key: cord-0785049-4oqlbp8v
authors: Terhoeve, Cristina; Bliss, Ryan; Ahmad, Rasheed
title: Ulnar Nerve Palsy as COVID-19 Sequelae in Three Patients
date: 2021-12-25
journal: J Hand Surg Glob Online
DOI: 10.1016/j.jhsg.2021.12.003
sha: 4c86d8380c12c626edba6b7b9262f0b4b5e3e619
doc_id: 785049
cord_uid: 4oqlbp8v

The pathophysiology and treatment of COVID-19 has been at the forefront of medical research this past year, and while great strides have been made in our knowledge of the disease, there is still much that is unknown. Greater than one third of patients with COVID-19 present with symptoms involving the nervous system. The reason for this is unclear, though several theories have been postulated. In this case study, we present three patients with severe ulnar nerve dysfunction following treatment for COVID-19 in the intensive care unit (ICU). We discuss reasons this may have occurred, the etiology of which is likely multifactorial. We are reporting these cases to inform and alert physicians to the possibility of ulnar nerve involvement in the presentation of patients with COVID-19.

still much that is unknown. Greater than one third of patients with COVID-19 present with 6 symptoms involving the nervous system. The reason for this is unclear, though several theories 7 have been postulated. In this case study, we present three patients with severe ulnar nerve 8 dysfunction following treatment for COVID-19 in the intensive care unit (ICU). We discuss 9 reasons this may have occurred, the etiology of which is likely multifactorial. We are reporting 10 these cases to inform and alert physicians to the possibility of ulnar nerve involvement in the 11 presentation of patients with COVID-19. 12

COVID-19, caused by a coronavirus named SARS-CoV-2, causes symptoms of fever, shortness 15 of breath, headache, anomia, ageusia, cough, myalgias, and diarrhea in those affected. 1 The 16 spread of cases increased exponentially over the past months and was declared a global to radial artery occlusion and digital ischemia. 3,4 We describe three patients who presented to our clinic with ulnar nerve palsy following COVID-19 treatment in the ICU. We postulate reasons 24 for this occurrence as well as the implications of each. Written informed consent was obtained 25 from each patient for publication of this case report. 26

65-year-old female retired respiratory therapist with a history of obstructive sleep apnea, hypertension, 30 and obesity presented with a one-week history of shortness of breath, fever, and cough. SARS-COV-2 31

Polymerase Chain Reaction (PCR) test was positive. She was initially hypoxic to 92% on room air. She 32 was started on supplemental oxygen and hydroxychloroquine. She was intubated 2 days later due to 33 worsening hypoxia. She was placed in prone position on the ventilator for a 24-hour period three days 34 later. She was ultimately intubated in the ICU for 41 days. During this time, norepinephrine bitartrate 35 was intermittently necessary to maintain her blood pressure. Two weeks after intubation, the patient was 36 diagnosed with acute tubular necrosis and treated with furosemide diuresis. As sedation was weaned, she 37 demonstrated symptoms of metabolic encephalopathy for approximately 5 days. The patient's first 38 complaint of right hand discomfort was reported 5 weeks after the onset of her COVID-19 symptoms. A 39 trial of Gabapentin was initiated by Pulmonology. She was hospitalized for 60 days total at which point 40 she was discharged to a long-term acute care facility, and the patient was weaned from the ventilator 10 41 days later. This case report suggests an association between ulnar nerve palsy and COVID-19. More 164 cases are required to support causality. We are reporting this case to inform and alert physicians 165 to the possibility of ulnar nerve involvement in the presentation of patients with COVID-19. 166

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