Diaphragmatic myoclonus due to SARS-CoV-2 infection

Abstract

A wide range of neurological signs and symptoms have been associated with SARS-CoV-2 infection. In the present report, we described two Italian patients diagnosed with diaphragmatic myoclonus after COVID-19. In both cases, mild lymphocytosis at cerebrospinal fluid analysis and no structural brain changes were reported. The pathophysiological origin of the myoclonus in the two cases was different. In case 1, electroencephalogram did not reveal any cortical correlates and brain imaging of the spine was unremarkable, while in case 2, cortical origin of myoclonus was demonstrated. With the present two cases, we confirm and extend the neurological manifestations of SARS-CoV-2 infection. Electronic supplementary material The online version of this article (10.1007/s10072-020-04766-y) contains supplementary material, which is available to authorized users.

Cerebrospinal fluid in COVID-19: A systematic review of the literature

“…CSF pleocytosis may be indicative of infection, inflammation or other CNS injury [ 247 ]. There were 29/409 patients (7%) who had a CSF WBC count of 21–100 cells/μL, all of whom had symptoms that localized to the CNS; 10 (34%) of these patients had CSF RBC counts provided, all of whom had a CSF RBC count of <300 cells/μL; Naz et al described a patient with headache and indicated that CSF was consistent with viral meningitis, but the CSF WBC count was unclear, as it was noted that he had 90 lymphocytes and 10 neutrophils (no units provided so we were unsure if these were percentages or numbers of cells), so we classified these findings as “increased WBC.” [ 10 , [27] , [28] , [29] , 44 , 75 , 79 , [127] , [128] , [129] , 140 , 145 , 154 , 160 , 161 , 170 , 173 , 183 , 184 , 187 , 198 , 205 , 208 , 216 ]

Fig. 3 Cerebrospinal fluid white blood cell count results.

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Myoclonus and cerebellar ataxia associated with COVID-19: a case report and systematic review

“…Including our case report, there were 51 cases of myoclonus or ataxia associated with COVID-19 identified. Of these, 23.5% (12/51) of cases had myoclonus and ataxia [ 9 – 16 ], 35.3% (18/51) of cases had myoclonus without ataxia [ 17 – 23 ], and 41.2% (21/51) of cases had ataxia without myoclonus [ 24 – 40 ]. Demographic information and COVID-19 characteristics are summarized in Table 1 and neurological features, investigations, treatments, and outcomes are summarized in Table 2 .…”

“…In the 21 cases with a clear time of onset for myoclonus, the median latency between COVID-19 symptoms and myoclonus was 13 days (IQR 11–21), with a minimum of 7 days and a maximum of 48 days. All cases, except one case of focal diaphragmatic myoclonus [ 17 ], described multifocal or generalized myoclonus, often involving a combination of the face, upper extremities, and lower extremities. Negative myoclonus was reported in four cases [ 22 , 23 ].…”

Neurological manifestations of coronavirus disease 2019: exploring past to understand present

“…Vascular • Ischemic stroke [ 23 ] • Ischemic stroke[ 1 ] • Ischemic stroke with large vesselocclusion [ 11 , 24 ] • Intracerebral hemorrhage,subarachnoidhemorrhage [ 25 , 26 ] • CVST [ 27 – 29 ] • PRES [ 30 – 33 ] • Microvascular occlusivedisorder [ 34 ] 3. Immunological • ADEM [ 35 ] • MS like illness [ 35 – 38 ] • ADEM[ 15 ] • Post infectious ADEM [ 38 , 39 ] • Acute transverse myelitis [ 40 – 43 ] • Anti-NMDA encephalitis [ 44 ] • Generalized and diaphragmaticmyoclonus [ 45 , 46 ] • Opsoclonus and ocularflutter [ 47 ] 4. Extrapyramidal features • Parkinsonism [ 48 ] • Parkinsonism [ 49 , 50 ] 5.…”

“…• ADEM [35] • MS like illness [35][36][37][38] • ADEM [15] • Post infectious ADEM [38,39] • Acute transverse myelitis [40][41][42][43] • Anti-NMDA encephalitis [44] • Generalized and diaphragmatic myoclonus [45,46] • Opsoclonus and ocular flutter [47]…”