Acquired peripheral nerve injuries associated with severe COVID-19

Franz, Colin K.; Murthy, Nikhil K.; Malik, George R.; Kwak, Jean Won; D’Andrea, Dom; Wolfe, Alexis R.; Farr, Ellen; Stearns, Melanie; Deshmukh, Swati; Tavee, Jinny; Sun, Fang; Swong, Kevin; Rydberg, Leslie; Cotton, R.; Wolfe, Lisa F.; Walter, James M.; Coleman, John M.; Li, Jinghua

doi:10.1101/2021.09.24.21263996

Cited by 3 publications

(1 citation statement)

References 27 publications

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“…In each case, the patients reported severe dyspnoea post resolution of the COVID-19 infection, but the lung parenchyma were normal on computed tomography images [ 34 , 35 ]. F ranz et al [ 36 ] reports a case series of 32 survivors of severe COVID-19 who suffered peripheral nerve injuries and identified five patients with unilateral phrenic nerve injury. It is quite possible that many other cases of phrenic neuritis post-COVID have been missed since not even all academic centres have access to sonographers with protocols and experience scanning the phrenic nerve and/or diaphragm [ 37 ], which has been reported to be both highly sensitive and specific for the diagnosis of phrenic nerve injuries [ 38 ].…”

Section: Independent Effects Of Covid-19 On Rm Performancementioning

confidence: 99%

The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection results in multiorgan damage primarily mediated by viral infiltration via angiotensin-converting enzyme-2 receptors on the surface of cells. A primary symptom for many patients is exertional dyspnoea which may persist even beyond recovery from the viral infection. Respiratory muscle (RM) performance was hypothesised as a contributing factor to the severity of coronavirus disease 2019 (COVID-19) symptoms, such as dyspnoea, and outcomes. This was attributed to similarities between patient populations at elevated risk for severe COVID-19 symptoms and those with a greater likelihood of baseline RM weakness and the effects of prolonged mechanical ventilation. More recent evidence suggests that SARS-CoV-2 infection itself may cause damage to the RM, and many patients who have recovered report persistent dyspnoea despite having mild cases, normal lung function or undamaged lung parenchyma. These more recent findings suggest that the role of RM in the persistent dyspnoea due to COVID-19 may be more substantial than originally hypothesised. Therefore, screening for RM weakness and providing interventions to improve RM performance appears to be important for patients with COVID-19. This article will review the impact of SARS-CoV-2 infection on RM performance and provide clinical recommendations for screening RM performance and treatment interventions.

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Section: Independent Effects Of Covid-19 On Rm Performancementioning

confidence: 99%

The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training

et al. 2022

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Left brachial plexopathy after prone positioning with COVID-19: a case series

Wunder¹,

Seslija

Liem

2023

UTMJ

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Prone positioning is a strategy shown to reduce mortality in patients who are mechanically ventilated for acute respiratory distress syndrome and has been used in the COVID-19 pandemic. It is not, however, without complications. Barotrauma, pressure sores, ventilator associated pneumonia and peripheral nerve injuries have all been implicated as complications of prone positioning. There have also been several reports of brachial plexopathy in patients who have undergone prolonged mechanical ventilation with prone positioning. Patient characteristics including body weight index, degree of critical illness, and suboptimal prolonged positioning have all been suggested as possible contributing factors, although, there has been less discussion concerning the action of rolling patients, and how it may contribute to the development of injuries. We describe 3 cases of left brachial plexus injury in patients who were consistently rolled on their left sides. Patients presented with isolated left upper extremity weakness without any structural etiology found on imaging. Electrodiagnostic studies subsequently confirmed a left brachial plexopathy in each of the cases. We suggest that the action of proning patients may contribute to injury. This observation has not yet been suggested in the literature, and carries clinical relevance, as greater attention and meticulous care may need to be employed when moving these individuals.

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Peripheral Neuropathy in Patients Recovering from Severe COVID-19: A Case Series

et al. 2022

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Background and Objectives: Neurological manifestations have been reported in a significant proportion of coronavirus disease 2019 (COVID-19) patients. We aimed to evaluate the prevalence and severity of peripheral nervous system (PNS) involvement in a large group of convalescent COVID-19 patients undergoing in-hospital multidisciplinary rehabilitation. Materials and Methods: Convalescent COVID-19 patients admitted to a Pulmonary Rehabilitation Unit were consecutively screened for inclusion within 48 h of discharge from an acute care setting. All included patients underwent electrophysiological examinations. Results: Among 102 enrolled patients (mean age 62.0 years, 82.4% males), PNS electrophysiological alterations were detected in 42.2%. Mononeuropathies exclusively involving the peroneal nerve were observed in 8.8% (n = 9), while multiple mononeuropathies were similarly reported in nine patients (8.8%). A symmetric sensorimotor polyneuropathy was documented in 24.5% of participants (n = 25). A significant difference was found for exercise capacity and pulmonary function in post hoc comparisons between the three study groups. Conclusions: The risk of neuropathy in the convalescent phase of COVID-19 is relevant. This should be considered when planning multidisciplinary rehabilitation strategies.

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Acquired peripheral nerve injuries associated with severe COVID-19

Cited by 3 publications

References 27 publications

The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training

The effects of COVID-19 on respiratory muscle performance: making the case for respiratory muscle testing and training

Left brachial plexopathy after prone positioning with COVID-19: a case series

Peripheral Neuropathy in Patients Recovering from Severe COVID-19: A Case Series

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