ObjectiveTo report 3 patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who developed generalized myoclonus.MethodsPatient data were obtained from medical records from the University Hospital “12 de Octubre,” Madrid, Spain.ResultsThree patients (2 men and 1 woman, aged 63–88 years) presented with mild hypersomnia and generalized myoclonus following the onset of the so-called inflammatory phase of coronavirus disease 2019 (COVID-19). All of them had presented previously with anosmia. Myoclonus was generalized with both positive and negative jerks, predominantly involving the facial, trapezius, sternocleidomastoid, and upper extremities muscles. These myoclonic jerks occurred spontaneously and were extremely sensitive to multisensory stimuli (auditive and tactile) or voluntary movements, with an exaggerated startle response. Other causes of myoclonus were ruled out, and none of the patients had undergone respiratory arrest or significant prolonged hypoxia. All of them improved, at least partially, with immunotherapy.ConclusionsOur 3 cases highlight the occurrence of myoclonus during the COVID-19 pandemic as a post- or para-infectious immune-mediated disorder. However, we cannot rule out that SARS-CoV-2 may spread transneuronally to first- and second-order structures connected with the olfactory bulb. Further investigation is required to clarify the full clinical spectrum of neurologic symptoms and optimal treatment.
OBJECTIVE:To report a case of a patient infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) who acutely developed a hypokinetic-rigid syndrome.METHODS:Patient data were obtained from medical records from the “Hospital Universitario 12 de Octubre” in Madrid, Spain. [123I]-ioflupane dopamine transporter single-photon emission CT (DaT-SPECT) images were acquired 4 hours after a single dose of 185 MBq of 123I-FP-CIT. Quantitative analysis was performed using DaTQUANTTM software providing the specific binding ratio (SBR) and z-score values of the striatum.RESULTS:We report a previously healthy 58-year-old man who developed hyposmia, generalized myoclonus, fluctuating and transient changes in level of consciousness, opsoclonus and an asymmetric hypokinetic-rigid syndrome with ocular abnormalities after a severe SARS-CoV-2 infection. DaT-SPECT confirmed a bilateral decrease in presynaptic dopamine uptake asymmetrically involving both putamina. Significant improvement in the parkinsonian symptoms was observed without any specific treatment.CONCLUSION:This case study provides clinical and functional neuroimaging evidence to support that SARS-CoV-2 can gain access to the central nervous system, affecting midbrain structures and leading to neurological signs and symptoms.
reports no disclosures relevant to the manuscript; Carla Amarante Cuadrado reports no disclosures relevant to the manuscript; Maialen González Arbizu reports no disclosures relevant to the manuscript; Pablo Rábano Suárez reports no disclosures relevant to the manuscript; Fernando Ostos Moliz reports no disclosures relevant to the manuscript; Laura Naranjo reports no disclosures relevant to the manuscript; Lidia Sabater reports no disclosures relevant to the manuscript; Eugenia Martínez-Hernández reports no disclosures relevant to the manuscript; Raquel Ruiz-García reports no disclosures relevant to the manuscript;
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