Medical Specialties Commons^™

From Covid-19 To Long Covid; The Forms Of The Neurological Manifestations, Sana Ahuja, Sufian Zaheer

Journal of Mind and Medical Sciences

Ever since the SARS-CoV-2 infection was declared a global pandemic in 2020, numerous multisystemic manifestations have been discovered. The COVID-19 is known to cause a wide spectrum of neurological symptoms like fatigue, headache, brain fog, stroke, smell and taste disorders, encephalopathy and neurodegenerative disorders. The neurological manifestations are more prevalent in the post-COVID syndrome or long COVID. The National Institute for Health and Care Excellence and WHO defined Ongoing Symptomatic COVID as 4-12 weeks post infection and post COVID-19 syndrome as persistence of symptoms beyond 12 weeks. So far there are limited data available regarding the pathophysiology of neurological symptoms …

Acute Aseptic Meningoencephalitis Due To Covid-19 In An Otherwise Healthy Patient: A Case Report, Shyama Appareddy, Norma Moncayo, Ronkino T. Mccoy, Jared Sperling, George Huddleston, Raza L. Kahn

Research Colloquium

Several studies have shown the extrapulmonary manifestations of COVID-19 disease caused by the SARS-CoV2 virus. Although extrapulmonary manifestation to the heart, kidney, blood, and skin are common, neurological and cerebrovascular manifestations are rare with most of these cases being described in patients who also have the pulmonary manifestation of the disease. Here we present the case of an 18 year-old male with no prior history of respiratory symptoms who presented to the emergency department with altered mental status. Neurology was consulted and the patient was started empirical on ceftriaxone, vancomycin, dexamethasone, and acyclovir for meningoencephalitis. Urine drug screen, head CT, …

Pediatric Covid-19 Encephalitis, Nelson D. Gonzalez, Dustin Paul, Ana Almeda, Samuel Serna, Linette Linsangan

Research Symposium

Background: Neurologic complications of COVID-19 in the pediatric population have been reported in a limited number of reports. There have been reports of COVID-19-associated encephalitis in pediatric cases along with neuroimaging findings revealing involvement of some parts of the nervous system. We present the first case of pediatric severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) - associated encephalitis targeting the parietal lobes.

Case: A 14-year-old morbidly obese Hispanic male with no past medical history presented to the hospital for new onset seizures. Family reported exposure to his COVID-19 positive mother, a one-week history of fever, and a three-month history of …

The Impact Of Covid-19 On Post-Recovery Memory, Chelsea Mcnamara, Alison Mancuso

Rowan-Virtua Research Day

The SARS-CoV-2 virus, responsible for the covid-19 pandemic, has had profound effects on countries worldwide. As the pandemic progressed, clinical and patient data continued to mount. A subset of symptoms named “Long Covid Syndrome” persisted in patients after recovering from infection. One commonly reported but understudied symptom was a deficit in memory function. Although commonly reported, prevalence of ‘brain fog’ has yet to be characterized using patient data. Using Rowan Medicine electronic patient data, we were able to collect information on patients before and after the emergence of the coronavirus. Data was collected on reported memory-related symptoms as well as …

A Rare Case Of Covid Encephalitis In A Vaccinated Patient, Christian Pena, Hari Movva, Hector Arredondo, Alberto Pena, Erik Hinojosa, Michael Rotko, Jorge Nadal, Michelle Lopez

MEDI 9331 Scholarly Activities Clinical Years

Background and Purpose: SARS-CoV-2 infection is known to cause primarily respiratory symptoms, however, neurological disorders such as anosmia and stroke have been seen. Encephalitis is a rare complication of COVID-19 with a reported incidence of less than 1%¹. Most patients develop both COVID-19 symptoms and encephalitis symptoms during the same period¹. In addition, the majority of reports are from patients with no prior vaccination. Here, we present a case of encephalitis 2 weeks after mild COVID-19 in a fully vaccinated male.

Case Presentation: A 68-year-old Hispanic male was brought to the ED due to new onset gaze deviation, generalized tonic …

Anti-Nmda Encephalitis In A Patient With Active Covid-19 Infection, Ali Abu-Alya, Janita Sidhu, Hamza Hansoti, Tyler Voss-Hamrick, Venkatachalam Veerappan, Ruhin Sidhu

Far West Division Research Day 2023

No abstract provided.

Case Based Review On Headaches And Cerebral Venous Thromboembolism Post Covid-19 Infection, Aishwarya Raich, Tanvir Khosla, Vishnu Halthore, Ali Abu-Alya, Venkatachalam Veerappan

Far West Division Research Day 2023

No abstract provided.

Descriptive Analysis Of Acute Ischemic Stroke In Covid-19 Patients Through The Course Of The Covid-19 Pandemic, Amman Bhasin, Jay Liuhong Liu, Keval Shah, Amin Marji, Ricky Sareini, Shishir Rao, Wazim Mohamed, Kumar Rajamani, Parthasarathi Chamiraju, Ayaz Khawaja

Medical Student Research Symposium

Coronavirus disease 2019 (COVID-19) has been associated with Acute Ischemic Stroke (AIS). Here, we characterize our institutional experience with management of COVID-19 and AIS. Baseline demographics, clinical, imaging, and outcomes data were determined in patients with COVID-19 and AIS presenting within March 2020 thru October 2020, and November 2020 thru August 2021, based on institutional COVID-19 hospitalization volume. Of 2512 COVID-19 patients, 35 (1.39%, mean age 63.3 years, 54% women) had AIS. AIS recognition was frequently delayed after COVID-19 symptoms (median 19.5 days). Four patients (31%) were on therapeutic anticoagulation at AIS recognition. AIS mechanism was undetermined or due to …

Meta-Analysis Of 175 Patients With Covid-19 And Seizures, Status Epilepticus, Or Cortical Myoclonus: An Individual Patient Data Analysis, Aditi Kappagantu Bs, Helena A. Brantz Ms, Amman Bhasin Ba, Cristina Jageka Bs, Rooqash Ali Md, Izzy Saef Md, Brittany M. Stopa Mph, Ayaz Khawaja Md

Medical Student Research Symposium

Objective

To characterize management and outcomes of seizures, status epilepticus, and cortical myoclonus in COVID-19, with individual patient data analysis of published literature.

Methods

Systematic literature review was conducted in accordance with PRISMA guidelines. Criteria included new-onset seizures, status epilepticus, and/or cortical myoclonus with concomitant COVID-19. COVID-19 severity was dichotomized into mild and severe cases. Good outcome was defined as discharge without severe deficits, and/or return to baseline.

Results

A total of 105 studies reporting 176 patients (male 56.3%;mean age 47.8,SD 25.6) were included. Status epilepticus occurred in 47 patients (26.7%) and myoclonus in 41 (23.3%). Severe COVID-19 occurred in …

Peripheral Neuropathy Evaluations Of Patients With Prolonged Long Covid., Anne Louise Oaklander, Alexander J Mills, Mary Kelley, Lisa S Toran, Bryan Smith, Marinos Dalakas, Avindra Nath

Department of Neurology Faculty Papers

Background and objectives: Recovery from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection appears exponential, leaving a tail of patients reporting various long COVID symptoms including unexplained fatigue/exertional intolerance and dysautonomic and sensory concerns. Indirect evidence links long COVID to incident polyneuropathy affecting the small-fiber (sensory/autonomic) axons.

Methods: We analyzed cross-sectional and longitudinal data from patients with World Health Organization (WHO)-defined long COVID without prior neuropathy history or risks who were referred for peripheral neuropathy evaluations. We captured standardized symptoms, examinations, objective neurodiagnostic test results, and outcomes, tracking participants for 1.4 years on average.

Results: Among 17 patients (mean age …

Barriers, Access And Management Of Paediatric Epilepsy With Telehealth., Kari Gali, Sucheta Joshi, Sarah Hueneke, Alexis Katzenbach, Linda Radecki, Trisha Calabrese, Linda Fletcher, Cristina Trandafir, Carey Wilson, Monisha Goyal, Courtney J. Wusthoff, Jean-Baptist Lepichon, Rhonda Corvalan, April Golson, Jessica Hardy, Michael Smith, Elizabeth Cook, Joshua L. Bonkowsky

Manuscripts, Articles, Book Chapters and Other Papers

Access to paediatric neurology care is complex, resulting in significant wait times and negative patient outcomes. The goal of the American Academy of Pediatrics National Coordinating Center for Epilepsy's project, Access Improvement and Management of Epilepsy with Telehealth (AIM-ET), was to identify access and management challenges in the deployment of telehealth technology. AIM-ET organised four paediatric neurology teams to partner with primary-care providers (PCP) and their multidisciplinary teams. Telehealth visits were conducted for paediatric epilepsy patients. A post-visit survey assessed access and satisfaction with the telehealth visit compared to an in-person visit. Pre/post surveys completed by PCPs and neurologists captured …

Complement In Autoimmune Inflammatory Myopathies, The Role Of Myositis-Associated Antibodies, Covid-19 Associations, And Muscle Amyloid Deposits., Marinos Dalakas

Department of Neurology Faculty Papers

Introduction

The inflammatory myopathies (IM) have now evolved into distinct subsets requiring clarification about their immunopathogenesis to guide applications of targeted therapies

Areas Covered

Immunohistopathologic criteria of IM with a focus on complement, anti-complement therapeutics, and other biologic immunotherapies. The COVID19-triggered muscle autoimmunity along with the correct interpretation of muscle amyloid deposits is discussed.

Expert Opinion

The IM, unjustifiably referred as idiopathic, comprise Dermatomyositis (DM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). In DM, complement activation with MAC-mediated endomysial microvascular destruction and perifascicular atrophy is the fundamental process, while innate immunity activation factors, INF1 and …

The Diverse Neurological Manifestations Of The Sars-Cov-2 Pandemic, Asmeda Spalding

Capstone Showcase

SARS-CoV-2 remains an international public health concern and can be encountered in all aspects of healthcare. Although most neurological manifestations are benign, clinicians must be aware and able to recognize more serious conditions that require urgent referral and intervention. Patients at risk for severe cases should be given extra attention given their propensity for neurological and clinical deterioration. This article highlights the most common and urgent neurological symptoms and diagnoses of the COVID-19 pandemic as well as clinical pearls for their identification.

Iranian Parents' Perceptions On Physical Activity For Their Children With Autism Spectrum Disorder During The Covid-19 Pandemic, Sarvin Salar, Justin A. Haegele, Hassan Daneshmandi

Human Movement Sciences Faculty Publications

Purpose: The COVID-19 pandemic is a remarkable health crisis that enforced most people to stay at home and quarantine for a period of time and seems to be having negative impacts on physical activity and mental health worldwide. Autism Spectrum Disorder (ASD), is a neurodevelopmental disorder with a deficit in social interaction characteristics, relationships, and stereotyped behaviors. This study examined Iranian parents’ perceptions of physical activity for their children with ASD during the COVID-19 pandemic.

Methods: In this study, an explanatory qualitative methodology was used and data were collected via semi-structured phone interviews. The samples included 40 Iranian parents (aged …

Characterizing Long Covid: Deep Phenotype Of A Complex Condition, Rachel R. Deer, Madeline A. Rock, Nicole Vasilevsky, Leigh Carmody, Halie Rando, Alfred J. Anzalone, Marc D. Basson, Tellen D. Bennett, Timothy Bergquist, Eilis A. Boudreau, Carolyn T. Bramante, James Brian Byrd, Tiffany J. Callahan, Lauren E. Chan, Haitao Chu, Christopher G. Chute, Ben D. Coleman, Hannah E. Davis, Joel Gagnier, Casey S. Greene, Ramakanth Kavuluru

Institute for Biomedical Informatics Faculty Publications

BACKGROUND: Numerous publications describe the clinical manifestations of post-acute sequelae of SARS-CoV-2 (PASC or "long COVID"), but they are difficult to integrate because of heterogeneous methods and the lack of a standard for denoting the many phenotypic manifestations. Patient-led studies are of particular importance for understanding the natural history of COVID-19, but integration is hampered because they often use different terms to describe the same symptom or condition. This significant disparity in patient versus clinical characterization motivated the proposed ontological approach to specifying manifestations, which will improve capture and integration of future long COVID studies.

METHODS: The Human Phenotype Ontology …

Cessation And Resumption Of Elective Neurointerventional Procedures During The Coronavirus Disease 2019 Pandemic And Future Pandemics, Tim W. Malisch, Sameer A. Ansari, Gary R. Duckwiler, Kyle M. Fargen, Steven W. Hetts, Franklin A. Marden, Athos Patsalides, Clemens M. Schirmer, Allan Brook, Justin F. Fraser

Neurosurgery Faculty Publications

At the time of this writing, the coronavirus disease 2019 pandemic continues to be a global threat, disrupting usual processes, and protocols for delivering health care around the globe. There have been significant regional and national differences in the scope and timing of these disruptions. Many hospitals were forced to temporarily halt elective neurointerventional procedures with the first wave of the pandemic in the spring of 2020, in order to prioritize allocation of resources for acutely ill patients and also to minimize coronavirus disease 2019 transmission risks to non-acute patients, their families, and health care workers. This temporary moratorium on …

Sars-Cov-2: A Potential Trigger Of Dermato-Neuro Syndrome In A Patient With Scleromyxedema, Mike Fritz, Daniel Tinker, Alex W. Wessel, Gabriela M. Morris, Linda Goldenberg, Mark Fesler, Lokesh Rukmangadachar, M. Yadira Hurley

Otolaryngology--Head & Neck Surgery Faculty Publications

No abstract provided.

Neuropsychological Symptoms Related To The Covid-19 Pandemic Experienced By The General Population And Particularly By The Healthcare Personnel, Alina Zorina Stroe, Alexandru Floris Stuparu, Silviu Docu Axelerad, Daniel Docu Axelerad, Aurelia Moraru

Journal of Mind and Medical Sciences

Undoubtedly, the outbreak of COVID-19 still represents an overanxious event for both society and population. The fear of getting infected is ubiquitous in the time of the pandemic. The population presented worrying thoughts related to the fact that the health care system was not able to provide enough services during the COVID-19 pandemic. The number of the hospital beds and ventilators was insufficient in order to ensure enough care, considering the increased number of COVID-19 cases that were admitted to the hospitals. Furthermore, people were fearful about the possibility of the global economy becoming decimated. The fright and also the …

Chronic Long-Covid Syndrome: A Protracted Covid-19 Illness With Neurological Dysfunctions, Abdul Mannan Baig

Department of Biological & Biomedical Sciences

After almost a year of COVID-19, the chronic long-COVID syndrome has been recognized as an entity in 2021. The patients with the long-COVID are presenting with ominous neurological deficits that with time are becoming persistent and are causing disabilities in the affected individuals. The mechanisms underlying the neurological syndrome in long-COVID have remained obscure and need to be actively researched to find a resolution for the patients with long-COVID. Here, the factors like site of viral load, the differential immune response, neurodegenerative changes, and inflammation as possible causative factors are debated to understand and investigate the pathogenesis of neuro-COVID in …

Addressing Health Disparities And Access In The Department Of Neurology Outpatient Setting In The Era Of The Covid-19 Pandemic: A Quality Improvement Initiative, V. Wang, M. Rehman, K. Burda, L. Liao, M. Braslavsky, T. Chuang, J. Diep, Md, E. Isaac, E. Wong

House Staff Quality Improvement and Patient Safety Conference (2020-)

Neurology, a largely outpatient specialty, has joined many other fields in the endeavor of incorporating telemedicine.^4,6,7 We present the results of analysis of the Epic Electronic Medical Record (EMR) of all outpatient visits from the Thomas Jefferson University Hospital Department of Neurology from 2019 to 2020 in order to identify areas of ethnic minority and geographic disparities with regards to usage of telemedicine. For our analyses, we have included Neurology patients across the General Neurology (JUP Neurology 909 Walnut NEU), Headache Center (HA), and Multiple Sclerosis Center (MS). Additionally, based on patient surveys from a subset of our outpatient …

Cerebral Venous Thrombosis Associated With Covid-19 Infection: An Observational, Multicenter Study, Sajid Hameed, Mohammad Wasay, Bashir A. Soomro, Ossama Mansour, Foad Abd-Allah, Tianming Tu, Raja Farhat, Naila Shahbaz, Husnain Hashim, Wasim Alamgir

Section of Neurology

Background and purpose: Coronavirus disease 2019 (CO-VID-19) has an increased propensity for systemic hypercoagulability and thromboembolism. An association with cerebrovascular diseases, especially cerebral venous thrombosis (CVT), has been reported among these patients. The objective of the present study was to identify risk factors for CVT as well as its presentation and outcome in COVID-19 patients.
Methods: This is a multicenter and multinational observational study. Ten centers in 4 countries (Pakistan, Egypt, Singapore, and the United Arab Emirates) participated in this study. The study included patients (aged >18 years) with symptomatic CVT and recent COVID-19 infection.
Results: Twenty patients (70% men) …

Neurological Complications Of Covid19 During March 2020 At Lcmc Health University Medical Center: Dataset, David Chachkhiani, Michael Y. Soliman, Delphi Barua, Marine Isakadze, Nicole R. Villemarette-Pittman, Deidre J. Devier, Jesus F. Lovera

School of Medicine Faculty Publications

We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint …

Declining Intensive Care Unit Mortality Of Covid-19: A Multi-Center Study, Sohaib Roomi, Syed Omar Shah, Waqas Ullah, Shan Abedin, Karyn L. Butler, Chiers, Kelly, Benjamin A. Kohl, Erika J. Yoo, Matthew Vibbert, Jack Jallo

Department of Surgery Faculty Papers

Background: Coronavirus disease 2019 (COVID-19) mortality has waned significantly over time; however, factors contributing towards this reduction largely remain unidentified. The purpose of this study was to evaluate the trend in mortality at our large tertiary academic health system and factors contributing to this trend. Methods: This is a retrospective cohort study of intensive care unit (ICU) patients diagnosed with COVID-19 between March and August 2020 admitted across 14 hospitals in the Philadelphia area. Collected data included demographics, comorbidities, admission risk of mortality score, laboratory values, medical interventions, survival outcomes, hospital and ICU length of stay (LOS) and discharge disposition. …

Anti-Sars-Cov-2 Antibodies Within Ivig Preparations: Cross-Reactivities With Seasonal Coronaviruses, Natural Autoimmunity, And Therapeutic Implications, Marinos Dalakas, Kleopatra Bitzogli, Harry Alexopoulos

Department of Neurology Faculty Papers

Introduction: Cross-reactivity to SARS-CoV-2 antigenic peptides has been detected on T-cells from pre-pandemic donors due to recognition of conserved protein fragments within members of the coronavirus's family. Further, preexisting antibodies recognizing SARS-CoV-2 with conserved epitopes in the spike region have been now seen in uninfected individuals. High-dose Intravenous Immunoglobulin (IVIg), derived from thousands of healthy donors, contains natural IgG antibodies against various antigens which can be detected both within the IVIg preparations and in the serum of IVIg-receiving patients. Whether IVIg preparations from pre-pandemic donors also contain antibodies against pre-pandemic coronaviruses or autoreactive antibodies that cross-react with SARS-CoV-2 antigenic epitopes, …

Rapid Decline In Telestroke Consults In The Setting Of Covid-19., Syed O. Shah., Robin Dharia, Jaime Stazi, Maureen Deprince, Robert H. Rosenwasswer

Farber Institute for Neuroscience Faculty Papers

Background and Purpose: As coronavirus disease 2019 (COVID-19) continues to be a global pandemic, there is a growing body of evidence suggesting that incidence of diseases that require emergent care, particularly myocardial infarction and ischemic stroke, has declined rapidly. The objective of this study is to quantify our experience of telestroke (TS) consults at a large tertiary comprehensive stroke center during the COVID-19 pandemic.

Methods: We retrospectively reviewed TS consults of patients presenting to our neuroscience network. Those with a confirmed diagnosis of acute ischemic stroke or transient ischemia attack were included. Data were compared from April 1, 2019, to …

Encephalopathy And Complex Hyperkinesia In A Patient With Severe Acute Respiratory Syndrome Coronavirus-2 Infection, Wenyang Li, Elif Pinar Coskun, Rolando Berger, John T. Slevin, L. Creed Pettigrew

Neurology Faculty Publications

No abstract provided.

Burnout Among Healthcare Providers Of Covid-19; A Systematic Review Of Epidemiology And Recommendations, Mehrdad Sharifi, Ali Akbar Asadi-Pooya, Razieh Sadat Mousavi-Roknabadi

Department of Neurology Faculty Papers

Introduction: In the current systematic review, we intended to systematically review the epidemiology of burnout and the strategies and recommendations to prevent or reduce it among healthcare providers (HCPs) of COVID-19 wards, so that policymakers can make more appropriate decisions.

Methods: MEDLINE (accessed from PubMed), Science Direct, and Scopus electronic databases were systematically searched in English from December 01, 2019 to August 15, 2020, using MESH terms and related keywords. After reading the title and the abstract, unrelated studies were excluded. The full texts of the studies were evaluated by authors, independently, and the quality of the studies was determined. …

The Influence Of Coronavirus Disease-2019 (Covid-19) On Parkinson’S Disease: An Updated Systematic Review, Vikash Jaiswal, Danah Alquraish, Zouina Sarfraz, Azza Sarfraz, Shavy Nagpal, Prakriti Singh Shrestha, Dattatreya Mukherjee, Prathima Guntipalli, Diana F. Sánchez Velazco, Arushee Bhatnagar

Department of Paediatrics and Child Health

Background: COVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host's angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson's disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. In this systematic review, we aim to provide thorough analyses of associations between COVID-19 …

Inflammatory Myopathies: Update On Diagnosis, Pathogenesis And Therapies, And Covid-19-Related Implications., Marinos C. Dalakas

Department of Neurology Faculty Papers

The inflammatory myopathies constitute a heterogeneous group of acquired myopathies that have in common the presence of endomysial inflammation. Based on steadily evolved clinical, histological and immunopathological features and some autoantibody associations, these disorders can now be classified in five characteristic subsets: Dermatomyositis (DM) Polymyositis (PM), Necrotizing Autoimmune Myositis (NAM), Anti-synthetase syndrome-overlap myositis (Anti-SS-OM), and Inclusion-Body-Myositis (IBM). Each inflammatory myopathy subset has distinct immunopathogenesis, prognosis and response to immunotherapies, necessitating the need to correctly identify each subtype from the outset to avoid disease mimics and proceed to early therapy initiation. The review presents the main clinicopathologic characteristics of each subset …

Acute Ischemic Stroke As The Presenting Feature Of Covid-19 In The Young And Pregnant, Nermila A. Ballmick, Jiri F. Kubac, Hossein Akhondi

HCA Healthcare Journal of Medicine

Introduction: Coronavirus disease (COVID-19) is an emerging and rapidly evolving public health issue that has become globally widespread and an overwhelming pandemic. Clinical manifestations of the disease include asymptomatic carrier states, acute respiratory distress syndrome, and even multiorgan dysfunction. Here, we present a unique and rare case of an acute ischemic stroke (AIS) in an asymptomatic pregnant woman with no predisposing medical illnesses.

Discussion: An 18-year-old G2P1 African American woman at 7 weeks gestational age with no significant medical or family history presenting to the Emergency Department during the initial phases of the pandemic with complaints of new onset left …