TABLE 1.
Characteristics of eight COVID-19–positive patients diagnosed with focal neuropathy on electrodiagnostic testing
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | Patient 7 | Patient 8 | |
|---|---|---|---|---|---|---|---|---|
| Age, yr | 73 | 46 | 40 | 70 | 66 | 74 | 64 | 48 |
| Sex | M | M | M | F | F | M | M | M |
| Race/ethnicity | Asian | Asian | Hispanic | Asian | White | White | Hispanic | Asian |
| BMI | 22.1 | 50.3 | 63.8 | 26.8 | 34.7 | 23.3 | 32.0 | 23.8 |
| Medical comorbidities | HTN, DMII | Morbid obesity | Morbid obesity, HLD, DMII | HTN, HLD | Obesity, Anxiety | None | HTN, HLD, DMII, Asthma | HTN, DMII, Asthma |
| Length of stay, d | 37 | 72 | 74 | 50 | 32 | 45 | 36 | 80 |
| Duration of mechanical ventilation, d | 23 | 59 | 60 | >44 | >29 | 43 | 23 | 63 |
| Prone therapy | No | No | Yes | Yes | Yes | No | Yes | No |
| Time between COVID-19 infection and onset of clinical symptoms, d | 44 | 31 | 72 | ≈ 69 | ≈ 43 | ≈ 70 | 80 | 84 |
| Time between clinical symptoms and initial EDX testing, d | 30 | 98 | 24 | ≈ 18 | ≈ 42 | ≈ 39 | 72 | 43 |
| Main objective findings—Medical Research Council Grading Scale for Muscle Strength | Right–hip flexion 0/5, knee extension 0/5 | Bilateral–knee flexion 0/5, dorsiflexion 0/5 | Bilateral–knee flexion 1/5, dorsiflexion 0/5 | Right–hip flexion 3/5, knee extension 2/5, ankle dorsiflexion 1/5, plantarflexion 4/5 | Left–elbow extension 5/5, wrist and finger extension 1/5 | Left–dorsiflexion 1/5 | Right–dorsiflexion 1/5 | Right–dorsiflexion 1/5 |
| Working diagnosis | Right femoral nerve injury | Bilateral sciatic nerve injury | Bilateral sciatic nerve injury | Right lumbar plexus injury | Left radial nerve injury | Left fibular nerve injury | Right fibular nerve injury | Right fibular nerve injury |
| Location of fibrillations and PSWs on EMG | Right RF, VL, VM, and IP | Bilateral TA, FL, GMH, GLH, BFLH, BFSH, left worse than right. | Bilateral TA, FL, GMH, EDL, BFLH. | Right TA, FL, VL, RF, BFLH, BFSH. | Left ECRL, ECU, EDC, and EIP. | Left TA | Right TA | Right TA and FL |
| Other pertinent EMG findings | No motor units seen firing in the femoral nerve innervated muscles | Reinnervation noted distally bilaterally with the exception of no motor units seen firing in the left TA | No motor units seen firing in the sciatic nerve innervated muscles. Bilateral sacral plexopathy cannot be totally excluded | Lumbar paraspinals showed normal activity. Decreased recruitment in the lumbar plexus innervated muscles | Reinnervation noted to the BR, ECR, and EDC | Findings are consistent with a left fibular neuropathy at the fibular head on a superimposed generalized peripheral lower polyneuropathy | Decreased recruitment in the right TA and FL | Evidence of a severe incomplete right common fibular neuropathy at the fibular head |
BFSH, biceps femoris short head; BR, brachioradialis; DMII, diabetes mellitus type 2; ECRL, extensor carpi radialis longus; ECU, extensor carpi ulnaris; EDC, extensor digitorum communis; EDL, extensor digitorum longus; EIP, extensor indicis proprius; EDX, electrodiagnostic testing; F, female; FL, fibularis longus; GLH, gastrocnemius lateral head; GMH, gastrocnemius medial head; HLD, hyperlipidemia; HTN, hypertension; IP, iliopsoas; M, male; RF, rectus femoris; TA, tibialis anterior; VL, vastus lateralis; VM, vastus medialis.