COVID-19-associated polyneuritis cranialis: Difference between revisions
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==Overview== | ==Overview== | ||
[[Polyneuritis]] cranialis literally means [[inflammation]] of the [[cranial nerves]]. It is a rare [[neurological disorder]] characterised by multiple [[Nerve palsy|cranial nerve palsies]] sparing the [[spinal cord]].<ref name="PavoneIncorpora2007">{{cite journal|last1=Pavone|first1=Piero|last2=Incorpora|first2=Gemma|last3=Romantshika|first3=Olga|last4=Ruggieri|first4=Martino|title=Polyneuritis Cranialis: Full Recovery after Intravenous Immunoglobulins|journal=Pediatric Neurology|volume=37|issue=3|year=2007|pages=209–211|issn=08878994|doi=10.1016/j.pediatrneurol.2007.05.002}}</ref> | |||
==Historical Perspective== | ==Historical Perspective== | ||
*In '''1937''' French physicians Guillain G. et al. first described a [[Infectious disease |postinfectious syndrome]] affecting the [[cranial nerves]], associated with albuminocytological dissociation. The syndrome did not involve the [[limbs]] unlike [[Guillain-Barré syndrome]] and was called 'polyneuritis cranialis'.<ref name="WakerleyYuki2015">{{cite journal|last1=Wakerley|first1=Benjamin R.|last2=Yuki|first2=Nobuhiro|title=Polyneuritis cranialis—subtype of Guillain–Barré syndrome?|journal=Nature Reviews Neurology|volume=11|issue=11|year=2015|pages=664–664|issn=1759-4758|doi=10.1038/nrneurol.2015.115}}</ref> | *In '''1937''' French physicians Guillain G. et al. first described a [[Infectious disease |postinfectious syndrome]] affecting the [[cranial nerves]], associated with albuminocytological dissociation. The syndrome did not involve the [[limbs]] unlike [[Guillain-Barré syndrome]] and was called 'polyneuritis cranialis'.<ref name="WakerleyYuki2015">{{cite journal|last1=Wakerley|first1=Benjamin R.|last2=Yuki|first2=Nobuhiro|title=Polyneuritis cranialis—subtype of Guillain–Barré syndrome?|journal=Nature Reviews Neurology|volume=11|issue=11|year=2015|pages=664–664|issn=1759-4758|doi=10.1038/nrneurol.2015.115}}</ref> | ||
*The first [[COVID-19]] [[outbreak]] news was first published by [[WHO]] on 5th January 2020.<ref name="urlWHO Timeline - COVID-19">{{cite web |url=https://www.who.int/news-room/detail/27-04-2020-who-timeline---covid-19?gclid=EAIaIQobChMIpYj3w_qi6gIVi8myCh04KgZ6EAAYASAAEgJ0yvD_BwE |title=WHO Timeline - COVID-19 |format= |work= |accessdate=}}</ref> | |||
*Since mid-January 2020, right after the start of [[COVID-10|SARS-CoV2]] [[outbreak]] neurological symptoms including the [[peripheral nervous system]] (PNS) symptoms have been reported in China (the first epicenter of the [[pandemic]]).<ref name="MaoWang2020">{{cite journal|last1=Mao|first1=Ling|last2=Wang|first2=Mengdie|last3=Chen|first3=Shanghai|last4=He|first4=Quanwei|last5=Chang|first5=Jiang|last6=Hong|first6=Candong|last7=Zhou|first7=Yifan|last8=Wang|first8=David|last9=Li|first9=Yanan|last10=Jin|first10=Huijuan|last11=Hu|first11=Bo|year=2020|doi=10.1101/2020.02.22.20026500}}</ref> | |||
*[WHO]] declared the [[COVID-19]] [[outbreak]] a [[pandemic]] on March 12, 2020. | |||
*Polyneuritis cralialis associated with [[COVID-19]] was first reported in two [[patients]] by Consuelo Gutiérrez-Ortiz et al. from Madrid, Spain on April 17th, 2020. The team reported both [[Guillain-Barré syndrome classification|Miller Fisher syndrome]] and polyneuritis cranialis in pattients with confirmed [[oropharyngeal]] [[RT PCR]] [[COVID-19]] test.<ref name="Gutiérrez-OrtizMéndez2020">{{cite journal|last1=Gutiérrez-Ortiz|first1=Consuelo|last2=Méndez|first2=Antonio|last3=Rodrigo-Rey|first3=Sara|last4=San Pedro-Murillo|first4=Eduardo|last5=Bermejo-Guerrero|first5=Laura|last6=Gordo-Mañas|first6=Ricardo|last7=de Aragón-Gómez|first7=Fernando|last8=Benito-León|first8=Julián|title=Miller Fisher Syndrome and polyneuritis cranialis in COVID-19|journal=Neurology|year=2020|pages=10.1212/WNL.0000000000009619|issn=0028-3878|doi=10.1212/WNL.0000000000009619}}</ref> | *Polyneuritis cralialis associated with [[COVID-19]] was first reported in two [[patients]] by Consuelo Gutiérrez-Ortiz et al. from Madrid, Spain on April 17th, 2020. The team reported both [[Guillain-Barré syndrome classification|Miller Fisher syndrome]] and polyneuritis cranialis in pattients with confirmed [[oropharyngeal]] [[RT PCR]] [[COVID-19]] test.<ref name="Gutiérrez-OrtizMéndez2020">{{cite journal|last1=Gutiérrez-Ortiz|first1=Consuelo|last2=Méndez|first2=Antonio|last3=Rodrigo-Rey|first3=Sara|last4=San Pedro-Murillo|first4=Eduardo|last5=Bermejo-Guerrero|first5=Laura|last6=Gordo-Mañas|first6=Ricardo|last7=de Aragón-Gómez|first7=Fernando|last8=Benito-León|first8=Julián|title=Miller Fisher Syndrome and polyneuritis cranialis in COVID-19|journal=Neurology|year=2020|pages=10.1212/WNL.0000000000009619|issn=0028-3878|doi=10.1212/WNL.0000000000009619}}</ref> | ||
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==Differentiating COVID-19-associated polyneuritis cranialis from other Diseases== | ==Differentiating COVID-19-associated polyneuritis cranialis from other Diseases== | ||
*COVID-19-associated polyneuritis | *COVID-19-associated polyneuritis cranials must be differentiated from other diseases that cause muscular [[weakness]] and [[ophthalmoparesis]] such as [[COVID-19]] associated [[Guillain-Barré syndrome|GBS]], [[COVID-19]] associated [[stroke]]. | ||
* | *''[[COVID-19]] associated [[Guillain-Barré syndrome]]'' is characterized by loss of [[deep tendon reflexes]]. Sensory and dysautonomic symptoms are also present.<ref name="pmid26948435">{{cite journal |vauthors=Willison HJ, Jacobs BC, van Doorn PA |title=Guillain-Barré syndrome |journal=Lancet |volume=388 |issue=10045 |pages=717–27 |date=August 2016 |pmid=26948435 |doi=10.1016/S0140-6736(16)00339-1 |url=}}</ref> | ||
**[[COVID-19]] associated [[stroke]]: | *Abnormal [[gait]] due to acute [[ataxia|ataxic neuropathy]] is present in ''[[Miller Fisher Syndrome|Miller Fisher type]]'' of [[Guillain-Barré syndrome|GBS]].<ref name="WakerleyYuki2015">{{cite journal|last1=Wakerley|first1=Benjamin R.|last2=Yuki|first2=Nobuhiro|title=Polyneuritis cranialis—subtype of Guillain–Barré syndrome?|journal=Nature Reviews Neurology|volume=11|issue=11|year=2015|pages=664–664|issn=1759-4758|doi=10.1038/nrneurol.2015.115}}</ref> | ||
*''[[COVID-19]] associated [[stroke]]'': | |||
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==Risk Factors== | ==Risk Factors== | ||
* In general More severe patients were likely to have neurologic symptoms | |||
There are no established risk factors for [disease name]. | There are no established risk factors for [disease name]. | ||
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===History and Symptoms=== | ===History and Symptoms=== | ||
The hallmark of polyneuritis cralialis is [[bulbar]] weakness with [[ophthalmoparesis]]. | The hallmark of polyneuritis cralialis is [[bulbar]] weakness with [[ophthalmoparesis]]. There is no [[ataxia]] or [[Hypersomnolence]] as seen in MFS. | ||
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*A positive qualitative real-time [[oropharyngeal]] swab [[RT PCR]] [[COVID-19]] test. | *A positive qualitative real-time [[oropharyngeal]] swab [[RT PCR]] [[COVID-19]] test. | ||
*Albuminocytological dissociation | *Albuminocytological dissociation | ||
*[[COVID-19|SARS-Cov-2]] in the CSF was not found. | |||
===Electrocardiogram=== | ===Electrocardiogram=== | ||
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===X-ray=== | ===X-ray=== | ||
There are no x-ray findings associated with [ | There are no x-ray findings associated with [[COVID-19]]-associated polyneuritis cranialis. | ||
OR | OR | ||
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===Echocardiography or Ultrasound=== | ===Echocardiography or Ultrasound=== | ||
There are no echocardiography/ultrasound | *There are no echocardiography/ultrasound findings associated with [[COVID-19]]-associated polyneuritis cranialis. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of [[COVID-19]] which include [[COVID-19-associated myocardial injury]], [[COVID-19-associated myocardial infarction]], [[COVID-19-associated arrhythmia and conduction system disease]], or [[COVID-19-associated pericarditis]]. | ||
*To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]].<br /> | |||
===CT scan=== | ===CT scan=== | ||
There are no CT scan findings associated with [ | There are no CT scan findings associated with [[COVID-19]]-associated polyneuritis cranialis. | ||
OR | OR | ||
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===MRI=== | ===MRI=== | ||
There are no MRI findings associated with [ | There are no MRI findings associated with [[COVID-19]]-associated polyneuritis cranialis. | ||
OR | OR | ||
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===Other Imaging Findings=== | ===Other Imaging Findings=== | ||
There are no other imaging findings associated with [ | There are no other imaging findings associated with [[COVID-19]]-associated polyneuritis cranialis. | ||
===Other Diagnostic Studies=== | ===Other Diagnostic Studies=== | ||
There are no other diagnostic studies associated with [ | There are no other diagnostic studies associated with [[COVID-19]]-associated polyneuritis cranialis. | ||
==Treatment== | ==Treatment== | ||
===Medical Therapy=== | ===Medical Therapy=== | ||
*The mainstay of therapy for [[COVID-19]]-associated polyneuritis cranialis is [[intravenous]] administration of [[immunoglobulin]] 0.4 g/kg for 5 days. It can be started after the neurological symptoms develop. | |||
*[[COVID-19 medical therapy]] is as important as treating the associated polyneuritis cranialis. | |||
*A few [[patients]] with [[COVID-19]]-associated polyneuritis cranialis may require [[physical therapy]] for residual [[muscle weakness]]. | |||
===Surgery=== | ===Surgery=== | ||
Surgical intervention is not recommended for the management of [ | Surgical intervention is not recommended for the management of [[COVID-19]]-associated polyneuritis cranialis. | ||
===Primary Prevention=== | ===Primary Prevention=== | ||
Revision as of 19:42, 9 July 2020
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COVID-19 Microchapters |
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Diagnosis |
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Treatment |
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Case Studies |
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COVID-19-associated polyneuritis cranialis On the Web |
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American Roentgen Ray Society Images of COVID-19-associated polyneuritis cranialis |
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Risk calculators and risk factors for COVID-19-associated polyneuritis cranialis |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Javaria Anwer M.D.[2]
Synonyms and keywords:
Overview
Polyneuritis cranialis literally means inflammation of the cranial nerves. It is a rare neurological disorder characterised by multiple cranial nerve palsies sparing the spinal cord.[1]
Historical Perspective
- In 1937 French physicians Guillain G. et al. first described a postinfectious syndrome affecting the cranial nerves, associated with albuminocytological dissociation. The syndrome did not involve the limbs unlike Guillain-Barré syndrome and was called 'polyneuritis cranialis'.[2]
- The first COVID-19 outbreak news was first published by WHO on 5th January 2020.[3]
- Since mid-January 2020, right after the start of SARS-CoV2 outbreak neurological symptoms including the peripheral nervous system (PNS) symptoms have been reported in China (the first epicenter of the pandemic).[4]
- [WHO]] declared the COVID-19 outbreak a pandemic on March 12, 2020.
- Polyneuritis cralialis associated with COVID-19 was first reported in two patients by Consuelo Gutiérrez-Ortiz et al. from Madrid, Spain on April 17th, 2020. The team reported both Miller Fisher syndrome and polyneuritis cranialis in pattients with confirmed oropharyngeal RT PCR COVID-19 test.[5]
Classification
There is no established system for the classification of COVID-19 associated polyneuritis cranialis but the disease itself is a Guillain-Barré syndrome-Miller Fisher syndrome interface.[2]
Pathophysiology
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.
Causes
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR
The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click here.
Differentiating COVID-19-associated polyneuritis cranialis from other Diseases
- COVID-19-associated polyneuritis cranials must be differentiated from other diseases that cause muscular weakness and ophthalmoparesis such as COVID-19 associated GBS, COVID-19 associated stroke.
- COVID-19 associated Guillain-Barré syndrome is characterized by loss of deep tendon reflexes. Sensory and dysautonomic symptoms are also present.[6]
- Abnormal gait due to acute ataxic neuropathy is present in Miller Fisher type of GBS.[2]
- COVID-19 associated stroke:
Epidemiology and Demographics
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
Patients of all age groups may develop [disease name].
OR
[Acute disease name] commonly affects [age group].
There is no racial predilection to [disease name].
OR
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
[Disease name] affects men and women equally.
OR
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
The majority of [disease name] cases are reported in [geographical region].
OR
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].
Risk Factors
- In general More severe patients were likely to have neurologic symptoms
There are no established risk factors for [disease name].
OR
The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
OR
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
Screening
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].
Natural History, Complications, and Prognosis
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
OR
Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
Diagnosis
Diagnostic Study of Choice
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
OR
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
OR
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
OR
There are no established criteria for the diagnosis of [disease name].
History and Symptoms
The hallmark of polyneuritis cralialis is bulbar weakness with ophthalmoparesis. There is no ataxia or Hypersomnolence as seen in MFS.
Physical Examination
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
Laboratory Findings
- A positive qualitative real-time oropharyngeal swab RT PCR COVID-19 test.
- Albuminocytological dissociation
- SARS-Cov-2 in the CSF was not found.
Electrocardiogram
There are no ECG findings associated with [disease name].
X-ray
There are no x-ray findings associated with COVID-19-associated polyneuritis cranialis.
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Echocardiography or Ultrasound
- There are no echocardiography/ultrasound findings associated with COVID-19-associated polyneuritis cranialis. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of COVID-19 which include COVID-19-associated myocardial injury, COVID-19-associated myocardial infarction, COVID-19-associated arrhythmia and conduction system disease, or COVID-19-associated pericarditis.
- To view the electrocardiogram findings on COVID-19, click here.
CT scan
There are no CT scan findings associated with COVID-19-associated polyneuritis cranialis.
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
MRI
There are no MRI findings associated with COVID-19-associated polyneuritis cranialis.
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, an MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].
Other Imaging Findings
There are no other imaging findings associated with COVID-19-associated polyneuritis cranialis.
Other Diagnostic Studies
There are no other diagnostic studies associated with COVID-19-associated polyneuritis cranialis.
Treatment
Medical Therapy
- The mainstay of therapy for COVID-19-associated polyneuritis cranialis is intravenous administration of immunoglobulin 0.4 g/kg for 5 days. It can be started after the neurological symptoms develop.
- COVID-19 medical therapy is as important as treating the associated polyneuritis cranialis.
- A few patients with COVID-19-associated polyneuritis cranialis may require physical therapy for residual muscle weakness.
Surgery
Surgical intervention is not recommended for the management of COVID-19-associated polyneuritis cranialis.
Primary Prevention
- The disease itself is associated with COVID-19 infection as believed to be an immune response so prevention of the infection itself is the most promising primary prevention strategy at the moment.
- There have been rigorous efforts in order to develop a vaccine for novel coronavirus and several vaccines are in the later phases of trials.[7]
- The only prevention for COVID-19 associated abdominal pain is the prevention and early diagnosis of the coronavirus-19 infection itself. According to the CDC, the measures include:[8]
- Frequent handwashing with soap and water for at least 20 seconds or using a alcohol based hand sanitizer with at least 60% alcohol.
- 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.
References
- ↑ 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.
- ↑ 2.0 2.1 2.2 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.
- ↑ "WHO Timeline - COVID-19".
- ↑ 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) - ↑ 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.
- ↑ Willison HJ, Jacobs BC, van Doorn PA (August 2016). "Guillain-Barré syndrome". Lancet. 388 (10045): 717–27. doi:10.1016/S0140-6736(16)00339-1. PMID 26948435.
- ↑ "NIH clinical trial of investigational vaccine for COVID-19 begins | National Institutes of Health (NIH)".
- ↑ "How to Protect Yourself & Others | CDC".