# ent

id: cord-320755-0zpnwl2k
type: GGP
entity:
  interferons 80 and teriflunomide 50 DMTs that neurologists would consider starting and not consider starting in newly diagnosed MS patients are given in Table 2 Overall high efficacy agents


id: cord-279511-s9h1jzzs
type: DISEASE
entity:
  disorders of skeleton muscle i e muscle dystrophies inflammatory myopathies muscle channalopathies neuromuscular junction i


id: cord-285574-i0dh1u5i
type: GGP
entity:
  Parkinson s disease adouble blind randomised controlled trial Mental health physical activity and quality of life in Parkinson s


id: cord-340468-3s3dv88w
type: WORK_OF_ART
entity:
  Plumereau Cécile Cho Tae Hee Buisson Marielle Amaz Camille Cappucci Matteo Derex Laurent Ong Elodie Fontaine Julia


id: cord-338979-ew046wcr
type: PROTEIN
entity:
  interleukin s IL 2 IL 7 granulocyte colony stimulating factor interferon alpha monocyte chemoattractant protein 1 macrophage inflammatory protein 1 alpha


id: cord-338979-ew046wcr
type: CELL_LINE
entity:
  China COVID 19 Presenting as acute ST elevation myocardial infarction Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan China Smell


id: cord-338928-y5l7cf31
type: DISEASE
entity:
  coronavirus swine hemagglutinating encephalomyelitis virus travels via peripheral nerves to the brainstem via trigeminal and vagal sensory nuclei 27 28 29 HCoV OC43 a coronavirus


id: cord-346530-o65m0whe
type: DISEASE
entity:
  confusion cognitive dysfunction memory deficit frontal syndrome psychiatric disorders paranoid delusion hallucinations weakness


id: cord-351896-j6h02ab5
type: CHEMICAL
entity:
  6 right MCA n 6 left internal carotid artery ICA n 2 right ICA n 2 left common carotid artery n 1 basilar artery n 1 left vertebral


id: cord-345200-rxv9batt
type: DISEASE
entity:
  CMV Cytomegalovirus EBV Epstein Barr virus HSV 1 Herpes simplex virus 1 HSV 2 Herpes simplex virus 2 HHV 6 Human herpes virus 6 HPeV Human parechovirus VZV Varicella zoster


# bib

id: cord-005014-qp4rrwr4
author: Martin, R.
date: 1988
txt: ./txt/cord-005014-qp4rrwr4.txt
cache: ./cache/cord-005014-qp4rrwr4.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7088014/
doi: 10.1007/bf00314352
summary:
  The diagnosis is confirmed by high titres of serum and CSF antibodies, specific for Borrelia burgdorferi, which has recently been identified as the aetiological agent of Lyme disease and Bannwarth''s syndrome [2] . The purpose of our study was to answer the questions whether the CSF immunoglobulin G (IgG) in lymphomeningoradiculitis is locally produced, whether its antigen specificity can be determined, and whether the persistence of a specific distribution pattern can be recorded over the course of the disease. In the present study, we used a rapid and sensitive immunoblotting technique [6] to detect and characterize intrathecally produced IgG in five patients suffering from chronic meningoradiculitis (Bannwarth''s syndrome) or radiculomyelitis. The presence of oligoclonal IgG bands in the CSF and not in the serum of patients suffering from meningoradiculitis or radiculomyelitis strongly favours the intrathecal production of these antibodies and was firstly demonstrated by Kriiger et al.

title:
  Persistent intrathecal secretion of oligoclonal, Borrelia burgdorferi-specific IgG in chronic meningoradiculomyelitis

abstract:
  In the cerebrospinal fluid IgG of five patients with lymphomeningoradiculitis (Bannwarth's syndrome) and radiculomyelitis studied by immunoblot technique an oligoclonal pattern was found. Most of these oligoclonal bands were specific for Borrelia burgdorferi. In patients suffering from chronic meningoradiculomyelitis, repeated CSF examination by this technique showed persistent secretion of identical IgG bands. Thus, the specific humoral immune response and the disease activity could be documented over the course of the disease.


id: cord-011302-pfepyvaw
title: The changing face of neurosurgery for the older person
author: Edlmann, Ellie
date: 2020-04-25
txt: ./txt/cord-011302-pfepyvaw.txt
cache: ./cache/cord-011302-pfepyvaw.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7223995/
doi: 10.1007/s00415-020-09854-9
summary:
  In this review, we consider changes in practice and current treatment outcomes in older patients with aneurysmal subarachnoid haemorrhage, traumatic head injury, and haemorrhagic strokes. A recent systematic review of endovascular treatment of ruptured aneurysms in patients aged over 65 reported good outcomes in 66%, with a mortality rate of around 26% at 1 year [36] . Koffijberg analysed the cost-effectiveness of treating ruptured aneurysms in patients aged over 70, identifying key parameters including patient age (and thus life expectancy), good or poor clinical condition on presentation, conservative or occlusive treatment (clipping or coiling) and good or poor outcomes [18] . This is supported by collaborations such as IMPACT (International Mission for Prognosis and Analysis of Clinical Trials in TBI) and CRASH (Corticosteroid Randomisation After Significant Head injury), who have used available evidence to develop prognostic calculators for TBI, where age is a corestratifying component and significantly increases chances of a poor outcome [17, 38] .

abstract:
  Increased life expectancy and illness prevention and treatment have led to a growing population of older patients. These changes in patient population are apparent in neurosurgery; however, relatively little is reported about specific outcomes and prognostication in this group. This review summarises the challenges and management changes occurring in the treatment of three common neurosurgical pathologies; aneurysmal subarachnoid haemorrhage, head injury, and haemorrhagic stroke. A move towards less invasive neurosurgical techniques has implications on the risk–benefit profile of interventions. This creates the opportunity to intervene in older patients with greater co-morbidity, as long as improved outcomes can be evidenced. A critical part of assessing appropriateness for surgical intervention in older patients may be to change from a mindset of age to one of frailty and growing interest in scales assessing this may aid treatment decisions in the future.


id: cord-012560-p5s0p7fd
title: One-year survival of patients with high-grade glioma discharged alive from the intensive care unit
author: Decavèle, Maxens
date: 2020-08-29
txt: ./txt/cord-012560-p5s0p7fd.txt
cache: ./cache/cord-012560-p5s0p7fd.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7456207/
doi: 10.1007/s00415-020-10191-0
summary:
  We sought to quantify 1-year mortality and evaluate the association between mortality and (1) functional status, and (2) management of anticancer therapy in patients with high-grade glioma discharged alive from the intensive care unit. On multivariate logistic regression analysis, two factors were independently associated with lower mortality 1 year after ICU admission: continuation of anticancer therapy after ICU discharge (OR 0.18, 95% CI 0.03-0.75, p = 0.028), and Karnofsky performance status at ICU admission (OR 0.90, 95% CI 0.85-0.95, p < 0.001). The main results of the study can be summarized as follows: in HGG patients discharged alive after an unplanned medical ICU stay (1), we observed a substantial proportion of survivors 1 year after ICU admission (more than one quarter of patients) and most of these patients exhibited relatively favorable performance status even 1 year after ICU admission, (2) continuation of anticancer therapy was possible in almost 50% of patients and was strongly associated with cancer progression and use of corticosteroids at admission, and (3) continuation of anticancer therapy and Karnofsky performance status at admission were associated with higher 1-year survival rates.

abstract:
  INTRODUCTION: Only limited data are available regarding the long-term prognosis of patients with high-grade glioma discharged alive from the intensive care unit. We sought to quantify 1-year mortality and evaluate the association between mortality and (1) functional status, and (2) management of anticancer therapy in patients with high-grade glioma discharged alive from the intensive care unit. PATIENTS AND METHODS: Retrospective observational cohort study of patients with high-grade glioma admitted to two intensive care units between January 2009 and June 2018. Functional status was assessed by the Karnofsky Performance Status. Anticancer therapy after discharge was classified as (1) continued (unchanged), (2) modified (changed or stopped), or (3) initiated (for newly diagnosed disease). RESULTS: Ninety-one high-grade glioma patients (73% of whom had glioblastoma) were included and 78 (86%) of these patients were discharged alive from the intensive care unit. Anticancer therapy was continued, modified, and initiated in 41%, 42%, and 17% of patients, respectively. Corticosteroid therapy at the time of ICU admission [odds ratio (OR) 0.07] and cancer progression (OR 0.09) was independently associated with continuation of anticancer therapy. The mortality rate 1 year after ICU admission was 73%. On multivariate analysis, continuation of anticancer therapy (OR 0.18) and Karnofsky performance status on admission (OR 0.90) were independently associated with lower 1-year mortality. CONCLUSION: The presence of high-grade glioma is not sufficient to justify refusal of intensive care unit admission. Performance status and continuation of anticancer therapy are associated with higher survival after intensive care unit discharge. PREVIOUS PRESENTATION: Preliminary results were presented at the most recent congress of the French Intensive Care Society, Paris, 2019. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10191-0) contains supplementary material, which is available to authorized users.


id: cord-025749-mip9mkef
title: Newly developed stroke in patients admitted to non-neurological intensive care units
author: Jo, Sungyang
date: 2020-06-02
txt: ./txt/cord-025749-mip9mkef.txt
cache: ./cache/cord-025749-mip9mkef.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7264485/
doi: 10.1007/s00415-020-09955-5
summary:
  OBJECTIVE: This study aimed to investigate characteristics and outcomes of newly developed stroke in patients admitted to the non-neurological intensive care units (ICU-onset stroke, IOS). In multivariable analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (adjusted odds ratio [AOR] = 1.04, 95% CI = 1.03−1.06, P < 0.001), prothrombin time (AOR = 0.99, 95% CI = 0.98−0.99, P = 0.013), cardiovascular surgery (AOR = 1.84, 95% CI = 1.34−2.50, P < 0.001), mechanical ventilation (AOR = 6.75, 95% CI = 4.87−9.45, P < 0.001), and extracorporeal membrane oxygenation (AOR = 2.77, 95% CI = 1.62−4.55, P < 0.001) were related to the development of IOS. (Table I The main reasons for delays in stroke recognition included the use of sedative agents following surgery (n = 51) or mechanical ventilation (n = 29), presumed metabolic encephalopathy (n = 18), and missed findings of neurological deficits during routine hourly evaluations (n = 4) (as described for 102 patients who had such a time interval beyond the median time of 8.9 h).

abstract:
  BACKGROUND: Little is known about newly developed stroke in patients admitted to the intensive care unit (ICU). OBJECTIVE: This study aimed to investigate characteristics and outcomes of newly developed stroke in patients admitted to the non-neurological intensive care units (ICU-onset stroke, IOS). METHODS: A consecutive series of adult patients who were admitted to the non-neurological ICU were included in this study. We compared neurological profiles, risk factors, and mortality rates between patients with IOS and those without IOS. RESULTS: Of 18,604 patients admitted to the ICU for non-neurological illness, 218 (1.2%) developed stroke (ischemic, n = 182; hemorrhagic, n = 36). The most common neurological presentation was altered mental status (n = 149), followed by hemiparesis (n = 55), and seizures (n = 28). The most common etiology of IOS was cardioembolism (50% [91/182]) for ischemic IOS and coagulopathy (67% [24/36]) for hemorrhagic IOS. In multivariable analysis, the Acute Physiology and Chronic Health Evaluation II (APACHE II) score (adjusted odds ratio [AOR] = 1.04, 95% CI = 1.03−1.06, P < 0.001), prothrombin time (AOR = 0.99, 95% CI = 0.98−0.99, P = 0.013), cardiovascular surgery (AOR = 1.84, 95% CI = 1.34−2.50, P < 0.001), mechanical ventilation (AOR = 6.75, 95% CI = 4.87−9.45, P < 0.001), and extracorporeal membrane oxygenation (AOR = 2.77, 95% CI = 1.62−4.55, P < 0.001) were related to the development of IOS. Stroke was associated with increased 3-month mortality after hospital discharge (AOR, 2.20; 95% CI, 1.58–3.05; P < 0.001), after adjustment for APACHE II and comorbidities. CONCLUSIONS: Patients who developed IOS had characteristics of initial critical illness and managements performed in the ICU as well as neurological presentations. The occurrence of IOS was related to high morbidity and mortality. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09955-5) contains supplementary material, which is available to authorized users.


id: cord-257310-wqu7t44n
title: Acute necrotizing myelitis and acute motor axonal neuropathy in a COVID-19 patient
author: Maideniuc, Catalina
date: 2020-08-09
txt: ./txt/cord-257310-wqu7t44n.txt
cache: ./cache/cord-257310-wqu7t44n.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10145-6
doi: 10.1007/s00415-020-10145-6
summary:
  A 61-year-old woman with COVID 19 infection developed acute necrotizing myelitis (ANM) and acute motor axonal neuropathy (AMAN), a rare variant of Guillain-Barré syndrome (GBS) without systemic signs of infection. Here we present a unique case of COVID 19 patients with acute necrotizing myelitis (ANM) and acute motor axonal neuropathy (AMAN), a rare variant of Guillain-Barré syndrome (GBS) without systemic signs of infection. However, MRI Cervical spine showed patchy T2 hyperintensities within the central cord extending from below the foreman magnum, proximal Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s0041 5-020-10145 -6) contains supplementary material, which is available to authorized users. The patient had a spinal fluid analysis that showed a hemorrhagic tap (red blood cells 312/mm 3 ) with normal white blood cells (3/mm 3) elevated protein (87 mg/ dl) and glucose (73 mg/dl). Acute necrotizing encephalitis, myelitis and variants of GBS such as axonal, demyelinating, and Miller Fisher Syndrome have been reported with the COVID 19 [2] [3] [4] [5] .

abstract:
  A 61-year-old woman with COVID 19 infection developed acute necrotizing myelitis (ANM) and acute motor axonal neuropathy (AMAN), a rare variant of Guillain-Barré syndrome (GBS) without systemic signs of infection. MRI of the cervical spine demonstrated longitudinally extensive transverse myelitis, and EMG was consistent with the diagnosis of AMAN. CSF testing was negative for SARS-CoV-2. High dose steroids followed by plasma exchange were administered, and the patient made a clinical recovery. Immunotherapy has some role in fastening the improvement of immune-mediated neurological conditions associated with COVID-19. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10145-6) contains supplementary material, which is available to authorized users.


id: cord-260856-15k7pkh5
author: Buchanan, Sarah M.
date: 2020-06-24
txt: ./txt/cord-260856-15k7pkh5.txt
cache: ./cache/cord-260856-15k7pkh5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32583050/
doi: 10.1007/s00415-020-10004-4
summary:
  OBJECTIVE: To explore the value of olfactory identification deficits as a predictor of cerebral β-amyloid status and other markers of brain health in cognitively normal adults aged ~ 70 years. 389 largely healthy and cognitively normal older adults were recruited from the MRC National Survey of Health and Development (1946 British Birth cohort) and investigated for olfactory identification deficits, as measured by the University of Pennsylvania Smell Identification Test. Outcome measures were imaging markers of brain health derived from 3 T MRI scanning (cortical thickness, entorhinal cortex thickness, white matter hyperintensity volumes); (18)F florbetapir amyloid-PET scanning; and cognitive testing results. In the current study, we explored associations between OI and markers of cerebral β-amyloid deposition (using 18 F-florbetapir PET scanning), neurodegeneration, and cognition in a uniquely well-characterised cohort of near identical age drawn from the MRC National Survey of Health and Development (NSHD; the British 1946 birth cohort).

title:
  Olfactory testing does not predict β-amyloid, MRI measures of neurodegeneration or vascular pathology in the British 1946 birth cohort

abstract:
  OBJECTIVE: To explore the value of olfactory identification deficits as a predictor of cerebral β-amyloid status and other markers of brain health in cognitively normal adults aged ~ 70 years. METHODS: Cross-sectional observational cohort study. 389 largely healthy and cognitively normal older adults were recruited from the MRC National Survey of Health and Development (1946 British Birth cohort) and investigated for olfactory identification deficits, as measured by the University of Pennsylvania Smell Identification Test. Outcome measures were imaging markers of brain health derived from 3 T MRI scanning (cortical thickness, entorhinal cortex thickness, white matter hyperintensity volumes); (18)F florbetapir amyloid-PET scanning; and cognitive testing results. Participants were assessed at a single centre between March 2015 and January 2018. RESULTS: Mean (± SD) age was 70.6 (± 0.7) years, 50.8% were female. 64.5% had hyposmia and 2.6% anosmia. Olfaction showed no association with β-amyloid status, hippocampal volume, entorhinal cortex thickness, AD signature cortical thickness, white matter hyperintensity volume, or cognition. CONCLUSION AND RELEVANCE: In the early 70s, olfactory function is not a reliable predictor of a range of imaging and cognitive measures of preclinical AD. Olfactory identification deficits are not likely to be a useful means of identifying asymptomatic amyloidosis. Further studies are required to assess if change in olfaction may be a proximity marker for the development of cognitive impairment. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10004-4) contains supplementary material, which is available to authorized users.


id: cord-262598-zk192s0x
title: Guillain–Barré syndrome in the COVID-19 era: another occasional cluster?
author: Tatu, Laurent
date: 2020-06-23
txt: ./txt/cord-262598-zk192s0x.txt
cache: ./cache/cord-262598-zk192s0x.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32577868/
doi: 10.1007/s00415-020-10005-3
abstract: nan
summary:
  entitled ''Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster?'' [1] . The authors reported an unusual cluster of seven patients affected by Guillain-Barré syndrome (GBS) in an Italian region (Friuli Venezia-Giulia), which coincided with the descending curve of the COVID-19 pandemic. In the public health crisis of March-April 2020, we encountered an unusually high number of GBS cases, admitting seven patients. Some authors report a possible correlation between acute symptomatic COVID-19 infection and GBS [4, 5] . Nevertheless, the issue raised by Gigli''s cases and those in this series is different: an abnormally high frequency of GBS amid the SARS-CoV-2 pandemic in patients without a COVID infection. Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster? Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Guillain-Barré syndrome related to COVID-19 infection


id: cord-263363-2um8ntvi
title: Excess neurological death in New York City after the emergence of COVID-19
author: de Havenon, Adam
date: 2020-07-20
txt: ./txt/cord-263363-2um8ntvi.txt
cache: ./cache/cord-263363-2um8ntvi.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10084-2
doi: 10.1007/s00415-020-10084-2
abstract: nan
summary:
  title: Excess neurological death in New York City after the emergence of COVID-19 Figure 1b shows the concept of excess non-COVID deaths, which averaged 1670/week during 03/21/20-05/30/20. In mid-March 2020, after the rise in COVID-19 infections in NYC, excess non-COVID deaths increased for cerebrovascular and Alzheimer''s disease, but this increase was far less than multiple other causes of death. Lack of widespread COVID-19 testing during this period [4] means that many of the excess non-COVID deaths were likely due to complications from undiagnosed COVID-19. The relatively small 11.8% increase in cerebrovascular death suggests that while stroke may complicate COVID-19 infection, it may not be as fatal as other complications. Despite these limitations, we found that the two most common neurological causes of death, cerebrovascular and Alzheimer''s disease, increased comparatively less than pulmonary, cardiac, and diabetic deaths in NYC during the recent peak of COVID-19 mortality.


id: cord-264647-9r443j3l
title: Spinal epidural abscess in COVID-19 patients
author: Talamonti, G.
date: 2020-09-10
txt: ./txt/cord-264647-9r443j3l.txt
cache: ./cache/cord-264647-9r443j3l.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10211-z
doi: 10.1007/s00415-020-10211-z
summary:
  OBJECTIVE: To report the peculiarity of spinal epidural abscess in COVID-19 patients, as we have observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2. METHODS: We reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we surgically managed over a 2-month period. A primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spread from adjacent infective sites, such as spondylodiscitis, generally occurring in patients with diabetes, obesity, cancer, or other chronic diseases. To our knowledge, cases of spinal epidural abscess in COVID-19 patients have not been reported to date. During the last three months, six patients with SARS-Corona Virus-2 (SARS-COV-2) were referred to us for acute spinal cord syndrome due to primary spinal epidural abscess (SEA) [1] .

abstract:
  OBJECTIVE: To report the peculiarity of spinal epidural abscess in COVID-19 patients, as we have observed an unusually high number of these patients following the outbreak of SARS-Corona Virus-2. METHODS: We reviewed the clinical documentation of six consecutive COVID-19 patients with primary spinal epidural abscess that we surgically managed over a 2-month period. These cases were analyzed for what concerns both the viral infection and the spinal abscess. RESULTS: The abscesses were primary in all cases indicating that no evident infective source was found. A primary abscess represents the rarest form of spinal epidural abscess, which is usually secondary to invasive procedures or spread from adjacent infective sites, such as spondylodiscitis, generally occurring in patients with diabetes, obesity, cancer, or other chronic diseases. In all cases, there was mild lymphopenia but the spinal abscess occurred regardless of the severity of the viral disease, immunologic state, or presence of bacteremia. Obesity was the only risk factor and was reported in two patients. All patients but one were hypertensive. The preferred localizations were cervical and thoracic, whereas classic abscess generally occur at the lumbar level. No patient had a history of pyogenic infection, even though previous asymptomatic bacterial contaminations were reported in three cases. CONCLUSION: We wonder about the concentration of this uncommon disease in such a short period. To our knowledge, cases of spinal epidural abscess in COVID-19 patients have not been reported to date. We hypothesize that, in our patients, the spinal infection could have depended on the coexistence of an initially asymptomatic bacterial contamination. The well-known COVID-19-related endotheliitis might have created the conditions for retrograde bacterial invasion to the correspondent spinal epidural space. Furthermore, spinal epidural abscess carries a significantly high morbidity and mortality. It is difficult to diagnose, especially in compromised COVID-19 patients but should be kept in mind as early diagnosis and treatment are crucial.


id: cord-266135-jbc9nml0
title: Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient
author: Princiotta Cariddi, Lucia
date: 2020-06-24
txt: ./txt/cord-266135-jbc9nml0.txt
cache: ./cache/cord-266135-jbc9nml0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10001-7
doi: 10.1007/s00415-020-10001-7
summary:
  title: Reversible Encephalopathy Syndrome (PRES) in a COVID-19 patient Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2. Brain CT and CTA were consistent with hemorrhagic Posterior Reversible Encephalopathy Syndrome (PRES; Fig. 1a, b) . Posterior reversible encephalopathy syndrome in infection, sepsis, and shock Posterior reversible encephalopathy syndrome (PRES) and infection: a systematic review of the literature Hemorrhagic posterior reversible encephalopathy syndrome as a manifestation of COVID-19 infection

abstract:
  Recently WHO has declared novel coronavirus disease 2019 (COVID-19) outbreak a pandemic. Acute respiratory syndrome seems to be the most common manifestation of COVID-19. Besides pneumonia, it has been demonstrated that SARS-CoV-2 infection affects multiple organs, including brain tissues, causing different neurological manifestations, especially acute cerebrovascular disease (ischemic and hemorrhagic stroke), impaired consciousness and skeletal muscle injury. To our knowledge, among neurological disorders associated with SARS-CoV2 infection, no Posterior Reversible Encephalopathy Syndrome (PRES) has been described yet. Herein, we report a case of a 64-year old woman with COVID19 infection who developed a PRES, and we suggest that it could be explained by the disruption of the blood brain barrier induced by the cerebrovascular endothelial dysfunction caused by SARS-CoV-2.


id: cord-266923-hd1tjj6b
title: Guillain-Barré syndrome following COVID-19: new infection, old complication?
author: Padroni, Marina
date: 2020-04-24
txt: ./txt/cord-266923-hd1tjj6b.txt
cache: ./cache/cord-266923-hd1tjj6b.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-09849-6
doi: 10.1007/s00415-020-09849-6
abstract: nan
summary:
  Taking together all these findings, the causal association between GBS and COVID-19 remains speculative, but more probable, given that GBS and Bickerstaff''s encephalitis have been already described as postinfectious complications of other coronavirus, sharing similarities with SARS-CoV-2 (Middle East respiratory syndrome, MERS-CoV) [11] . If our hypothesis will be confirmed in larger case series, neurologists and other clinicians should be aware of the important early recognition and treatment of the potential neuromuscular and autonomic worsening leading to cardio-respiratory failure in patients with GBS and mild or controlled pulmonary COVID-19 Notwithstanding the causative relationship remains unproved, we believe that our case description provide further evidence to the heterogenous and multi-systemic complications associated with SARS-CoV-2. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study Guillain-Barré syndrome associated with SARS CoV-2 infection: causality or coincidence Toscana virus associated with Guillain-Barré syndrome: a case-control study


id: cord-267624-v6e9zzfg
title: Impact of the COVID-19 outbreak on acute stroke care
author: Rinkel, L. A.
date: 2020-07-20
txt: ./txt/cord-267624-v6e9zzfg.txt
cache: ./cache/cord-267624-v6e9zzfg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32691235/
doi: 10.1007/s00415-020-10069-1
summary:
  We included consecutive patients who presented to the emergency departments with a suspected stroke and assessed the change in number of patients as an incidence-rate ratio (IRR) using a Poisson regression analysis. We assessed the impact of the COVID-19 outbreak on trends in hospital admissions for (suspected) stroke, patient characteristics, and workflow parameters of acute stroke care in Amsterdam, the Netherlands. Study outcomes were: (1) change in the number of emergency department presentations; (2) change in proportion of stroke patients treated with IVT and EVT; (3) change in IVT and EVT treatment times; and (4) in-hospital complications. We observed a 24% decrease in the number of patients with a suspected stroke in the hospitals in the Amsterdam area during the height of the COVID-19 outbreak compared to a pre-COVID-19 control period. In summary, we found a substantial decrease in the number of suspected stroke presentations during the COVID-19 outbreak in the Amsterdam area, but no evidence for a change in quality of acute stroke care.

abstract:
  BACKGROUND AND PURPOSE: There are concerns that the coronavirus disease 2019 (COVID-19) outbreak negatively affects the quality of care for acute cardiovascular conditions. We assessed the impact of the COVID-19 outbreak on trends in hospital admissions and workflow parameters of acute stroke care in Amsterdam, The Netherlands. METHODS: We used data from the three hospitals that provide acute stroke care for the Amsterdam region. We compared two 7-week periods: one during the peak of the COVID-19 outbreak (March 16th–May 3th 2020) and one prior to the outbreak (October 21st–December 8th 2019). We included consecutive patients who presented to the emergency departments with a suspected stroke and assessed the change in number of patients as an incidence-rate ratio (IRR) using a Poisson regression analysis. Other outcomes were the IRR for stroke subtypes, change in use of reperfusion therapy, treatment times, and in-hospital complications. RESULTS: During the COVID-19 period, 309 patients presented with a suspected stroke compared to 407 patients in the pre-COVID-19 period (IRR 0.76 95%CI 0.65–0.88). The proportion of men was higher during the COVID-19 period (59% vs. 47%, p < 0.001). There was no change in the proportion of stroke patients treated with intravenous thrombolysis (28% vs. 30%, p = 0.58) or endovascular thrombectomy (11% vs 12%, p = 0.82) or associated treatment times. Seven patients (all ischemic strokes) were diagnosed with COVID-19. CONCLUSION: We observed a 24% decrease in suspected stroke presentations during the COVID-19 outbreak, but no evidence for a decrease in quality of acute stroke care.


id: cord-268572-uhak283t
title: Control of SARS-CoV-2 infection in rituximab-treated neuroimmunological patients
author: Woo, Marcel S.
date: 2020-07-11
txt: ./txt/cord-268572-uhak283t.txt
cache: ./cache/cord-268572-uhak283t.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10046-8
doi: 10.1007/s00415-020-10046-8
abstract: nan
summary:
  title: Control of SARS-CoV-2 infection in rituximab-treated neuroimmunological patients However, few details about the effect of individual immunotherapies have been reported, which could instruct us about the immunological control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Here, we report on two individuals with underlying neuroimmunological diseases who were under stable rituximab therapy-a B cell-depleting monoclonal antibody [6, 7] -when confirmed COVID-19 developed. Patient 2 was a 68-year-old female with neuromyelitis optica spectrum disorder (NMOSD, diagnosed 2014, EDSS 6.0), who was directly admitted to our intensive care unit (ICU) on March 29th, 2020 with progressive respiratory failure and infection of the urinary tract. She had a B cell count of 25/µL (Ref. 80-500/µL, Supplementary Table 2) at the day of admission and tested negative for SARS-CoV-2-specific antibodies (3.5 AU/mL; Ref. In summary, we report on two patients who developed COVID-19 while under treatment with rituximab due to neuroimmunological diseases. Antibody responses to SARS-CoV-2 in patients with COVID-19


id: cord-270596-31g9hlm9
author: Bracaglia, Martina
date: 2020-06-25
txt: ./txt/cord-270596-31g9hlm9.txt
cache: ./cache/cord-270596-31g9hlm9.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10014-2
doi: 10.1007/s00415-020-10014-2
abstract: nan
summary:
  To our knowledge, this is the first case of GBS in patient with asymptomatic COVID-19 and laboratory tests consistent with SARS-COV-2 infection. Interesting in our case a patient asymptomatic for COVID-19 develops neurological impairment as a unique clinical event, probably as part of dysimmune process. We believe this association may not be a coincidence, more cases could be evaluated, possibly supported by serological and CSF tests, and underlines the importance of looking for neurological impairment in COVID-19 disease and address the correct treatment, such as IvIg, also for respiratory function worsening independently from pneumonitis. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Guillain-Barré syndrome associated with SARS-CoV-2 infection Early Guillain-Barré syndrome in Coronavirus Disease 2019 (COVID-19): a case report from an Italian COVID-hospital Facial diplegia, a possible atypical variant of Guillain-Barré Syndrome as a rare neurological complication of SARS-CoV-2 Guillan-Barré syndrome associated with COVID-19 infection: A case report

title:
  Acute inflammatory demyelinating polyneuritis in association with an asymptomatic infection by SARS-CoV-2


id: cord-279511-s9h1jzzs
author: Di Stefano, Vincenzo
date: 2020-07-13
txt: ./txt/cord-279511-s9h1jzzs.txt
cache: ./cache/cord-279511-s9h1jzzs.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10064-6
doi: 10.1007/s00415-020-10064-6
summary:
  title: Significant reduction of physical activity in patients with neuromuscular disease during COVID-19 pandemic: the long-term consequences of quarantine Hence, the aim of this study was to estimate the levels of PA, measured as energy expenditure (MET–minute/week), among patients with neuromuscular disease (NMD) before and during the last week of quarantine. In healthy controls, a significant reduction of PA was reported during quarantine compared to before quarantine for vigorous-intensity PA (p = 0.04), moderate-intensity PA (p = 0.01), walking activity (p < 0.0001), total PA level (p < 0.0001) and MVPA level (p = 0.001). Finally, it has to be considered that a more sensible muscle mass loss is reported following physical inactivity in older people and in neuromuscular disease, compared to healthy young subjects [10, 13] . This was in agreement with a recent study that reported a high level of total weekly energy expenditure before the COVID-19 quarantine in healthy subjects [25] .

title:
  Significant reduction of physical activity in patients with neuromuscular disease during COVID-19 pandemic: the long-term consequences of quarantine

abstract:
  BACKGROUND: Quarantine was the measure taken by governments to control the rapid spread of COVID-19. This restriction resulted in a sudden change in people’s lifestyle, leading to an increase in sedentary behavior and a related decrease in the practice of physical activity (PA). However, in neuromuscular diseases patients need to perform regular PA to counteract the negative consequences of the disease. Hence, the aim of this study was to estimate the levels of PA, measured as energy expenditure (MET–minute/week), among patients with neuromuscular disease (NMD) before and during the last week of quarantine. METHODS: A total of 268 Italian subjects, living in Sicily, completed an adapted version of the IPAQ-SF. Participants comprised 149 NMD, enrolled at the Neuromuscular Clinic of Palermo and 119 healthy subjects (control group). The SF-12 questionnaire was also administered to NMD. The Mann–Whitney U and the Kruskal–Wallis rank-sum tests were used for statistical analyses. RESULTS: We observed a significant decrease of the total weekly PA level during COVID-19 quarantine in both patients and controls. Moreover, a significant difference in the total weekly PA level was found depending on the presence of neuromuscular disease, impaired walking, gender and BMI. Finally, we found a correlation between SF-12 scores and the entity of the reduction of PA level during quarantine, thus confirming a relevant association with the quality of life in NMD. CONCLUSION: Our study confirmed that COVID-19 quarantine has affected the practice of PA among both NMD and healthy controls.


id: cord-285574-i0dh1u5i
author: Ferini-Strambi, Luigi
date: 2020-07-21
txt: ./txt/cord-285574-i0dh1u5i.txt
cache: ./cache/cord-285574-i0dh1u5i.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10070-8
doi: 10.1007/s00415-020-10070-8
summary:
  The main goal of this viewpoint review is to assess the vulnerability to SARS-CoV-2 infection and development of COVID-19 among neurological disorders with different pathogenesis and age-related targets such as neurodegenerative vs neuroimmunological diseases. Since SARS-CoV-2 effects on neurodegenerative, as well as neuroimmune diseases, might vary across the different pathogenesis and clinical features, we consider the evidence within three sections: (i) vulnerability to the infection; (ii) modification of the clinical course of disease, in relation to clinical neurological manifestations, disease progression and innovative strategies, to support clinicians in the management of the disease; (iii) trigger for future neurodegeneration. Taken together, these findings suggest that although PD patients may represent a particularly vulnerable population for age-related target, respiratory muscle rigidity related to the disease, and presence of several comorbidities, PD by itself do not appears increase the risk of being infected by SARS-CoV-2 and developing COVID-19 ( Fig. 1) .

title:
  COVID-19 and neurological disorders: are neurodegenerative or neuroimmunological diseases more vulnerable?

abstract:
  Neurological disorders and coronavirus 2019 (COVID-19) pandemic are two conditions with a recent well-documented association. Intriguing evidences showed that COVID-19 infection can modify clinical spectrum of manifested neurological disorders but also it plays a crucial role in the development of future diseases as long-tem consequences. In this viewpoint review, we aimed to assess the vulnerability to SARS-CoV-2 infection and development of COVID-19 among neurological disorders. With this in mind, we tested the hypothesis that age rather than neuropathology itself could be decisive in neurodegenerative diseases such as Parkinson’s disease, whereas neuropathology rather than age may be critical in neuroimmunological diseases such as Multiple Sclerosis. Highlighting the role of potential susceptibility or protection factors from this disastrous infection, we also stratify the risk for future neurodegeneration.


id: cord-298894-t5hyfum3
author: Rifino, Nicola
date: 2020-10-07
txt: ./txt/cord-298894-t5hyfum3.txt
cache: ./cache/cord-298894-t5hyfum3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10251-5
doi: 10.1007/s00415-020-10251-5
summary:
  Neurological manifestations were classified as: (a) cerebrovascular disease [53 pts (38.7%)] including 37 ischemic and 11 haemorrhagic strokes, 4 transient ischemic attacks, 1 cerebral venous thrombosis; (b) peripheral nervous system diseases [31 (22.6%)] including 17 Guillain–Barrè syndromes; (c) altered mental status [49 (35.8%)] including one necrotizing encephalitis and 2 cases with RT-PCR detection of SARS-Cov-2 RNA in CSF; (d) miscellaneous disorders, among whom 2 patients with myelopathy associated with Ab anti-SARS-CoV-2 in CSF. COVID-19 diagnosis was confirmed: (1) by real-time reverse-transcriptase polymerase-chain-reaction (RT-PCR) on nasopharyngeal specimens [13] ; or (2) by RT-PCR on bronchoalveolar lavage (BAL) obtained by bronchoscopy in case of high clinical suspicion of SARS-CoV-2 infection and negative test results on at least two nasopharyngeal swabs performed at least 24 h apart; or (3) in the presence of characteristic radiological interstitial pneumonia associated with typical symptoms (fever, dry cough, dyspnea), even with negative RT-PCR, with no other possible aetiologic explanation.

title:
  Neurologic manifestations in 1760 COVID-19 patients admitted to Papa Giovanni XXIII Hospital, Bergamo, Italy

abstract:
  OBJECTIVES: Evidences from either small series or spontaneous reporting are accumulating that SARS-CoV-2 involves the Nervous Systems. The aim of this study is to provide an extensive overview on the major neurological complications in a large cohort of COVID-19 patients. METHODS: Retrospective, observational analysis on all COVID-19 patients admitted from February 23rd to April 30th, 2020 to ASST Papa Giovanni XXIII, Bergamo, Italy for whom a neurological consultation/neurophysiological assessment/neuroradiologic investigation was requested. Each identified neurologic complication was then classified into main neurologic categories. RESULTS: Of 1760 COVID-19 patients, 137 presented neurologic manifestations that manifested after COVID-19 symptoms in 98 pts and was the presenting symptom in 39. Neurological manifestations were classified as: (a) cerebrovascular disease [53 pts (38.7%)] including 37 ischemic and 11 haemorrhagic strokes, 4 transient ischemic attacks, 1 cerebral venous thrombosis; (b) peripheral nervous system diseases [31 (22.6%)] including 17 Guillain–Barrè syndromes; (c) altered mental status [49 (35.8%)] including one necrotizing encephalitis and 2 cases with RT-PCR detection of SARS-Cov-2 RNA in CSF; (d) miscellaneous disorders, among whom 2 patients with myelopathy associated with Ab anti-SARS-CoV-2 in CSF. Patients with peripheral nervous system involvement had more frequently severe ARDS compared to patients with cerebrovascular disease (87.1% vs 42%; difference = 45.1% 95% CI 42.0–48.2; χ(2)= 14.306; p < 0.0002) and with altered mental status (87.1% vs 55.6%; difference = 31.5% 95% CI 27.5–37.5%; χ(2)= 7.055; p < 0.01). CONCLUSION: This study confirms that involvement of nervous system is common in SARS-CoV-2 infection and offers clinicians useful information for prevention and prompt identification in order to set the adequate therapeutic strategies.


id: cord-301162-ux40twpt
title: The emotional impact of the COVID-19 pandemic on individuals with progressive multiple sclerosis
author: Chiaravalloti, Nancy D.
date: 2020-08-19
txt: ./txt/cord-301162-ux40twpt.txt
cache: ./cache/cord-301162-ux40twpt.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10160-7
doi: 10.1007/s00415-020-10160-7
summary:
  During study closure, a COVID Impact Survey was administered via telephone or email to all participants, along with measures of depressive symptoms, anxiety symptoms, quality of life, and MS symptomatology that were previously administered pre-pandemic. All participants additionally completed selected Patient-Reported Outcomes (PROs) that were previously administered at study enrollment (baseline) to evaluate changes in depression, anxiety, quality of life (QOL), and MS symptomatology during the time period in which lockdown restrictions were in place. Despite the fact that the majority of participants reported some impact of the virus on their psychological well-being on the COVID Impact Interview, we saw little change in regard to symptoms of depression and anxiety and overall QOL on standardized PROs. The international composition of our sample indicates that these findings are largely consistent across widely dispersed geographical locations.

abstract:
  OBJECTIVE: Individuals with pre-existing chronic illness have shown increased anxiety and depression due to COVID-19. Here, we examine the impact of the COVID-19 pandemic on emotional symptomatology and quality of life in individuals with Progressive Multiple Sclerosis (PMS). METHODS: Data were obtained during a randomized clinical trial on rehabilitation taking place at 11 centers in North America and Europe. Participants included 131 individuals with PMS. Study procedures were interrupted in accordance with governmental restrictions as COVID-19 spread. During study closure, a COVID Impact Survey was administered via telephone or email to all participants, along with measures of depressive symptoms, anxiety symptoms, quality of life, and MS symptomatology that were previously administered pre-pandemic. RESULTS: 4% of respondents reported COVID-19 infection. No significant changes were noted in anxiety, quality of life, or the impact of MS symptomatology on daily life from baseline to lockdown. While total HADS-depression scores increased significantly at follow-up, this did not translate into more participants scoring above the HADS threshold for clinically significant depression. No significant relationships were noted between disease duration, processing speed ability or EDSS, and changes in symptoms of depression or anxiety. Most participants reported the impact of the virus on their psychological well-being, with a little impact on financial well-being. The perceived impact of the pandemic on physical and psychological well-being was correlated with the impact of MS symptomatology on daily life, as well as changes in depression. CONCLUSIONS: Overall, little change was noted in symptoms of depression or anxiety or overall quality of life.


id: cord-302062-wqmynngg
title: Large artery ischemic stroke in severe COVID-19
author: Sierra-Hidalgo, Fernando
date: 2020-06-27
txt: ./txt/cord-302062-wqmynngg.txt
cache: ./cache/cord-302062-wqmynngg.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32594301/
doi: 10.1007/s00415-020-09967-1
abstract: nan
summary:
  title: Large artery ischemic stroke in severe COVID-19 Among hospitalized patients, stroke occurred a median of 5.5 days after admission (IQR 3.5-7.5). Only one patient met definite TOAST criteria for the diagnosis of large artery atherosclerotic infarction, and another one had a probably cardioembolic stroke due to preexisting atrial fibrillation (incomplete evaluation) [2] . None of the other six patients met diagnostic criteria for atherosclerotic, cardioembolic, or small vessel ischemic stroke (three with cryptogenic strokes, and three with incomplete evaluation). In this series of eight patients, although the evidence is limited by its observational nature and sample size, severe COVID-19 was associated with non-atherosclerotic, large artery ischemic strokes. If larger prospective studies confirm these observations, hypercoagulability associated with COVID-19 might be a contributory cause for large vessel ischemic stroke. Until robust evidence is available, the observation of intraarterial thrombi in the absence of significant atherosclerosis among these patients warrants consideration of individualized enhanced thromboprophylaxis for hospitalized patients with severe forms of SARS-CoV-2 infection.


id: cord-308288-3ewdy5l3
author: Domingues, Renan Barros
date: 2020-06-20
txt: ./txt/cord-308288-3ewdy5l3.txt
cache: ./cache/cord-308288-3ewdy5l3.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-09996-w
doi: 10.1007/s00415-020-09996-w
summary:
  However, no case has been described of an association between the novel coronavirus (SARS-COV-2) and CNS demyelinating disease so far. Here, we report a case of a patient with mild respiratory symptoms and neurological manifestations compatible with clinically isolated syndrome. The viral genome of SARS-COV-2 was detected and sequenced in CSF with 99.74–100% similarity between the patient virus and worldwide sequences. This report suggests a possible association of SARS-COV-2 infection with neurological symptoms of demyelinating disease, even in the absence of relevant upper respiratory tract infection signs. The viral genome was demonstrated by RT-PCR technique in cerebrospinal fluid sample (CSF), suggesting that the virus has the ability to infect central nervous system (CNS) [1] . However, no case has been described of an association between SARS-COV-2 and CNS demyelinating disease so far. This case report suggests a possible association between CNS focal symptoms compatible with demyelinating disease and SARS-COV-2 infection.

title:
  First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease

abstract:
  The association between coronaviruses and central nervous system (CNS) demyelinating lesions has been previously shown. However, no case has been described of an association between the novel coronavirus (SARS-COV-2) and CNS demyelinating disease so far. SARS-COV-2 was previously detected in cerebrospinal fluid (CSF) sample of a patient with encephalitis. However, the virus identity was not confirmed by deep sequencing of SARS-COV-2 detected in the CSF. Here, we report a case of a patient with mild respiratory symptoms and neurological manifestations compatible with clinically isolated syndrome. The viral genome of SARS-COV-2 was detected and sequenced in CSF with 99.74–100% similarity between the patient virus and worldwide sequences. This report suggests a possible association of SARS-COV-2 infection with neurological symptoms of demyelinating disease, even in the absence of relevant upper respiratory tract infection signs.


id: cord-312167-d16ylykc
author: Lazzarin, Serena Marita
date: 2020-11-03
txt: ./txt/cord-312167-d16ylykc.txt
cache: ./cache/cord-312167-d16ylykc.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/33141250/
doi: 10.1007/s00415-020-10296-6
abstract: nan
summary:
  title: Successful treatment of HIV-associated tumefactive demyelinating lesions with corticosteroids and cyclophosphamide: a case report Two days after the last dose, a follow-up brain MRI showed dimensional decrease of both frontal lesions, with disappearance of mass effect; gadolinium enhancement was substantially decreased (Fig. 1 ). A clinical and neuroradiological 6-month follow-up has been scheduled to assess the stability of patient''s condition; [4] , but we cannot even exclude a direct role for HIV in the demyelinating process. Based on our experience, a treatment with cyclophosphamide may be a valid alternative in steroid-resistant HIV patients with TDLs. Author contributions SML contributed to paper conception, data collection, analysis and interpretation, literature review and paper drafting. Fig. 1 (1) Serial 1.5-T MRI axial brain scans, performed after admission (a), at one (b) and 3 months (c) after the clinical onset of a frontal lobe syndrome due to large tumefactive demyelinating lesions.

title:
  Successful treatment of HIV-associated tumefactive demyelinating lesions with corticosteroids and cyclophosphamide: a case report


id: cord-319805-b6ypt5d0
title: Association of history of cerebrovascular disease with severity of COVID-19
author: Siepmann, Timo
date: 2020-08-06
txt: ./txt/cord-319805-b6ypt5d0.txt
cache: ./cache/cord-319805-b6ypt5d0.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32761508/
doi: 10.1007/s00415-020-10121-0
summary:
  We systematically searched electronic databases including MEDLINE (accessed by PubMed), EMBASE and Cochrane Library for identification of all available observational studies that reported on laboratory-confirmed COVID-19 patients aged ≥18 years with information given on disease severity and past history of CVD. Multivariable logistic regression was performed to explore the predictive value of history of CVD for severity outcomes of COVID-19 including clinical severity according to the classification by the National Health Commission guidelines on the Diagnosis and Treatment of COVID-19, in-hospital death and necessity of intensive care [10]. When considering only published data from Chinese cohorts in pooled analysis (n = 1805), history of CVD was also associated with increased risk of severity of COVID-19 (RR 2.39, 95% CI 1.94-2.94; p < 0.0001) with similar results on sensitivity analyses for study-specific severity outcomes (clinical parameters: RR 1.83, 95% CI 1.28-2.63; p = 0.001; necessity of intensive care: RR 2.9, 95% CI 1.61-5.24; p < 0.0001 and in-hospital death: RR 2.14, 95% CI 1.7-2.7; p < 0.0001).

abstract:
  OBJECTIVE: To determine whether a history of cerebrovascular disease (CVD) increases risk of severe coronavirus disease 2019 (COVID-19). METHODS: In a retrospective multicenter study, we retrieved individual data from in-patients treated March 1 to April 15, 2020 from COVID-19 registries of three hospitals in Saxony, Germany. We also performed a systematic review and meta-analysis following PRISMA recommendations using PubMed, EMBASE, Cochrane Library databases and bibliographies of identified papers (last search on April 11, 2020) and pooled data with those deriving from our multicenter study. Of 3762 records identified, 11 eligible observational studies of laboratory-confirmed COVID-19 patients were included in quantitative data synthesis. Risk ratios (RR) of severe COVID-19 according to history of CVD were pooled using DerSimonian and Laird random effects model. Between-study heterogeneity was assessed using Cochran’s Q and I2-statistics. Severity of COVID-19 according to definitions applied in included studies was the main outcome. Sensitivity analyses were conducted for clusters of studies with equal definitions of severity. RESULTS: Pooled analysis included data from 1906 laboratory-confirmed COVID-19 patients (43.9% females, median age ranging from 39 to 76 years). Patients with previous CVD had higher risk of severe COVID-19 than those without [RR 2.07, 95% confidence interval (CI) 1.52–2.81; p < 0.0001]. This association was also observed in clusters of studies that defined severe manifestation of the disease by clinical parameters (RR 1.44, 95% CI 1.22–1.71; p < 0.0001), necessity of intensive care (RR 2.79, 95% CI 1.83–4.24; p < 0.0001) and in-hospital death (RR 2.18, 95% CI 1.75–2.7; p < 0.0001). CONCLUSION: A history of CVD might constitute an important risk factor of unfavorable clinical course of COVID-19 suggesting a need of tailored infection prevention and clinical management strategies for this population at risk. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10121-0) contains supplementary material, which is available to authorized users.


id: cord-320149-3q4q98a6
author: Di Carlo, Davide Tiziano
date: 2020-08-01
txt: ./txt/cord-320149-3q4q98a6.txt
cache: ./cache/cord-320149-3q4q98a6.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-09978-y
doi: 10.1007/s00415-020-09978-y
summary:
  An increasing body of evidence suggests that patients with the coronavirus disease (COVID-19) might have a heterogeneous spectrum of neurological symptoms METHODS: A systematic search of two databases was performed for studies published up to May 29th, 2020. The pathophysiology of this association is under investigation and warrants additional studies, Physicians should be aware of this possible association because during the epidemic period of COVID-19, early recognition of neurologic manifestations otherwise not explained would raise the suspect of acute respiratory syndrome coronavirus 2 infection. Our systematic review of 2499 patients reported the occurrence of a wide spectrum of neurologic complications in hospitalized patients with laboratory-confirmed COVID-19 infection, supporting the possible neuroinvasive potential of SARS-CoV-2. Recently, several case reports described the occurrence of ischemic and hemorrhagic stroke (see supplementary material 1), confirming the association of cerebrovascular complications with severe COVID-19 infection, older age, and the presence of multiple comorbidity [46, 47] .

title:
  Exploring the clinical association between neurological symptoms and COVID-19 pandemic outbreak: a systematic review of current literature

abstract:
  OBJECT: The novel severe acute respiratory syndrome (SARS)-CoV-2 outbreak has been declared a pandemic in March, 2020. An increasing body of evidence suggests that patients with the coronavirus disease (COVID-19) might have a heterogeneous spectrum of neurological symptoms METHODS: A systematic search of two databases was performed for studies published up to May 29th, 2020. PRISMA guidelines were followed. RESULTS: We included 19 studies evaluating 12,157 patients with laboratory-confirmed COVID-19 infections. The median age of patients was 50.3 (IQR 11.9), and the rate of male patients was 50.6% (95% CI 49.2–51.6%). The most common reported comorbidities were hypertension and diabetes (31.1%, 95% CI 30–32.3% and 13.5%, 95% CI 12.3–14.8%, respectively). Headache was reported in 7.5% of patients (95% CI 6.6–8.4%), and dizziness in 6.1% (95% CI 5.1–7.1%). Hypo/anosmia, and gustatory dysfunction were reported in 46.8 and 52.3%, of patients, respectively. Symptoms related to muscular injury ranged between 15 and 30%. Three studies reported radiological confirmed acute cerebrovascular disease in 2% of patients (95% CI 1.6–2.4%). CONCLUSIONS: These data support accumulating evidence that a significant proportion of patients with COVID-19 infection develop neurological manifestations, especially olfactory, and gustatory dysfunction. The pathophysiology of this association is under investigation and warrants additional studies, Physicians should be aware of this possible association because during the epidemic period of COVID-19, early recognition of neurologic manifestations otherwise not explained would raise the suspect of acute respiratory syndrome coronavirus 2 infection. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09978-y) contains supplementary material, which is available to authorized users.


id: cord-320755-0zpnwl2k
author: Mateen, Farrah J.
date: 2020-07-07
txt: ./txt/cord-320755-0zpnwl2k.txt
cache: ./cache/cord-320755-0zpnwl2k.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32638107/
doi: 10.1007/s00415-020-10045-9
summary:
  The overall objectives of this study were threefold: (1) to report the range of impacts of COVID-19 on neuroimmunologists'' practice across the USA and Canada; (2) to probe the MS DMT prescribing decisions and planning of neuroimmunologists in the setting of a viral pandemic; and (3) determine the unmet needs and sources of uncertainty that dominate the care of MS patients. Rather than emphasizing fact checking, the survey queried awareness of local COVID-19 cases and patients'' health practices, impressions and worries on the risk of COVID-19 to patients taking MS DMTs, and prescribing patterns in various special situations, naming the exact DMTs. As an example, issues related to older patients with MS were queried, defined as age 55 years and older (given the usual age cutoff for most DMT trials to date) or 60 years and older (given the Centers for Disease Control and Prevention''s general consideration of people aged 60 years and older as a higher risk group) [11] , depending on the question.

title:
  Impact of COVID-19 on U.S. and Canadian neurologists’ therapeutic approach to multiple sclerosis: a survey of knowledge, attitudes, and practices

abstract:
  OBJECTIVE: To report the understanding and decision-making of neuroimmunologists and their treatment of patients with multiple sclerosis (MS) during the early stages of the SARS-CoV-2 (COVID-19) outbreak. METHODS: A survey instrument was designed and distributed online to neurologists in April 2020. RESULTS: There were 250 respondents (response rate 21.8%). 243 saw > = 10 MS patients in the prior 6 months (average 197 patients) and were analyzed further (92% USA, 8% Canada; average practice duration 16 years; 5% rural, 17% small city, 38% large city, 40% highly urbanized). Patient volume dropped an average of 79% (53–11 per month). 23% were aware of patients self-discontinuing a DMT due to fear of COVID-19 with 43% estimated to be doing so against medical advice. 65% of respondents reported deferring > = 1 doses of a DMT (49%), changing the dosing interval (34%), changing to home infusions (20%), switching a DMT (9%), and discontinuing DMTs altogether (8%) as a result of COVID-19. Changes in DMTs were most common with the high-efficacy therapies alemtuzumab, cladribine, ocrelizumab, rituximab, and natalizumab. 35% made no changes to DMT prescribing. 98% expressed worry about their patients contracting COVID-19 and 78% expressed the same degree of worry about themselves. > 50% believed high-efficacy DMTs prolong viral shedding of SARS-CoV-2 and that B-cell therapies might prevent protective vaccine effects. Accelerated pace of telemedicine and practice model changes were identified as major shifts in practice. CONCLUSIONS: Reported prescribing changes and practice disruptions due to COVID-19 may be temporary but could have a lasting influence on MS care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-10045-9) contains supplementary material, which is available to authorized users.


id: cord-325296-zrvykzof
title: Parainfectious encephalitis in COVID-19: “The Claustrum Sign”
author: Zuhorn, Frédéric
date: 2020-09-03
txt: ./txt/cord-325296-zrvykzof.txt
cache: ./cache/cord-325296-zrvykzof.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32880721/
doi: 10.1007/s00415-020-10185-y
abstract: nan
summary:
  Follow-up has been carried out four months later showing a normalization in cell count of CSF and improvement of MRI findings, although the claustrum lesions persisted. While immunological markers remained unspecific and imaging findings of acute necrotizing encephalitis were absent in our patient, brain MRI disclosed a unique pattern, a.k.a. the claustrum sign. Common MRI findings in a recent study of COVID-19 encephalopathy were cortical signal abnormalities on FLAIR images (37%), accompanied by diffusion reduction, leptomeningeal enhancement and cortical blooming artifacts in some cases. MRI findings in COVID-19 encephalitis, especially when suggesting autoimmune encephalopathy may imply therapeutic interventions, such as immunosuppressive therapy. Recently, progressive clinical improvement along with a reduction of inflammatory CSF parameters has been observed in COVID-19 encephalitis, following high-dose steroid treatment [11] . In summary, a previously undescribed imaging pattern in parainfectious COVID-19 encephalitis is presented that bears a strong resemblance to MRI findings in autoimmune encephalitic syndromes, such as known from epileptic or encephalitis caused by antineuronal antibodies.


id: cord-331423-5wpx0bd0
title: SARS-CoV-2 associated Guillain–Barré syndrome
author: Pelea, Teodor
date: 2020-08-08
txt: ./txt/cord-331423-5wpx0bd0.txt
cache: ./cache/cord-331423-5wpx0bd0.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10133-w
doi: 10.1007/s00415-020-10133-w
summary:
  Presented herein is a severe case of SARS-CoV-2 associated Guillain–Barré syndrome (GBS), showing only slight improvement despite adequate therapy. Therefore patients with SARS-CoV-2 infection are at risk of being affected by coincident immune-mediated neurological diseases such as GBS. Severe course of GBS-associated SARS-CoV-2 infections occur also in patients with mild respiratory symptoms, but must be taken into account with seriously ill cases. To date, the previously described courses of the SARS-CoV-2 infection-associated GBS do not describe a special clinical pattern. Taking into account that GBS can cause a considerable impairment of the respiratory system, clinicians dealing with SARS-CoV-2 positive-tested patients should have to pay attention to symptoms of the peripheral nervous system. Taking into account that GBS can cause a considerable impairment of the respiratory system, clinicians dealing with SARS-CoV-2 positive-tested patients should have to pay attention to symptoms of the peripheral nervous system.

abstract:
  Presented herein is a severe case of SARS-CoV-2 associated Guillain–Barré syndrome (GBS), showing only slight improvement despite adequate therapy. To date, only few cases of GBS associated with this infection have been described. This case report summarizes the insights gain so far to GBS with this antecedent trigger. So far, attention has mostly focused on complications of the CNS involvement. Taking into account that GBS can cause a considerable impairment of the respiratory system, clinicians dealing with SARS-CoV-2 positive-tested patients should pay attention to symptoms of the peripheral nervous system. As far as we know from this reported case and the review of the current literature, there seems to be no association with antiganglioside antibodies or a positive SARS-CoV-2 RT-PCR in CSF. An obvious frequent occurrence of a bilateral facial weakness or bilateral peripheral facial diplegia should be emphasized.


id: cord-334814-stswaiep
title: Causality in COVID-19-associated stroke: a uniform case definition for use in clinical research
author: Vogrig, Alberto
date: 2020-08-01
txt: ./txt/cord-334814-stswaiep.txt
cache: ./cache/cord-334814-stswaiep.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32740765/
doi: 10.1007/s00415-020-10103-2
abstract: nan
summary:
  Even if the World Health Organization (WHO) has provided definition for suspected, probable, and confirmed COVID-19 cases, we believe that only patients with laboratory-confirmed SARS-CoV-2 should enter in the classification, in addition to clinic-radiological evidence of acute stroke (ischemic or hemorrhagic). Minor criteria were designed to capture additional evidence of a causal and biologically plausible association: (1) onset of stroke few days to 3 weeks after COVID-19 symptoms [3] [4] [5] ,(2) lack of cardiovascular risk factors [1, 8] ,(3) D-dimer and/or lactate dehydrogenase elevation [3] [4] [5] . Typical clinical features of COVID-19-related stroke include large vessel occlusion, multi-territory involvement, and posterior circulation predisposition (Fig. 1a-g) [3] [4] [5] 8 ]. In particular, case 12 was a previously healthy 50-year-old man who developed a posterior circulation stroke 3 days after the onset of COVID-19 symptoms in the context of vertebral artery dissection [7] , consistent with our proposed definition.


id: cord-335593-cjb0daps
title: Neurological comorbidity and severity of COVID-19
author: Romagnolo, Alberto
date: 2020-08-04
txt: ./txt/cord-335593-cjb0daps.txt
cache: ./cache/cord-335593-cjb0daps.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-10123-y
doi: 10.1007/s00415-020-10123-y
summary:
  However, no data have been reported yet on the prevalence and the association with infection severity of pre-existing neurological comorbidities in COVID-19 patients. In this study, we evaluated the prevalence of neurological pre-existing comorbidities in a large cohort of patients admitted to ER and diagnosed with COVID-19, estimating their association with infection severity. Patients with neurological comorbidity showed an OR of 2.3 of suffering from severe COVID-19, even after including age and other clinical and demographic characteristics in the multivariate analysis. In conclusion, our study reports the prevalence of different neurological diseases in a large cohort of patients with COVID-19, assessing their association with the infection severity. In our sample, patients with pre-existing neurological diseases showed a significantly higher risk for severe infection, in particular when associated with other comorbidities, suggesting that this population deserves a thorough evaluation since the earliest phases of overt or suspected COVID-19.

abstract:
  OBJECTIVE: Neurological symptoms of COVID-19 patients have been recently described. However, no comprehensive data have been reported on pre-existing neurological comorbidities and COVID-19. This study aims at evaluating the prevalence of neurological comorbidities, and their association with COVID-19 severity. METHODS: We evaluated all consecutive patients admitted to the Emergency Room (ER) of our hospital between the 3rd March and the 14th April 2020, and diagnosed with COVID-19. Data on neurological and non-neurological diseases were extracted, as well as data on demographic characteristics and on severity degree of COVID-19. The prevalence of neurological comorbidities was calculated, and multivariate binary logistic regression analyses were used to estimate the association between neurological diseases and COVID-19 severity. RESULTS: We included 344 patients. Neurological comorbidities accounted for 22.4% of cases, with cerebrovascular diseases and cognitive impairment being the most frequent. Neurological comorbidity resulted independently associated with severe COVID-19 (OR 2.305; p = 0.012), as well as male gender (p = 0.001), older age (p = 0.001), neoplastic diseases (p = 0.039), and arterial hypertension (p = 0.045). When neurological comorbidity was associated with non-neurological comorbidities, the OR for severe COVID-19 rose to 7.394 (p = 0.005). Neurological patients, in particular cerebrovascular and cognitively impaired ones, received more respiratory support indication. CONCLUSION: Neurological comorbidities represent a significant determinant of COVID-19 severity, deserving a thorough evaluation since the earliest phases of infection. The vulnerability of patients affected by neurological diseases should suggest a greater attention in targeting this population for proactive viral screening.


id: cord-338751-2eo7ityc
title: Multifocal laminar cortical brain lesions: a consistent MRI finding in neuro-COVID-19 patients
author: Anzalone, Nicoletta
date: 2020-06-06
txt: ./txt/cord-338751-2eo7ityc.txt
cache: ./cache/cord-338751-2eo7ityc.txt
extension: .txt
mime: text/plain
url: https://doi.org/10.1007/s00415-020-09966-2
doi: 10.1007/s00415-020-09966-2
abstract: nan
summary:
  title: Multifocal laminar cortical brain lesions: a consistent MRI finding in neuro-COVID-19 patients They are part of a series of 21 patients presenting with neurological symptoms studied with brain MRI with otherwise no significant imaging findings. Although the predominantly parieto-occipital distribution of the lesions recalls posterior reversible encephalopathy syndrome (PRES) [5] , the prevalent cortical involvement and diffusion MRI pattern are not typical of PRES. More recently, evidence of direct viral infection of the endothelial cell and diffuse endothelial inflammation has been reported, resulting Fig. 1 Forty-seven-year-old man diagnosed with COVID-19 and presenting neurological signs of agitation and spatial disorientation after weaning from mechanical ventilation. Multiple, cortical areas of punctiform and gyriform FLAIR and DWI hyperintensity (arrows) in both parietal lobes, with no ADC changes Fig. 2 Fifty-four-year-old woman diagnosed with COVID-19 and presenting neurological signs of agitation and spatial disorientation after weaning from mechanical ventilation.


id: cord-338928-y5l7cf31
title: Neurological manifestations associated with COVID-19: a review and a call for action
author: Leonardi, Matilde
date: 2020-05-20
txt: ./txt/cord-338928-y5l7cf31.txt
cache: ./cache/cord-338928-y5l7cf31.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32436101/
doi: 10.1007/s00415-020-09896-z
summary:
  While the epidemic of Coronavirus disease 2019 (COVID-19) continues to spread globally, more and more evidences are collected about the presence of neurological manifestations and symptoms associated with it. The review shows that although more and more papers are reporting neurological manifestations associated with COVID-19; however, many items remain unclear and this uncertainty calls for a global action that requires close coordination and open-data sharing between hospitals, academic institutions and the fast establishment of harmonised research priorities and research consortia to face the NeuroCOVID-19 complications. Reports are emerging from China and Italy and increasingly from several countries of neurological symptoms associated with SARS-CoV-2, which may be worsening clinical pictures, respiratory outcomes and mortality rates in patients with COVID-19. Observations from Italy have confirmed Chinese data noting a high number of patients with hyposmia, anosmia and varying patterns of possibly centrally mediated symptoms including respiratory manifestations. Mechanisms of host defense following severe acute respiratory syndrome-coronavirus (SARS-CoV) pulmonary infection of mice

abstract:
  While the epidemic of Coronavirus disease 2019 (COVID-19) continues to spread globally, more and more evidences are collected about the presence of neurological manifestations and symptoms associated with it. A systematic review has been performed of papers published until 5 April 2020. 29 papers related to neurological manifestations associated with COVID-19 were examined. The results show presence of central and peripheral nervous system manifestations related to coronavirus. Neurological manifestations, or NeuroCOVID, are part of the COVID-19 clinical picture, but questions remain regarding the frequency and severity of CNS symptoms, the mechanism of action underlying neurological symptoms, and the relationship of symptoms with the course and severity of COVID-19. Further clinical, epidemiological, and basic science research is urgently needed to understand and address neurological sequalae of COVID-19. Concomitant risk factors or determinants (e.g. demographic factors, comorbidities, or available biomarkers) that may predispose a person with COVID-19 to neurological manifestations also need to be identified. The review shows that although more and more papers are reporting neurological manifestations associated with COVID-19; however, many items remain unclear and this uncertainty calls for a global action that requires close coordination and open-data sharing between hospitals, academic institutions and the fast establishment of harmonised research priorities and research consortia to face the NeuroCOVID-19 complications.


id: cord-338979-ew046wcr
title: A review of pathophysiology and neuropsychiatric manifestations of COVID-19
author: Jasti, Madhu
date: 2020-06-03
txt: ./txt/cord-338979-ew046wcr.txt
cache: ./cache/cord-338979-ew046wcr.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32494854/
doi: 10.1007/s00415-020-09950-w
summary:
  This novel coronavirus reportedly had symptoms resembling that of Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV) seen in the year 2003 [3] . A recently published study that looked at 214 cases of severe coronavirus illness treated in Wuhan during the early phase of the global pandemic reported that about 36% of patients displayed neurological symptoms [11] . There have been a fair number of reports suggesting SARS-CoV-2 infecting the neurons, raising questions about the direct effects of the virus on the brain that play a role in patients'' deaths. By contrast, there have been a few case reports which mention no penetrance of virus into the central nervous system as evidenced by the absence of SARS-CoV-2 in CSF and that the CNS effects are secondary to elevated inflammatory markers as CSF analyses during the acute stage showed pleocytosis with increased IL-8 and TNF-α concentrations [17] .

abstract:
  INTRODUCTION: The outbreak of coronavirus disease 2019 (COVID-19) has become one of the most serious pandemics of the recent times. Since this pandemic began, there have been numerous reports about the COVID-19 involvement of the nervous system. There have been reports of both direct and indirect involvement of the central and peripheral nervous system by the virus. OBJECTIVE: To review the neuropsychiatric manifestations along with corresponding pathophysiologic mechanisms of nervous system involvement by the COVID-19. BACKGROUND: Since the beginning of the disease in humans in the later part of 2019, the coronavirus disease 2019 (COVID-19) pandemic has rapidly spread across the world with over 2,719,000 reported cases in over 200 countries [World Health Organization. Coronavirus disease 2019 (COVID-19) situation report-96.,]. While patients typically present with fever, shortness of breath, sore throat, and cough, neurologic manifestations have been reported, as well. These include the ones with both direct and indirect involvement of the nervous system. The reported manifestations include anosmia, ageusia, central respiratory failure, stroke, acute inflammatory demyelinating polyneuropathy (AIDP), acute necrotizing hemorrhagic encephalopathy, toxic–metabolic encephalopathy, headache, myalgia, myelitis, ataxia, and various neuropsychiatric manifestations. These data were derived from the published clinical data in various journals and case reports. CONCLUSION: The neurological manifestations of the COVID-19 are varied and the data about this continue to evolve as the pandemic continues to progress.


id: cord-340468-3s3dv88w
author: Plumereau, Cécile
date: 2020-09-09
txt: ./txt/cord-340468-3s3dv88w.txt
cache: ./cache/cord-340468-3s3dv88w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32902732/
doi: 10.1007/s00415-020-10199-6
summary:
  METHODS: We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). Although some studies have reported an impact of the pandemic on acute ischemic stroke (AIS) care in terms of admissions and reperfusion therapy volumes along with longer treatment times and a decrease in the use of stroke imaging compared with control periods in 2019, other reports have not detected significant effects on revascularization procedures [3] [4] [5] [6] [7] [8] [9] [10] . The objective of our study was to assess the impact of the COVID-19 pandemic on the volume of AIS patients treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT), as well as pre and intra-hospital delays ( Fig. 1 ).

title:
  Effect of the COVID-19 pandemic on acute stroke reperfusion therapy: data from the Lyon Stroke Center Network

abstract:
  BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic would have particularly affected acute stroke care. However, its impact is clearly inherent to the local stroke network conditions. We aimed to assess the impact of COVID-19 pandemic on acute stroke care in the Lyon comprehensive stroke center during this period. METHODS: We conducted a prospective data collection of patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) and/or mechanical thrombectomy (MT) during the COVID-19 period (from 29/02/2020 to 10/05/2020) and a control period (from 29/02/2019 to 10/05/2019). The volume of reperfusion therapies and pre and intra-hospital delays were compared during both periods. RESULTS: A total of 208 patients were included. The volume of IVT significantly decreased during the COVID-period [55 (54.5%) vs 74 (69.2%); p = 0.03]. The volume of MT remains stable over the two periods [72 (71.3%) vs 65 (60.8%); p = 0.14], but the door-to-groin puncture time increased in patients transferred for MT (237 [187–339] vs 210 [163–260]; p < 0.01). The daily number of Emergency Medical Dispatch calls considerably increased (1502 [1133–2238] vs 1023 [960–1410]; p < 0.01). CONCLUSIONS: Our study showed a decrease in the volume of IVT, whereas the volume of MT remained stable although intra-hospital delays increased for transferred patients during the COVID-19 pandemic. These results contrast in part with the national surveys and suggest that the impact of the pandemic may depend on local stroke care networks.


id: cord-340984-blkhfhe2
title: Neurological manifestations of COVID-19: a review of what we know so far
author: Gklinos, Panagiotis
date: 2020-05-26
txt: ./txt/cord-340984-blkhfhe2.txt
cache: ./cache/cord-340984-blkhfhe2.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32458197/
doi: 10.1007/s00415-020-09939-5
summary:
  Prompt diagnosis and immediate management of the neurological manifestations of the novel coronavirus will not only improve the prognosis of COVID-19 patients but will also prevent the dissemination of the disease due to misdiagnosed cases. COVID-19 is confirmed to be caused by a novel coronavirus (2019 novel coronavirus, 2019-nCoV) and presents with symptoms similar to those of severe acute respiratory syndrome coronavirus (SARS-CoV) in 2003. However, neurological manifestations of the novel coronavirus are not precepted by all clinicians, thus, leading to inappropriate management of COVID-19 patients presenting with non-specific neurological symptoms initially. This article aims to review the cases, which reported neurological symptoms at presentation or during the course of the disease and discuss the potential mechanisms of Central Nervous System (CNS) involvement in COVID-19. The other study is a retrospective case series in Wuhan, China, which reported the neurological symptoms of COVID-19 patients [13] .

abstract:
  Coronavirus disease 2019 (COVID‐19) has become a pandemic disease globally. While it mostly presents with respiratory symptoms, it has already been found that it could manifest with a series of neurological symptoms as well, either at presentation or during the course of the disease. Symptoms vary from non-specific such as headache or dizziness to more specific such as convulsions and cerebrovascular disease (CVD). This study aims to give an overview of the neurological manifestations of COVID-19 and discuss the potential pathogenetic mechanisms of central nervous system (CNS) involvement. Clinicians and especially internists, neurologists, and infectious disease specialists should be aware of these symptoms and able to recognize them early. Prompt diagnosis and immediate management of the neurological manifestations of the novel coronavirus will not only improve the prognosis of COVID-19 patients but will also prevent the dissemination of the disease due to misdiagnosed cases.


id: cord-345200-rxv9batt
title: Guillain-Barré syndrome in the COVID-19 era: just an occasional cluster?
author: Gigli, Gian Luigi
date: 2020-05-19
txt: ./txt/cord-345200-rxv9batt.txt
cache: ./cache/cord-345200-rxv9batt.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32430572/
doi: 10.1007/s00415-020-09911-3
abstract: nan
summary:
  In 2020, from March 1st to April 15th, we observed instead seven new cases diagnosed as GBS, in addition to a relapse in one more patient. Considering a population of 535,516 inhabitants in the province of Udine (2017 census), the monthly incidence in March-April period of previous years was 0.12 new cases/100.000 inhabitants per month (in line with the epidemiological literature [1, 2] ) versus 0.65 cases/100.000 inhabitants per month during the ongoing pandemic. Despite the serologic and swab negativity of the others, we think that the association with the descending slope of SARS-CoV-2 infection should still be evaluated, since the specificity and sensitivity of these tests are not yet completely assessed and the exact slope of the humoral immune response curve to this new virus is still unknown. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence? Guillain-Barré syndrome associated with Zika virus infection in Colombia


id: cord-345437-j3akzx10
title: What has caused the fall in stroke admissions during the COVID-19 pandemic?
author: Perry, Richard
date: 2020-06-29
txt: ./txt/cord-345437-j3akzx10.txt
cache: ./cache/cord-345437-j3akzx10.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32601757/
doi: 10.1007/s00415-020-10030-2
abstract: nan
summary:
  During the current COVID-19 pandemic there has been a decline in stroke admissions in centres all over the world [1, 2] and no doubt this phenomenon has contributed to the sharp fall in the number of patients attending Emergency Departments in England during March 2020 [3] . These are the patients most likely to decide to manage their stroke at home, perhaps for fear of the risk of contracting COVID-19 whilst in hospital. They are the most likely to have their neurological symptoms missed at a time of severe respiratory illness from the virus, or to be turned away from overstretched emergency services rather than being directed into the stroke pathway [4] . Figure 1 shows the distribution of stroke severities (using the National Institutes of Health Stroke Scale) in admissions to our Hyperacute Stroke Unit for two 40-day periods: before the decline in emergency admissions in England [3] (1st February to 12th March, blue triangles) and after it (1st April to 11th May 2020, red circles).


id: cord-346530-o65m0whe
title: Mixed central and peripheral nervous system disorders in severe SARS-CoV-2 infection
author: Chaumont, H.
date: 2020-06-12
txt: ./txt/cord-346530-o65m0whe.txt
cache: ./cache/cord-346530-o65m0whe.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32533322/
doi: 10.1007/s00415-020-09986-y
abstract: nan
summary:
  title: Mixed central and peripheral nervous system disorders in severe SARS-CoV-2 infection We report four cases of severe COVID-19 in male patients aged 50-70 with the combination of central and peripheral nervous system disorders occurring unexpectedly late after the first symptoms. Several acute neurological syndromes have been associated with SARS-CoV-2 infection, including anosmia and ageusia [1, 2] , meningoencephalitis [3, 4] , acute hemorrhagic necrotizing encephalopathy [5] , axonal or demyelinating polyradiculoneuropathy [6] [7] [8] , polyneuritis cranialis [8] . They consisted of miscellaneous symptoms such as confusion, cognitive dysfunction (memory deficit, frontal syndrome), psychiatric disorders (paranoid delusion, hallucinations), weakness, pyramidal signs, dysautonomia, swallowing dysfunction, vertical supranuclear eye palsy, upper limbs myoclonus, fasciculation and focal muscle atrophy (Table 1) . COVID-19-associated acute hemorrhagic necrotizing encephalopathy: CT and MRI features Neurologic features in severe SARS-CoV-2 infection


id: cord-351896-j6h02ab5
title: Neurological involvement of coronavirus disease 2019: a systematic review
author: Ghannam, Malik
date: 2020-06-19
txt: ./txt/cord-351896-j6h02ab5.txt
cache: ./cache/cord-351896-j6h02ab5.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32561990/
doi: 10.1007/s00415-020-09990-2
summary:
  The following search strategy was implemented and these keywords and their synonyms (in the all fields) were combined in each database as follows: ("COVID 19" OR "coronavirus") AND ("brain" OR "CNS" OR "spinal cord" OR "nerve" OR "neurologic" OR "stroke" OR "cerebrovascular" OR "cerebral vein thrombosis" OR "sinus thrombosis" OR "Intracerebral hemorrhage" OR "hemorrhage" OR "myelitis" OR "GBS" OR "Guillain Barre syndrome" OR "neuropathy" OR "radiculopathy" OR "cranial neuropathy" OR "myopathy" OR "myositis" OR "rhabdomyolysis" OR "encephalitis" OR "encephalopathy" OR "meningitis" OR "meningoencephalitis" OR "seizure" OR "convulsion" OR "epilepsy") [ Fig. 1 ]. [11] For each study, the following descriptive, microbiological, and clinical information was extracted: patient demographic data, SARS-CoV-2 testing from nasal swab and CSF, neurological symptoms and signs and their onset in relation to respiratory or gastrointestinal (GI) symptoms or anosmia or dysgeusia, any neurological investigations and CSF or any other relevant laboratory testing (such as CK, LDH, CRP, D-dimer, lupus anticoagulant, fibrinogen, ganglioside antibodies), neurological diagnosis, occurrence of respiratory failure (defined as need for intubation, abnormal PO2 in blood gas, or Glasgow Coma Scale score less than or equal 8), treatments administered for the neurological diagnosis, and final outcome.

abstract:
  BACKGROUND: In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. OBJECTIVE: To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. METHODS: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. RESULTS: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. CONCLUSIONS: Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain–Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00415-020-09990-2) contains supplementary material, which is available to authorized users.


id: cord-352703-2g7mqnte
author: Glasmacher, Stella A.
date: 2020-09-05
txt: ./txt/cord-352703-2g7mqnte.txt
cache: ./cache/cord-352703-2g7mqnte.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32889618/
doi: 10.1007/s00415-020-10207-9
abstract: nan
summary:
  title: The immediate impact of the COVID-19 pandemic on motor neuron disease services and mortality in Scotland We completed a population-based analysis of the Scottish MND Register, CARE-MND [2] and a clinician survey, to measure the impact of the pandemic on (1) diagnostic rate, (2) mortality rate, and, (3) delivery of services. We compared all-cause mortality between 01/03-01/06 in 2015-2019 (comparator period) and 01/03-01/06 2020 (COVID-19 period) using multivariable Poisson regression including age (< 50, 50-70, > 70 years) and year (2015-2020) as independent variables. We performed Chi-squared test to compare socioeconomic status (SIMD) [3] between those who died and survivors during the COVID-19 period. There was no difference in all-cause mortality between the COVID-19 and comparator periods (pooled regression coefficient 1.09 95% CIs 0.78, 1.53; P = 0.61). Our study is the first to demonstrate at a national level that rates of new MND diagnoses and all-cause mortality in pwMND have thus far been unaffected by COVID-19.

title:
  The immediate impact of the COVID-19 pandemic on motor neuron disease services and mortality in Scotland


id: cord-355841-m6dl8a0w
title: Acute transverse myelitis after COVID-19 pneumonia
author: Munz, Maike
date: 2020-05-26
txt: ./txt/cord-355841-m6dl8a0w.txt
cache: ./cache/cord-355841-m6dl8a0w.txt
extension: .txt
mime: text/plain
url: https://www.ncbi.nlm.nih.gov/pubmed/32458198/
doi: 10.1007/s00415-020-09934-w
abstract: nan
summary:
  A repeated throat swab showed a negative SARS-CoV2 PCR. Magnetic resonance imaging (MRI) of the spine revealed T2 signal hyperintensity of the thoracic spinal cord at Th9 level suggestive of acute transverse myelitis rather than multiple sclerosis [3] (Fig. 1a) . SARS-CoV2-PCR in the CSF and oligoclonal bands were negative. Follow-up MRI on day 6 further showed a patchy hyperintensity of the thoracic myelon at Th9-10 and at Th3-5 level (Fig. 1d) , suggestive of transverse myelitis. Follow-up CSF on day 12 showed normalization of cell count (3/µl) and regressing protein levels (734 mg/l), no Maike Munz and Swen Weßendorf authors contributed equally. Cases of Guillain-Barré Syndrome in association with severe COVID-19 infections were reported [6] . In a series of 58 severely affected COVID-19 patients, 67% showed clinical corticospinal tract signs but received no spinal MRI [7] . Preprint) Acute myelitis after SARS-CoV-2 infection: A case report https


