Table 1.
Published Cases linking Parkinson’s disease with COVID-19
| Authors | Cohen ME et al. [2] | Faber I et al. [3] | Méndez-Guerrero et al. [4] |
|---|---|---|---|
| Time of publication | Sep-2020 | Aug-2020 | Jul-2020 |
| Case 1 | Case 2 | Case 3 | |
| Age | 45 years old | 35 years old | 58 years old |
| Gender | Male | Female | Male |
| Family history of parkinsonism | Nil | Nil | Nil |
| Use of drug that can cause parkinsonism | Nil | NIL | Nil |
| Length of hospital stay for initial COVID-19 infection | 3 days | No hospitalization required | > 47 days |
| Severity of COVID-19 infection | Mild | Mild | Severe (mechanical ventilation required) |
| Interval between COVID-19 infection and parkinsonism | 20 to 30 days | 10 days | 32 days |
| Prodromal parkinsonian symptoms | Nil | Nil | Nil |
| Parkinsonian features at presentation | Micrographia, hypophonia, hypomimia, tremor, cogwheel rigidity, bradykinesia | Hypomimia, eyelid retraction, slow and hypometric saccades, asymmetric bradykinesia and cogwheel rigidity, stooped posture and parkinsonian gait | Hypomimia, bradykinesia, cogwheel rigidity, postural and rest tremor |
| Other neurological signs | Nil | Nil | Myoclonus, decreased consciousness, opsoclonus |
| Cognition | Normal | Normal | Not evaluated |
| Response to antiparkinson drugs | Good (pramipexole and biperiden) | Good (levodopa/ benserazide) | Poor (trial of apomorphine) |
| Follow-up period | 1 month | – | – |
| Clinical outcome | Improvement observed | Significant improvement observed | Spontaneous significant improvement observed |
| Routine blood tests | Unremarkable | Unremarkable | Unremarkable at the time when parkinsonism developed (including copper and ceruloplasmin) |
| CSF studies |
6 white blood cells, normal glucose and protein No evidence of infection |
0 cell, normal glucose and protein No evidence of infection |
8 cell, normal glucose and mildly elevated protein 0.82 g/L No evidence of infection |
| Common neuronal antibodies | Negative in serum and CSF | – | Negative in serum and CSF |
| Anti-SARS-CoV-2 IgG | Detected in serum but not in CSF | – | – |
| RT-PCR of the CSF for SARS-CoV-2 | Negative | – | Negative |
| MRI brain | Normal | Normal (including nigrosome-1 and neuromelanin imaging) | Normal |
| DaT scan | – | Decreased dopamine transporter density on the left putamen | A bilateral decrease in presynaptic dopamine uptake asymmetrically involving both putamina worse on the left side |
| PET scan | Decreased18F-FDOPA uptake in both putamen and mild decreased uptake in the left caudate | FDG-PET normal | – |
| MIBG | – | – | No cardiac autonomic denervation |
| Genetic testing | Negative | – | – |