Mononeuritis multiplex: an unexpectedly frequent feature of severe COVID-19

Abstract

The prolonged mechanical ventilation that is often required by patients with severe COVID-19 is expected to result in significant intensive care unit-acquired weakness (ICUAW) in many of the survivors. However, in our post-COVID-19 follow-up clinic we have found that, as well as the anticipated global weakness related to loss of muscle mass, a significant proportion of these patients also have disabling focal neurological deficits relating to multiple axonal mononeuropathies. Amongst the 69 patients with severe COVID-19 that have been discharged from the intensive care units in our hospital, we have seen 11 individuals (16%) with such a mononeuritis multiplex. In many instances, the multi-focal nature of the weakness in these patients was initially unrecognised as symptoms were wrongly assumed to relate simply to "critical illness neuromyopathy". While mononeuropathy is well recognised as an occasional complication of intensive care, our experience suggests that such deficits are surprisingly frequent and often disabling in patients recovering from severe COVID-19.

Keywords: COVID-19; Mononeuritis multiplex; Nerve injury; Neuropathy.

Fig. 1

Schematic homuncular illustration of the sensory and motor deficits arising from the multiple mononeuropathies present in 11 patients recovering from severe COVID-19. Hatched shading indicates posterior muscle groups (hamstrings and triceps). In those neuropathies listed as sciatic, there was involvement of both common peroneal and tibial divisions