Abnormal movements in hospitalized COVID-19 patients: A case series

Clark, Jeffrey R.; Liotta, Eric M.; Reish, Nicholas J.; Shlobin, Nathan A.; Hoffman, Steven C.; Orban, Zachary S.; Lim, Patrick H.; Koralnik, Igor J.; Batra, Ayush

doi:10.1016/j.jns.2021.117377

Cited by 15 publications

(13 citation statements)

References 18 publications

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“…Of the patients undergoing mechanical ventilation, 39 were men (84.78%), and seven were women (15.22%). The mean age was 59.87 ; 59.13 for men, and 64.00 (53)(54)(55)(56)(57)(58)(59)(60)(61)(62)(63)(64)(65)(66)(67)(68)(69)(70)(71)(72) for women. In available detailed data, hyperkinetic movement disorders occurred on average 7.78 days (n = 18, 1-34) after extubation.…”

Section: Resultsmentioning

confidence: 99%

“…These cases were included into a primary group and further analysed in detail. This primary group did not include cases of people undergoing mechanical ventilation, or with significant organic damage to the central nervous system, or in the absence of information as to the identification of the pathogen; a total of 53 cases [12,13,27,40,46,[55][56][57][58][59][60][61][62][63][64]. 46 of them were intubated, three patients did not have a SARS-CoV-2 confirmation test, in two patients the primary diagnosis was a stroke, one case presented with subacute thyroiditis, and one case concerned a patient with multiple system atrophy.…”

Section: Resultsmentioning

confidence: 99%

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Autoimmune mediated hyperkinetic movement disorders in SARS-CoV-2 infection — a systematic review

Hirschfeld

2021

Neurol Neurochir Pol.

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Introduction. Various neurological symptoms have been confirmed in the course of SARS-CoV-2 infection. Some of these are undoubtedly the aftermath of the developing inflammation and increased coagulation processes. However, there is also a group of symptoms that derive from possible autoimmune processes. These include primary hyperkinetic movement disorders such as myoclonus, ataxia, opsoclonus, and tremors. This study systematically reviews scientific reports presenting patients with hyperkinetic movement disorders as one of the neurological symptoms. Material and methods.The available literature was systematically reviewed as per the recommendations of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The PubMed database was used in the range from 1 April, 2020, to 31 July, 2021.Results. The PubMed database search identified 102 cases of patients with SARS-CoV-2 infection who developed hyperkinetic movement disorders. After excluding patients undergoing mechanical ventilation (n = 46) and a few other cases (n = 7), a group of 49 non-intubated patients was obtained. The mean age of the patients was 57.92 years, and 75.51% of the patients were male. The most common hyperkinetic movement disorders were ataxia (83.67%), myoclonus (67.35%), and tremor (30.61%). Symptoms appeared on average within two weeks of the first symptoms of infection. Most patients had symptoms significantly reduced or withdrawn (67.44%) or early partial improvement (30.23%). Conclusions.Based on the meta-analysis, it can be concluded that hyperkinetic movement disorders in the course of SARS--CoV-2 infection are an early symptom with a potential autoimmune background. They have a good prognosis with the applied treatment. Further observations are needed to determine their frequency and the most effective methods of treatment.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Autoimmune mediated hyperkinetic movement disorders in SARS-CoV-2 infection — a systematic review

Hirschfeld

2021

Neurol Neurochir Pol.

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“…Infection-associated myoclonus can often be encountered among patients with severe viral, bacterial, or parasitic infections and is characterized by abrupt, brief, and sometimes repetitive contractions of the trunk, limbs, or face muscles [16,25]. Myoclonus is reportedly the most common movement disorder in hospitalized COVID-19 patients [52]. Given the numerous cases of myoclonus in patients without a remarkable history of abnormal movements (see Table 1) and the close temporal association of myoclonus with COVID-19 symptoms, one could suspect a causal link between the two conditions.…”

Section: Myoclonus and Covid-19mentioning

confidence: 99%

“…Tremor is another type of COVID-19-associated abnormal movement observed in hospitalized COVID-19 patients [52]. We identified 9 cases of tremor occurring in COVID-19 patients, whose clinical and treatment-associated data are described in Table 1 (cases no.…”

Section: Tremor and Covid-19mentioning

confidence: 99%

Movement Disorders Associated with COVID-19

Salari

Harofteh

Etemadifar

et al. 2021

Parkinson's Disease

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As neurological complications associated with COVID-19 keep unfolding, the number of cases with COVID-19-associated de novo movement disorders is rising. Although no clear pathomechanistic explanation is provided yet, the growing number of these cases is somewhat alarming. This review gathers information from 64 reports of de novo movement disorders developing after/during infection with SARS-CoV-2. Three new cases with myoclonus occurring shortly after a COVID-19 infection are also presented. Treatment resulted in partial to complete recovery in all three cases. Although the overall percentage of COVID-19 patients who develop movement disorders is marginal, explanations on a probable causal link have been suggested by numerous reports; most commonly involving immune-mediated and postinfectious and less frequently hypoxic-associated and ischemic-related pathways. The current body of evidence points myoclonus and ataxia out as the most frequent movement disorders occurring in COVID-19 patients. Some cases of tremor, chorea, and hypokinetic-rigid syndrome have also been observed in association with COVID-19. In particular, parkinsonism may be of dual concern in the setting of COVID-19; some have linked viral infections with Parkinson’s disease (PD) based on results from cerebrospinal fluid analyses, and PD is speculated to impact the outcome of COVID-19 in patients negatively. In conclusion, the present paper reviewed the demographic, clinical, and treatment-associated information on de novo movement disorders in COVID-19 patients in detail; it also underlined the higher incidence of myoclonus and ataxia associated with COVID-19 than other movement disorders.

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“…Myoclonus has been quite widely documented as one of the major movement disorder manifestations of cerebral involvement of SARS-CoV-2 infection. 2 This phenomenon may be related not only to hypoxia but also to generalized metabolic factors.…”

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confidence: 99%