COVID-19-Induced Left Sciatic Neuropathy Requiring Prolonged Physical Medicine and Rehabilitation

Abstract

A growing number of case reports and series have described a wide spectrum of neurological manifestations of COVID-19 disease including encephalopathy, cerebrovascular disease, and Guillain-Barre syndrome (GBS). However, peripheral neuropathy associated with COVID-19 disease has been uncommonly reported.Here, we describe a young patient with a COVID-19 infection who developed unilateral sciatic neuropathy during the course of treatment requiring prolonged physical medicine and rehabilitation stay. She was treated in the intensive care unit (ICU) for hypoxic respiratory failure for 22 days total, during which she was intubated, sedated, and paralyzed for 14 days. She received dexamethasone, convalescent plasma, and remdesivir for COVID-19; she also received ceftriaxone and azithromycin for possible superimposed bacterial pneumonia. The hypoxic respiratory failure was improved progressively, and she was extubated. On day 17 of ICU stay, she reported numbness and weakness in left leg and had 0/5 motor strength at the left ankle in all directions. She was able to move left hip and knee and had decreased sensation to light touch and pain from the level of the left knee to the toes. Imaging of the brain and spine showed no obvious findings that would explain the neurological symptoms. On electromyography (EMG), there was acute denervation in the left tibialis anterior muscle. She required prolonged physical medicine and rehabilitation care, greater than 60 days during which she had some improvement in sensation, but remained without ankle movement for two more months. This could be a rare manifestation of COVID-19-induced sciatic mono-neuropathy given her symptoms, EMG reports, clinical exam, and normal imaging studies.

COVID-19 associated unilateral sciatic neuropathy

“…There is a case of painful neuropathy associated with the COVID-19, which is an uncommon type of a neuropathy 4 . A case of sciatic neuropathy was reported by Acharya et al with some similarities to the case we have reported 5 .…”

A COVID-19 e as manifestações em pé e tornozelo: uma revisão integrativa

“…The results were compiled and presented descriptively in Table 1 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) .…”

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

“…Mononeuritis was identified in five patients admitted to the intensive care unit, either brachial or peroneal mononeuritis. There are a few reports in the literature, and they are attributed to vasculitis-like mechanisms of the vasa nervorum ( 43 ). Four patients had polyneuropathy, but because of logistic limitations during the pandemic, we were not able to assess between Guillain-Barre syndrome and other types of neuropathies, such as critical illness polyneuropathy.…”