key: cord-1005339-hbxpn5a1
authors: Siepmann, Timo; Kitzler, Hagen H.; Reichmann, Heinz; Barlinn, Kristian
title: Variability of symptoms in neuralgic amyotrophy following infection with SARS‐CoV‐2
date: 2020-10-01
journal: Muscle Nerve
DOI: 10.1002/mus.27084
sha: 57345b89dad234dd2f440d53f05160748b34d408
doc_id: 1005339
cord_uid: hbxpn5a1

nan

We confirm that we have read the Journal's position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

The report of Cacciavillani and colleagues contributes to the discussion of the possibility of peripheral nerve involvement in coronavirus disease 2019 (COVID-1 9) and adds to our observation of neuralgic amyotrophy following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Their case viewed in conjunction with a growing body of evidence underscores a relevant pathophysiological problem of the disease. The mechanisms whereby SARS-CoV-2 targets the human organism might extend beyond the known pathway of binding to the angiotensin-converting enzyme 2 receptor, which is expressed in the epithelium of the respiratory tract, the endothelium, the gastrointestinal system and other organs. 1 In fact, a direct neuroinvasive potential has been suggested by several authors. Supporting this hypothesis is a recent investigation that detected SARS-CoV-2 RNA in 36.4% (8/22) of brain biopsies obtained from fatal COVID-19 cases 2 , but the route whereby the virus invades the nervous system is unclear. Interestingly, research prior to the COVID-19 pandemic showed that earlier coronaviruses such as hemagglutinating encephalomyelitis virus may first enter peripheral nerve terminals before traveling to the central nervous system (CNS) via synapse-connected routes. 3, 4 Whether this mechanism also applies to SARS-CoV-2 remains to be answered. However, our patient as well the patient reported by Cacciavillani and colleagues presented with symptoms of peripheral nerve involvement without any signs of CNS damage. In fact, peripheral nerve damage might occur in almost 10% of patients hospitalized for SARS-CoV-2 infection. 5 This article is protected by copyright. All rights reserved. Whether peripheral nervous system complications following COVID-19 such as neuralgic amyotrophy result from direct neuroinvasion or from an auto-immune post-infectious mechanism needs to be elucidated. 6 Understanding the sequence of events leading to neural damage in patients with COVID-19 might help identify diagnostic and therapeutic targets, highlighting the need for prospective research on patterns of peripheral and central nervous system involvement in patients with COVID-19.

The report of Cacciavillani includes an important observation that differed from our report. This article is protected by copyright. All rights reserved.

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Lesion distribution among 281 patients with sporadic neuralgic amyotrophy. Muscle Nerve