Table 1.
Patient | #1 | #2 | #3 | #4 | #5 |
---|---|---|---|---|---|
Age, years | 61 | 72 | 57 | 69 | 25 |
Sex | M | F | M | M | F |
Diagnosis | Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) | Acute inflammatory demyelinating polyradiculoneuropathy (AIDP) | Acute motor sensory axonal neuropathy (AMSAN) | Myelitis | Myelitis |
Early symptoms of COVID-19 | Cough, hyposmia and dysgeusia | Fever (up to 39°C), cough, ageusia | Fever (up to 39°C), cough and dysgeusia | Fever and asthenia | Fever (up to 38°C), anosmia and dysgeusia |
Need for mechanical ventilation | Yes | No | No | No | No |
COVID-19 treatment | None | Antibiotics, LMWH and hydroxychloroquine | None | Antibiotics, lopinavir/ritonavir, LMWH and hydroxychloroquine | LMWH |
Latency of neurological symptoms, days | 21 | 8 | 12 | 3 | 15 |
CSF findings | Normal, SARS-CoV-2 RT-qPCR negative | 1st exam: normal, SARS-CoV-2 RT-qPCR negative 2nd exam: albumin-cytological dissociation |
Normal, SARS-CoV-2 RT-qPCR negative | Marked pleocytosis with neutrophil prevalence, hyperproteinorrachia and oligoclonal bands, SARS-CoV-2 RT-qPCR negative | Normal (polyclonal distribution of immunoglobulins), SARS-CoV-2 RT-qPCR negative |
Brain MRI findings | Not performed | Chronic cerebrovascular disease | Not performed | Normal | Normal |
Spinal cord MRI findings | – | No signs of myelitis nor thickening or contrast enhancement of nerve roots | No signs of myelitis nor thickening or contrast enhancement of nerve roots | Multiple small T2-hyperintense cervical and thoracic lesions, mostly affecting the lateral and posterior columns | T2-hyperintensity at the thoracic spinal cord level mainly affecting the T3 and T8-T10 myelomeres |
Neurological symptoms at baseline | Impaired walking and sensory loss at the lower limbs which rapidly evolved to tetraparesis with acute respiratory failure | Walking impairment and diffuse paresthesia, gradually evolving in a tetraparesis with sensory deficit in the four limbs | Progressive sensory-motor deficit in the four limbs (sensory symptoms prevalent on motor impairment) | Acute urinary retention, rapidly followed by complete motor and sensory impairment in the lower limbs | Hyposthenia in both legs, paresthesia and numbness with upper level at the breast line and sensation of incomplete bladder emptying |
Acute Treatments of the neurological syndrome | IVIG, 1 cycle of 3 days (0.4 g/die) | IVIG, 2 cycles of 5 days each (0.4 g/die) within the first month | IVIG, 1 cycle of 5 days (0.4 g/die) | IVIG, 1 cycle of 5 days (0.4 g/die) | 2 cycles of IV methylprednisolone 1 g/day (each of 7 days) with a 3-month interval |
Chronic treatments of the neurological syndrome | None | Plasma exchange cycles, 6 times over 14 days | None | None | Low dose of oral prednisone with a tapering scheme over 2 months |
Duration of rehabilitation treatment including physiotherapy and occupational therapy, days | 120 | 179 | 36 | 128 | 72 |
Clinical outcome | Autonomy recovery; persistence of mild distal weakness at lower limbs | Autonomy in self transferring, ability to walk with aids and bilateral support | Autonomy recovery; walking with right ankle-foot orthosis | Autonomy recovery; normal walking but with early fatigue | Autonomy recovery; persistence of distal weakness at lower limbs and gait ataxia |
IVIG, intravenous immunoglobulin; LMWH, low molecular weight heparin.