto
Critical illness neuropathy in severe COVID-19: a case series
title Critical illness neuropathy in severe COVID-19: a case series
title_full Critical illness neuropathy in severe COVID-19: a case series
title_fullStr Critical illness neuropathy in severe COVID-19: a case series
title_full_unstemmed Critical illness neuropathy in severe COVID-19: a case series
title_short Critical illness neuropathy in severe COVID-19: a case series
title_sort critical illness neuropathy in severe covid-19: a case series
topic Covid-19
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8414960/
https://www.ncbi.nlm.nih.gov/pubmed/34477990
http://dx.doi.org/10.1007/s10072-021-05471-0
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