Peripheral Nervous System Manifestations Research Articles

Central and Peripheral Nervous System Manifestations Associated with Dengue Illness

Dengue illness, caused by the dengue viruses, continues to be a major global health concern, with increasing incidence and the emergence of severe manifestations such as neurological complications. An overview of the current understanding of dengue epidemiology, clinical manifestations, and research priorities is presented here. Dengue transmission has escalated in recent years, exacerbated by factors such as vector expansion, climate change, and socioeconomic challenges. The clinical spectrum of dengue ranges from mild febrile illness to severe manifestations, including hemorrhagic fever and neurological complications. Neurological manifestations of dengue, once considered rare, are now increasingly reported, encompassing encephalitis, myelitis, and Guillain–Barré Syndrome, among others. Diagnosis primarily relies on laboratory methods such as RT/PCR, NS1 antigen detection, and serological assays. Despite advancements in understanding the dengue pathogenesis, there remains a critical need for effective vaccines, antiviral drugs, improved surveillance methods, predictive models for disease severity, and long-term studies on post-Dengue sequelae. Integrated programs and holistic approaches to dengue control are essential for mitigating its impact. Addressing these research priorities will be pivotal in combating dengue and reducing its global burden.

Peripheral Nervous System Manifestations of MOG Antibody Associated Disease (P9-14.015)

Peripheral Nervous System Manifestations of MOG Antibody Associated Disease (P9-14.015)

Neurological manifestations and risk factors associated with poor prognosis in hospitalized children with Omicron variant infection.

There are increasing reports of neurological manifestation in children with coronavirus disease 2019 (COVID-19). However, the frequency and clinical outcomes of in hospitalized children infected with the Omicron variant are unknown. The aim of this study was to describe the clinical characteristics, neurological manifestations, and risk factor associated with poor prognosis of hospitalized children suffering from COVID-19 due to the Omicron variant. Participants included children older than 28days and younger than 18years. Patients were recruited from December 10, 2022 through January 5, 2023. They were followed up for 30days. A total of 509 pediatric patients hospitalized with the Omicron variant infection were recruited into the study. Among them, 167 (32.81%) patients had neurological manifestations. The most common manifestations were febrile convulsions (n = 90, 53.89%), viral encephalitis (n = 34, 20.36%), epilepsy (n = 23, 13.77%), hypoxic-ischemic encephalopathy (n = 9, 5.39%), and acute necrotizing encephalopathy (n = 6, 3.59%). At discharge, 92.81% of patients had a good prognosis according to the Glasgow Outcome Scale (scores ≥ 4). However, 7.19% had a poor prognosis. Eight patients died during the follow-up period with a cumulative 30-day mortality rate of 4.8% (95% confidence interval (CI) 1.5-8.1). Multivariate analysis revealed that albumin (odds ratio 0.711, 95% CI 0.556-0.910) and creatine kinase MB (CK-MB) levels (odds ratio 1.033, 95% CI 1.004-1.063) were independent risk factors of poor prognosis due to neurological manifestations. The area under the curve for the prediction of poor prognosis with albumin and CK-MB was 0.915 (95%CI 0.799-1.000), indicating that these factors can accurately predict a poor prognosis. Conclusion: In this study, 32.8% of hospitalized children suffering from COVID-19 due to the Omicron variant infection experienced neurological manifestations. Baseline albumin and CK-MB levels could accurately predict poor prognosis in this patient population. What is Known: • Neurological injury has been reported in SARS-CoV-2 infection; compared with other strains, the Omicron strain is more likely to cause neurological manifestations in adults. • Neurologic injury in adults such as cerebral hemorrhage and epilepsy has been reported in patients with Omicron variant infection. What is New: • One-third hospitalized children with Omicron infection experience neurological manifestations, including central nervous system manifestations and peripheral nervous system manifestations. • Albumin and CK-MB combined can accurately predict poor prognosis (AUC 0.915), and the 30-day mortality rate of children with Omicron variant infection and neurological manifestations was 4.8%.

Peripheral nervous system manifestations of MOG antibody associated disease.

Recent studies have reported the involvement of peripheral nervous system (PNS) in association with MOG-IgG, including isolated neuropathies. In this retrospective study we characterized the PNS involvement in MOG antibody associated disease (MOGAD). Six out of 215 MOGAD patients had PNS involvement (all polyradiculopathy) that occurred concurrently with a CNS demyelinating episode. We also demonstrated MOG expression in healthy human controls' proximal nerve root. Nine patients with true-positive MOG-IgG1 had PNS involvement temporally unrelated to a CNS demyelinating event. All these patients had an alternate etiology of PNS involvement. Isolated peripheral neuropathy is not a feature of MOGAD, but inflammatory nerve root involvement can occur concurrently with CNS demyelinating events.

The outcome and risk factors associated with central and peripheral nervous system involvement in hospitalized COVID-19 patients: a retrospective cohort study.

SARS-CoV-2 infection can affect any organ, including both the central nervous system (CNS) and peripheral nervous system (PNS). The aim of this study was to explore the outcome and risk factors associated with the involvement of either CNS or PNS in a cohort of hospitalized COVID-19 patients. We performed a retrospective observational cohort study of hospitalized adult patients with COVID-19, between May 2020 and December 2022, presenting with new onset neurological disabilities any time after admission. We included 115 patients, 72 with CNS manifestations and 43 with PNS involvement. The CNS manifestations were COVID-19-associated encephalopathy, headache, neurovascular events, and seizures in 80.5, 43, 31.9, and 11.1% of patients, respectively. The neurovascular events were ischemic stroke in 17 (23.6%) patients, hemorrhagic stroke in 6 (8.3%) patients, venous thrombosis in 1 (1.4%) patient, and subarachnoid hemorrhage in 1 (1.4%) patient. Cranial nerve involvement was the most frequent PNS manifestation in 34 (79%) cases, followed by mononeuritis in 5 (11.6%) patients and polyneuropathy in 4 (9.3%) patients. The affected cranial nerves were the vestibulocochlear nerve in 26 (60.5%) patients, the olfactory nerve in 24 (55.8%) patients, the oculomotor nerves in 5 (11.6%) patients, and the facial nerve in 1 (2.3%) patient. Two patients (9.3%) presented with polyneuritis cranialis. Older age (HR = 1.02, 95% CI: 1.003-1.037, p = 0.01), COVID severity (HR = 2.53, 95% CI: 1.42-4.5, p = 0.002), ischemic cardiac disease (HR = 2.42, 95% CI: 1.05-5.6, p = 0.03), and increased D-dimers (HR = 1.00, 95% CI: 1.00-1.00, p = 0.02) were independently associated with the development of CNS manifestations. The factors associated with in-hospital mortality were age (HR = 1.059, 95% CI: 1.024-1.096, p = 0.001), C-reactive protein (HR = 1.006, 95% CI: 1.00-1.011, p = 0.03), CNS involvement (HR = 9.155, 95% CI: 1.185-70.74, p = 0.03), and leucocyte number (HR = 1.053, 95% CI: 1.026-1.081, p < 0.001). COVID-19-associated encephalopathy was the most common CNS manifestation in our study, but neurovascular events are also important considering the overlap between inflammatory and prothrombotic pathways, especially in severe cases. CNS involvement was associated with in-hospital all-cause mortality. PNS findings were various, involving mostly the cranial nerves, especially the vestibulocochlear nerve.

Characterization of orthopedic manifestations in patients with mucopolysaccharidosis II using data from 15 years of the Hunter Outcome Survey.

Mucopolysaccharidosis II (MPS II) is a rare, life-limiting lysosomal storage disease caused by reduced iduronate-2-sulfatase activity. Patients experience broad ranging signs and symptoms, including bone and joint manifestations. This study reported on orthopedic involvement and management in patients with MPS II using 15 years of data from the Hunter Outcome Survey (HOS). Of the 245 patients in the study population, 90.2% had skeletal deformity (median onset, 2.8 years), 76.7% had upper body stiffness (onset, 4.2 years), and 61.2% had lower body stiffness (onset, 5.3 years); 63.7% of patients had at least three joint manifestations. Orthopedic manifestations were common in adults and children with MPS II, and in patients with and without cognitive impairment. Joint range of motion (JROM) was restricted in all joints assessed (shoulder, elbow, hip, wrist, knee, and ankle). Little correlation was observed between JROM measurements, subjective reports of joint stiffness and limited function, and 6-minute walk test results. Patients with joint stiffness and limited function were generally more likely to have central and peripheral nervous system, pulmonary, and cardiovascular manifestations than those without these symptoms. Carpal tunnel decompression was the most common orthopedic surgery (recorded in 49/245 patients [20.0%]), but orthopedic surgeries were uncommon overall. Our findings highlight the need for routine monitoring of orthopedic manifestations using multiple assessment types in patients with MPS II to help inform clinical decision-making and improve patient quality of life. They also underline the contribution of factors other than orthopedic manifestations to the walking ability of patients with MPS II.

Infectious Neuropathies.

This article discusses the clinical manifestations and management of infectious peripheral neuropathies. Several infectious etiologies of peripheral neuropathy are well-recognized and their treatments are firmly established. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with several central and peripheral nervous system manifestations, including peripheral neuropathies. Additionally, some COVID-19 vaccines have been associated with Guillain-Barré syndrome. These disorders are an active area of surveillance and research. Recent evidence-based guidelines have provided updated recommendations for the diagnosis and treatment of Lyme disease. Infectious agents of many types (primarily bacteria and viruses) can affect the peripheral nerves, resulting in various clinical syndromes such as mononeuropathy or mononeuropathy multiplex, distal symmetric polyneuropathy, radiculopathy, inflammatory demyelinating polyradiculoneuropathy, and motor neuronopathy. Knowledge of these infections and the spectrum of peripheral nervous system disorders associated with them is essential because many have curative treatments. Furthermore, understanding the neuropathic presentations of these disorders may assist in diagnosing the underlying infection.

Post-infectious neurological complications of COVID-19 – A tertiary care center experience

BackgroundThe neurological manifestations of acute SARS-CoV-2 infection are well established, but limited understanding of the post-infectious neurological complications of COVID-19 (PINCC) contributes to significant morbidity and mortality. Hence in this study, we aimed to describe the clinical, radiological, and electrophysiological spectrum and outcome of PINCC from a tertiary referral center. MethodsWe identified 18 cases with diverse neurological manifestations following recovery from an acute SARS-CoV-2 infection. The neurological manifestations, magnetic resonance imaging findings of the brain and spinal cord, nerve conduction studies, and the treatment and outcome data were collected from electronic medical records. ResultsThe mean age of presentation was 47± 18.5 years, and 11 patients (61 %) were male. For 11 (61 %) patients, prior COVID-19 symptoms were minimal or absent. The mean time to onset of neurological manifestations was 3 weeks after COVID-19 infection (range 1–8 weeks). 14 patients (77.8 %) had central nervous system (CNS) manifestations, and 4 (22.2 %) had peripheral nervous system (PNS) manifestations. The CNS manifestations included cerebrovascular events in 7, demyelination in 4, and aseptic meningitis, amnestic mild cognitive impairment, and disseminated tuberculosis in one case each. PNS manifestations were Guillain-Barré syndrome, mononeuritis multiplex, asymmetric polyradiculoneuropathy, and isolated diaphragm palsy in one patient each. ConclusionPost-infectious neurological complications of COVID-19 can involve both central and peripheral nervous system and is independent of the severity of acute infection.

Neurologic and Psychiatric Manifestations of Bradykinin-Mediated Angioedema: Old and New Challenges.

Neurologic manifestations have been occasionally described in patients with bradykinin-mediated angioedema. The existing literature is currently limited to case series and case reports mainly described in the hereditary forms (HAE) concerning central nervous system (CNS) involvement. On the contrary, very little is known about peripheral and autonomic nervous system manifestations. CNS involvement in HAE may present with symptoms including severe headaches, visual disturbance, seizures, and various focal and generalized deficits. In addition, a stroke-like clinical picture may present in HAE patients. In turn, some drugs used in patients with cardiovascular and neurologic disorders, such as recombinant tissue plasminogen activator (r-tPA) and angiotensin-converting enzyme inhibitors (ACEI), may produce medication-induced angioedema, resulting in a diagnostic challenge. Finally, most patients with HAE have higher levels of psychological distress, anxiety, and depression. With this review, we aimed to provide an organized and detailed analysis of the existing literature on neurologic and psychiatric manifestations of HAE to shed light on these potentially invalidating symptoms and lay the foundation for further personalized diagnostic pathways for patients affected by this protean disease.

Evaluating the frequency of neurological symptoms in COVID-19 patients: A cross-sectional study.

Due to the recent emergence of COVID-19, the exact pathology of this disease has not been determined. Therefore, this study evaluated the frequency of neurological symptoms in patients with COVID-19. This cross-sectional study was conducted on 2200 in patients with COVID-19 who were selected from an educational hospital in Sanandaj, Iran, from April 2020 to March 2021. The research samples were selected by census, all patients with COVID-19 were admitted to the hospital. The data collection tool was a checklist of the studied variables (dizziness, headache, and impaired consciousness) prepared by the researchers based on the specialists' opinions. The researcher completed these checklists based on the patients' hospitalization records. The data were analyzed by descriptive and analytical statistical tests using SPSS Software Version 20. The quantitative variables were compared using the independent t-test. The χ 2 test was also used to compare qualitative variables. A pValue of less than 0.05 was considered statistically significant. The mean age of the patients was 57.41 years old, of whom 53.1% were male. The average blood oxygen level of the patients was 88.10%, and most disease symptoms were related to shortness of breath and cough, with a frequency of 24.3%. In addition, 20.8% of patients needed hospitalization in intensive care unit. The highest frequency of central and peripheral nervous system manifestations was related to headache, ageusia (loss of sense of taste), hyposmia (A decreased sense of smell and anosmia (The complete loss of smell). Finally, 15.3% of patients died, and 84.7% recovered. The analytical findings showed a significant relationship between the disease outcome and patients' dizziness, consciousness disorder, seizure and ageusia. There was a significant relationship between gender and headache in patients. There was a significant difference between the mean age and oxygen level with central and peripheral nervous system manifestations (dizziness, headache, impaired consciousness, smell disorder) and the disease outcome in patients. The pathophysiology of COVID-19 virus infection involving the central nervous system is not fully understood. Neurological symptoms of this virus include delirium, headache, decreased level of consciousness, and seizures. Identifying the symptoms and mechanisms of neurological complications of COVID-19 is necessary for proper screening and complete treatment because a patient infected by COVID-19 may not show respiratory failure signs but may be a carrier. A complete and accurate knowledge of the symptoms and complications of this infection for proper screening of patients to prevent transmission and spread of this disease is critically needed.

A single-center retrospective study of hospitalized COVID-19 patients: demographics, laboratory markers, neurological complications, ICU admission, and mortality.

This single-center retrospective study evaluated clinical and neurological sequelae, demographics, as well as laboratory markers, in hospitalized COVID-19 patients from January to September 2020. Among 1248 inpatients (median age: 68 years; 651 women), 387 (31%) were admitted to the ICU. Central nervous system (CNS) manifestations were present in 521 (41.74%) patients, while peripheral nervous system manifestations were observed in 84 (6.73%). COVID-19-related mortality occurred in 314 (25.16%) cases. ICU-admitted patients were predominantly male (P<0.0001), older (age≥60; P=0.037) and had more comorbidities such as diabetes (P=0.001), hyperlipidemia (P=0.043), and coronary artery disease (P=0.015). ICU patients exhibited more CNS manifestations (P=0.001), including impaired consciousness (P<0.0001) and acute cerebrovascular disease (P=0.023). Biomarkers linked to admission to the ICU included elevated white blood cell count, ferritin, lactate dehydrogenase, creatine kinase, blood urea nitrogen, creatinine, and acute phase reactants (e.g. erythrocyte sedimentation rate and C-reactive protein). ICU patients demonstrated lower lymphocyte and platelet counts compared to non-ICU patients. Those with CNS involvement in the ICU often exhibited elevated blood urea nitrogen, creatinine, and creatine kinase levels. Higher mortality from COVID-19 was observed in ICU patients (P<0.0001). Multiple serum biomarkers, comorbidities, and neurological manifestations in COVID-19 patients have been consistently documented and may be linked to increased morbidity, ICU admission, and mortality. Recognizing and addressing these clinical and laboratory markers is essential for effective COVID-19 management.

Lupus nephritis: clinical characteristics, serological associations, pattern of pro- and anti-inflammatory markers

The present study aimed to investigate the prevalence, clinical, and laboratory characteristics of renal involvement in a large cohort of Ukrainian patients with systemic lupus erythematosus (SLE).&#x0D; Methods. A total of 380 patients with SLE were enrolled in this cross-sectional study, including 176 with lupus nephritis (LN) and 204 with non-renal SLE. Patients were reviewed for demographic details, clinical SLE manifestations, SLE Disease Activity Index 2000 (SLEDAI-2K), and SLICC/ACR Damage Index. Laboratory evaluations included complete blood count with an erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), anti-CRP antibodies, serum creatinine, complement C3 and C4 levels, urinalysis, 24-hour urine protein, specific autoantibodies, interleukin-6 (IL-6), IL-10.&#x0D; Results. There was a significantly higher frequency of malar rash, lymphadenopathy, splenomegaly, serositis, pulmonitis, fever, necrotizing vasculitis, and a history of arterial/venous thrombosis in patients with LN; while Raynaud’s phenomenon, Sjogren’s syndrome, peripheral nervous system manifestations occurred more often in patients with non-renal SLE. Patients with LN were found to have higher ESR levels and lower IL-10 levels. Either frequency of anti-dsDNA positivity and its titer were higher in the LN group with no differences regarding other autoantibodies. C3 and C4, CRP, hs-CRP, anti-CRP, and IL-6 levels showed no significant difference between the groups.&#x0D; Multivariate analysis demonstrated that LN was positively associated with pulmonitis (OR 5.34 (95% CI 1.88-15.10), p=0.002), arterial/venous thrombosis (OR 6.80 (95% CI 1.87-24.70), p=0.004), anti-dsDNA positivity (OR 6.22 (95% CI 1.89-20.50), p=0.003), higher SLEDAI-2K score (OR 1.15 (95% CI 1.08-1.23), p&lt;0.001) and negatively associated with Raynaud’s syndrome (OR 0.20 (95% CI 0.08-0.49), p&lt;0.001) and younger age at disease onset (OR 0.96 (95% CI 0.93-0.99), p=0.003).&#x0D; In the LN group, 27 patients (15.3%) had nephrotic syndrome. In multivariate logistic analysis, male sex (OR 5.21 (95% CI 1.77-15.30), p=0.003) and higher SLICC/ACR score (OR 2.12 (95% CI 1.45-3.09), p&lt;0.001) were associated with increased risk of nephrotic syndrome, whereas lymphadenopathy (OR 0.31 (95% CI 0.12-0.80), p=0.02) was associated with decreased risk of nephrotic syndrome development.&#x0D; Conclusions. Our cohort of Ukrainian LN patients showed different characteristics in demographic, clinical, and laboratory findings compared to patients with non-renal SLE. These features are mostly on par with LN patients of other nationalities around the world.

Immune Checkpoint Inhibitor Associated Central Nervous System Autoimmunity.

Outcome and re-challenge data of central nervous system (CNS) autoimmunity triggered by immune checkpoint inhibitors (ICI) are limited. We aim to describe a large series of ICI-triggered CNS-autoimmunity, and to compare these patients with spontaneous paraneoplastic syndromes (PNS). Retrospective review of Mayo Clinic patients with ICI-triggered CNS-autoimmunity (2/2015-6/2021). Clinical characteristics were compared to spontaneous PNS patients (with antineuronal nuclear antibody [ANNA]-1 or (anti-Hu) and/or neuroendocrine tumors [NET] within the same period. Thirty-one patients were included, 55% female, median age 63 years (range 39-76). Median time from ICI initiation was 3.65 months (range 0.8-44.5). Most common associated malignancies were melanoma and small-cell lung cancer. CNS manifestations included encephalitis (16), meningoencephalitis (8), cerebellar ataxia (4), demyelinating syndrome (2), myelopathy (1). MRI was abnormal in 62%. CSF was inflammatory in 70%. Neural autoantibodies were identified in 47%, more frequently in patients with NET (P=0.046). ICI was discontinued in 97%; 90% received immunosuppressive treatment. After median 6.8 months follow-up (range 0.7-46), 39% had unfavorable outcomes (grade ≥3). This associated with higher severity degree at onset, shorter period from ICI to neurological onset, and encephalitis. Four patients were re-challenged with ICI and one relapsed. Patients with NET and with ANNA-1 ICI-triggered CNS autoimmunity had associated peripheral nervous system manifestations more frequently than their spontaneous counterparts (P=0.007 and P=0.028, respectively). One third of ICI-related CNS-autoimmunity patients have unfavorable outcomes related to their clinical presentation. Relapses may occur after ICI re-challenge. Neural autoantibodies are often present, more commonly in patients with NET.

Neurological Manifestations Post-COVID-19 Vaccination: A Review of Case Studies (P12-3.010)

<h3>Objective:</h3> To discern the central (CNS) and peripheral nervous system (PNS) manifestations associated with COVID-19 vaccines from individual case studies and describe their clinical and imaging findings, management, and outcomes. <h3>Background:</h3> With ten vaccines approved by the World Health Organization (WHO) and nearly 64% of people fully vaccinated worldwide, we have observed several neurological presentations post-COVID-19-vaccination, such as acute disseminated encephalomyelitis (ADEM), which have been reported in the Vaccine Adverse Event Reporting System (VAERS) and the Medicines and Healthcare products Regulatory Agency (MHRA). <h3>Design/Methods:</h3> A thorough literature search of Google Scholar and PubMed was conducted from December 2020 to October 2021, which included case reports of neurological complications with the following COVID-19 vaccines: Pfizer-BioNTech, Moderna, J&amp;J/Janssen, AstraZeneca, Sinovac-CoronaVac, Sputnik V, and COVAXIN. <h3>Results:</h3> Among the 51 cases, AstraZeneca was the most frequently administered vaccine (28, 55%), followed by Pfizer-BioNTech (8, 16%), Moderna (2,4%), Janssen (2,4%), Sputnik (1, 2%), and COVAXIN (1, 2%). The most common CNS manifestation was cerebral venous sinus thrombosis (CVST) (n=14) in females (64%) younger than 50 years (71%) after the first AstraZeneca dose (93%). Others included CNS demyelinating disorders [transverse myelitis, ADEM, multiple sclerosis, and neuromyelitis optica] (n=9), encephalopathy/encephalitis (n=3), seizures (n=3), and aseptic meningoencephalitis (n=1). The most common PNS manifestation was Guillain–Barré syndrome (GBS) (n=14) in males (71%) older than 50 years (79%), followed by Bell’s palsy (n=5), small fiber neuropathy (n=1), and phantosmia (n=1); most of these occurred with AstraZeneca (28.55%) and Pfizer-BioNTech (9.18%). IVIG and steroids were the treatment of choice. Nine out of the 14 patients with CVST (64%) died. However, most cases overall (42 out of 51) were non-fatal (82%). <h3>Conclusions:</h3> Several post-marketing CNS and PNS adverse events have occurred following the COVID-19 vaccination, including CVST, GBS, and TM. Further studies with non-vaccinated controls might help understand the pathophysiologic mechanisms of these neurological manifestations. <b>Disclosure:</b> Miss Beard has nothing to disclose. Kanika Sharma has nothing to disclose. Dr. Sharma has nothing to disclose. Dr. Basha has nothing to disclose. Mr. JHA has nothing to disclose. Dr. Sriwastava has nothing to disclose.

Porphyric neuropathy in black South Africans: a case series

Abstract Porphyria is a rare disorder that results from mutations in the genes important in haem biosynthesis. Several types are described. Acute attacks lead to central, autonomic and peripheral nervous system manifestations. These acute attacks typically occur in acute intermittent porphyria, and less so in variegate porphyria. The neuropathy in this condition can mimic Guillain-Barré syndrome (GBS), and is often misdiagnosed and incorrectly treated. It is rare in general, but considered to be extremely uncommon in the black African population. We describe five black South African patients, three of whom were diagnosed with variegate porphyria, with the presenting manifestation of a severe neuropathy. The neuropathy was atypical in nature and variable in presentation and highlight the importance of considering porphyria in such patients.

Neurological Manifestations of Hospitalized COVID-19-Infected Patients: A Single-Center Cohort Study

Background: Although COVID-19 preferentially affects the respiratory system, it has been demonstrated that coronaviruses frequently invade the nervous system. Objectives: We aimed to report the frequency and type of neurological manifestations in hospitalized patients with COVID-19. Methods: This is a retrospective, prospective observational cohort study. Data were collected from April to July 2020 at Bu-Ali Sina University Hospital, Sari, Iran. Demographic data and clinical symptoms were recorded at the onset of the disease. Neurological manifestations were recorded into 5 categories: nonspecific central nervous system (CNS) manifestations, acute cerebrovascular disease (CVD), meningitis/encephalitis, peripheral nervous system manifestations, and inflammatory disorders (myelitis and acute disseminated encephalomyelitis). Results: A total of 420 patients were admitted to the hospital with confirmed SARS-CoV-2 infection. Of the 420 patients hospitalized with COVID-19, 282 (67%) showed some form of neurological symptoms, of whom 48.33% had nonspecific neurological symptoms. Further, 35 (8.3%) patients had acute CVD, 2 patients had encephalitis (the RNA of SARS-CoV-2 was detected in cerebrospinal fluid (CSF), 1 patient had myelitis, and 83 (19.76%) patients had peripheral nervous system manifestations. Conclusions: Neurologic symptoms (from mild symptoms to life-threatening CNS disorders) are common in admitted patients with COVID-19. As a result of coagulation disorder in patients with COVID-19, some conditions (such as stroke) can be seen, even during recovery.

Demographic, Clinical, and Investigational Characteristics of COVID-19- related Guillain-Barré Syndrome with Differences from Typical and Another Virus-related Guillain-Barré Syndrome.

SARS-CoV-2 infection typically presents with fever and respiratory symptoms. Besides this, COVID-19-related central and peripheral nervous system manifestations are emerging. This study summarises the demographics, clinical profiles, laboratory findings, management strategies, and outcomes in a large number of patients with COVID-19-related GBS and its variants. We also compared its clinical profile with Zika and dengue virus-related GBS. The authors carried out a literature search up to Dec 31, 2020, in MEDLINE, PubMed, SCOPUS, Cochrane database, and Google Scholar for all published articles. The study identified 54 different types of articles consisting of 70 cases from 17 countries worldwide. A maximum of 15 cases (21.4 %) were identified from Italy, followed by the USA (12; 17.1 %), Spain (11; 15.7 %), and Iran (10; 14.3 %). The age group that was more than 60 years had the most cases, i.e., 32 (45.7 %), followed by the age group 40-60 with 25 cases (35.7 %) with a male to female ratio of 2. Maximum cases were treated with IVIG infusion 58 (82.9 %), followed by Plasma exchange 13 (18.6 %) cases. Out of 70 cases, 7 (10 %) cases were manifested as Miller-Fisher syndrome. The most predominant electrodiagnostic variant was demyelinating neuropathy in 41 (73.21 %) cases. The outcome reported in 67 cases was survival in 63 (90 %) cases and death in 4 (5.7 %) cases. Covid-19-related GBS were reported worldwide with a better outcome. Both postinfectious and parainfectious patterns were reported. Early recognition with prompt management of GBS can prevent further severe morbidity and mortality.

COVID-19 AND ITS RELATION TO ANOSMIA, AGEUSIA AND OTHER NEUROLOGICAL MANIFESTATIONS

Background: Coronavirus disease (COVID-19) is an infectious disease and highly contagious caused by a newly discovered coronavirus (SARS-CoV-2),was firstly reported in Wuhan. SARS-CoV-2belongs to the family Coronaviridae, which belongs to the order Nidovirales. It has be report that bats are the primary natural reservoir that houses a number of CoVs. Risk Factors include: Age, Gender, Diabetes, Hypertension, Cardiovascular Diseases, Malignancy.&#x0D; The Aim: of this study to review the impact this virus has on the nervous system. And to explore the neurological manifestations experienced by coronavirus disease (COVID-19) patients.&#x0D; Methods: The study was a review article. Data was collected during the period from 1– 29 September, 2021. PubMed and EBSCO Information Services were chosen as the search databases for the publications used within the study. Topics concerning the updates in types, management, and outcomes the neurological manifestations of Covid-19 cases, published in English around the world. No software was utilized to analyze the data. The data was extracted based on our specific objectives.&#x0D; Results: Myalgia, headache, altered sensorium, hyposmia, and hypogeusia were the most commonly reported neurological signs of COVID-19. COVID-19 can also cause ischemic stroke, intracerebral hemorrhage, encephalomyelitis, and acute myelitis in the central nervous system, as well as peripheral nervous system manifestations like Guillain-Barré syndrome and Bell's palsy and skeletal muscle manifestations like rhabdomyolysis in the peripheral nervous system.&#x0D; Conclusion: We conclude that neurological manifestations includingischemic strokes, hypogeusia, hyposmia represents the most evident neurological manifestations in COVID-19 patients.

A Study on the Correlations Between Comorbid Disease Conditions and Central and Peripheral Neurological Manifestations of COVID-19

Background Medical comorbidities and neurological manifestations are commonly associated with COVID-19, though specific relationships remain unclear. Objective The aim of this study is to investigate the relationship between medical comorbidities and neurological manifestations in patients with COVID-19. Methods We reviewed medical comorbidities and COVID-19-related central nervous system (CNS) and peripheral nervous system (PNS) manifestations in 484 consecutive patients with COVID-19. Results Neurological manifestations were seen in 345 (71%) of 484 COVID-19 patients. CNS manifestations included headaches (22%), altered mental status (19%), dizziness (8%), gait imbalance (5%), strokes (four patients, <1%), and seizures (two patients, <1%). PNS manifestations included myalgia (31%), hypogeusia (8%), hyposmia (6%), critical illness myopathy (nine patients, 2%), visual disturbance (six patients, 1%), rhabdomyolysis (four patients, <1%), and nerve pain (one patient, <1%). There were 153 (32%) patients with CNS manifestations, 98 (20%) patients with PNS manifestations, and 94 (19%) patients with combined CNS and PNS manifestations. Comorbidities such as cardiac disease (22%), dementia (17%), hypertension (16%), and chronic obstructive pulmonary disease (COPD; 13%) were significantly associated with CNS manifestations. No comorbidities were associated with PNS manifestations. Conclusion Neurological manifestations were common in our sample of 484 COVID-19 patients, with headache and altered mental status being the most common CNS manifestations and myalgia being the most common PNS manifestation. Cardiac disease, dementia, hypertension, and COPD were more common in patients with CNS manifestations. Providers should be vigilant about the possible emergence of CNS manifestations in COVID-19 patients with these comorbid conditions.

A Retrospective Observational Study of Neurological Manifestations in COVID-19 (SON-CoV).

Coronavirus disease 2019 (COVID-19) has neurologic manifestations associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to retrospectively analyze SARS COVID-19 patients with neurological manifestations and identify patterns of presentation including the site of neuroaxis involvement, neuroimaging, and associated systemic involvement. This retrospective observational study was conducted at two tertiary care hospitals in western Rajasthan. Data on age, sex, presenting symptoms, and comorbidities (hypertension, diabetes, cardiac, cerebrovascular disease, and cancer) were collected from 28th February 2020 to 31st December 2020 through medical records, discharge summaries, and radiological studies. Verbal/written patient consent was obtained due to the prevailing COVID-19 norms at the time of the first wave. Major inclusion criteria were as follows: age &gt;18 years, consent from patient/surrogate, positive RT-PCR report in case of active COVID cases, or positive COVID antibody test in case of post-COVID neurological sequelae. All neurological manifestations were reviewed by at least two neurologists and were divided into central nervous system (CNS) and peripheral nervous system (PNS) manifestations. Systemic features and their temporal relationship with neurological features were recorded. Various other specialized assessments and therapeutic interventions were conducted. Statistical analysis was performed using the SPSS software. A Chi-square test was performed to determine the association between variables. Student's t-test and one-way analysis of variance were used to determine differences in mean values. Statistical significance was set at p &lt; 0.05. The mean age was 57.32 years for the CNS group and 40 years for the PNS group (p = 0.025). Age was significantly lower in the PNS group than in the CNS group (p = 0.025). Anemia, leucocytosis, and elevated serum creatinine were more commonly seen in the CNS group, although the difference was not statistically significant. The most common CNS manifestations were stroke (41.8%), of which ischemic stroke constituted 83% of cases, followed by seizure (22%), encephalopathy (20.9%), headache (15.1%), and vertigo (3.8%). The most common PNS manifestation was neuropathy (57%), which included Guillain-Barré syndrome (GBS), critical illness neuropathy, and autonomic neuropathy Conclusion: CNS symptoms of COVID-19 are more common than PNS symptoms. Stroke is the most frequent (46%) COVID-CNS symptom, which occurs in people of age above 35 years and is associated with high mortality.