Table 1.
Description of demographic data, time to onset of neurological symptoms, diagnostic criteria, intervention and outcomes from 11 reported studies with neuromuscular complications associated with SARS- COV-2 infection.
| Number of Patients | Sex | Age | Pre- neuro symptoms | Presenting neurological symptoms | Time to onset of neuro- symptoms from initial symptom | Diagnosis | Lumbar Puncture | Radiological findings | Electrodiagnostic studies | Intervention | Outcome | Time to outcome from onset of neurological symptoms | Follow up | References |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1 | M | 71 | Low grade fever | Paresthesia, weakness | 1 week | GBS | Albumino-cytological disproportion (protein 54 mg/dl, cells: 9 /Ul) | CT head: negative | Decreased to absent SNAP, Markedly increased CMAP distal latency. |
Lopinavir ritonavir IVIG (0.4 g/kg/d for 5days) | Death: Severe respiratory failure. | 3 days | NA | (8) |
| 1 | M | 64 | Fever, cough | Paresthesia,tetraparesis | 11 days | GBS | Albuminocytologic dissociation (protein 1.66 g/l, Cells: normal) | NA | Decreased velocities, absent F waves | Lopinavir +Ritonavir + IVIG (0.4 g/kg/d for 5 days) | Unavailable | NA | NA | (9) |
| 1 | M | 70 | Myalgia, fatigue, cough | Paresthesia, allodynia, flaccid paralysis | 10 days | GBS | Albumino-cytologic dissociation | MRI-ruled out myelopathy | Sensorimotor demyelinating polyneuropathy with sural sparing pattern. | IVIG (0.4 g/kg/d for 5 days) | Rehabilitation | 15 days | NA | (10) |
| 1 | M | 54 | Fever, cough | Numbness, weakness lower extremities | 10 day | GBS | Not Performed | MRI: Unremarkable | Not Performed |
IVIG + Hydroxychloroquine |
Rehabilitation | Unavailable | NA | (11) |
| 1 | F | 61 | Fatigue | Bilateral lower extremity weakness | 1 day | GBS | Albumino-cytologic dissociation (Protein 124 mg/dl, normal cells) | NA | Delayed distal latencies and absent F waves | Umifenovir+ Lopinavir+ Ritanovir+ IVIG | Complete neurological recovery | 30 days | NA | (12) |
| 1 | M | 65 | Fever, cough, dyspnea | Bilateral lower extremity weakness | 10 days | GBS | Not obtained | MRI Brain, Spine: Negative | Absent SNAP, Decreased CMAP amplitude | Lopinavir + Ritonavir Hydroxychloroquine IVIG(0.4 g/kg/d for 5 days) | Unavailable | NA | NA | (13) |
| 5 | F | 77 | Fever, cough | 1.Flaccid areflexic tetraplegia ascending to facial weakness and respiratory failure | 7 days | GBS | Albumino-cytologic dissociation (protein:101 mg/dl, cells: 4/UL) | MRI head: Normal. MRI Spine: Enhancement of caudal nerve roots | Decreased ulnar SNAP, decreased tibial and ulnar CMAP. Absent ulnar and tibial F waves. |
IVIG 2 cycles | Poor Outcome: Persistent severe UE weakness, dysphagia and LE paraparesis, neuromuscular respiratory failure. | 2 weeks | NA | (14) |
| M | 23 | Fever, sore throat | 2. Facial diplegia, lower limb paresthesia, ataxia | 10 days | GBS | Albumino-cytologic dissociation (protein:123 mg/dl, no cell) | MRI head: Enhancement of b/l facial nerves. MRI Spine: normal. |
Decreased ulnar SNAP, decreased tibial and ulnar CMAP. Decrease in facial nerve cMAP amplitude. Absent F waves | IVIG | Decreased facial and extremity weakness | Unavailable | NA | (14) | |
| M | 55 | Fever, cough | 3. Flaccid tetraparesis, facial weakness. | 10 days | GBS | Alb minocytologic dissociation (protein: 193 mg/dl, no cells) | MRI head: Normal. MRI Spine: Enhancement of caudal nerve roots | Decreased ulnar and tibial CMAP Absent ulnar and tibial F waves | IVIG 2 cycles | Poor Outcome: Neuromuscular respiratory failure | 1 month | NA | (14) | |
| M | 76 | Dry cough, anosmia | 4. Flaccidtetraparesis and ataxia | 5 days | GBS | Normal protein, no cells | MRI head: normal. MRI Spine: normal | Increased tibial latencies, decreased CMAP amplitude, decreased velocities. Decreased ulnar amplitude. | IVIG | Mild Improvement, Unable to stand at 1 month | 1 month | NA | (14) | |
| M | 61 | Dry cough, Anosmia, ageusia | 5. Facial weakness, flaccid paraplegia,respiratory failure | 7 days | GBS | Albuminocytologic dissociation (protein: 40 mg/dl, cells: 3/UL) | MRI head: NA. MRI Spine: normal | Increased tibial latencies, decreased CMAP amplitude, decreased velocities. Decreased sural SNAP, absent tibial F waves. | IVIG + PLEX | Tetraplegic, neuromuscular respiratory failure | 1 month | NA | (14) | |
| 2 | M | 50 | Fever, cough, malaise, headache | Anosmia, ageusia, right internuclear ophthalmoparesis, right fascicular oculomotor palsy, ataxia | 5 day | MillerFisher syndrome | Albuminocytologic dissociation, positive GD1b-IgG antibodies. | NA | NA | IVIG | Full neurological recovery, except residual ageusia and anosmia | 2 weeks | (15) | |
| M | 39 | Fever, diarrhea | Ageusia, bilateral abducens palsy, areflexia | 3 day | Polyneuritis cranialis | Albuminocytologic dissociation | NA | NA | Acetaminophen | Full neurological recovery | 2weeks | After 2 weeks, complete recovery | (15) | |
| 1 | M | 64 | Fever, fatigue | Flaccid LE paralysis, Urinary and bowel incontinence | 7 days | Acutemyelitis | NA | NA | NA | Moxifloxacin + tamiflu + Ganciclovir+Lopinavir+ Ritonavir+Dexamethasone+ IVIG |
Rehabilitation | 14days | NA | (16) |
| 1 | M | 62 | Weakness | Diplopia, left eye ptosis | 5 day | Oculomotor Palsy | NA | MRI, MRA negative | NA | Moxifloxacin, Tamiflu, Lopinavir, Ribavirin, Steroids, IVIG (0.4 g/kg once every day) | Death due to respiratory failure |
12 days | NA | (17) |
| 1 | F | 65 | Pain in mastoid region | Left peripheral facial palsy | 1 day | Left Bell's Palsy | NA | MRI Brian: Unremarkable | NA | arbidol and ribavirin | Recovery | Unavailable | 1month | (18) |