Peripheral neurological complications during COVID-19: A single center experience

Abstract

Background and aims: We highlight the peripheral neurologic complications of coronavirus disease 2019 (COVID-19) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an ongoing global health emergency.

Methods: We evaluated twenty-five patients admitted to the COVID-19 Recovery Unit (CRU) at New York-Presbyterian Weill Cornell University Medical Center after intensive care hospitalization with confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), whom neurology was consulted for weakness and/or paresthesias. All patients were clinically evaluated by a neuromuscular neurologist who performed electrodiagnostic (EDX) studies when indicated. Magnetic resonance imaging (MRI) of the affected regions, along with nerve and muscle biopsies were obtained in select patients to better elucidate the underlying diagnosis.

Results: We found fourteen out of twenty-five patients with prolonged hospitalization for COVID-19 infection to have peripheral neurological complications, identified as plexopathies, peripheral neuropathies and entrapment neuropathies. The other eleven patients were not found to have peripheral neurologic causes for their symptoms. Patients with peripheral neurological complications often exhibited more than one type of concurrently. Specifically, there were four cases of plexopathies, nine cases of entrapment neuropathies, and six cases of peripheral neuropathies, which included cranial neuropathy, sciatic neuropathy, and multiple mononeuropathies.

Conclusions: We explore the possibility that the idiopathic peripheral neurologic complications could be manifestations of the COVID-19 disease spectrum, possibly resulting from micro-thrombotic induced nerve ischemia.

Keywords: Brachial plexopathy; COVID-19; Entrapment neuropathy; Peripheral neuropathy; RA02; SARS-CoV-2.

Fig. 1

Nerve biopsy, MRI findings, and intraoperative photos. Nerve biopsy, MRI findings, and intraoperative photos: (A) Epoxy resin section of the nerve, magnification x400. Axonal loss associated with numerous macrophages engulfing degenerating nerve fibers. (B) Electron microscopy, original magnification x5000. A macrophage appears to be stripping myelin sheath. (C) MRI FLAIR: normal intensity of the posterior interosseous branch of the radial nerve prior to the supinator tunnel, left, and increased intensity within the supinator tunnel, right. (D) MRI neurogram demonstrates enlargement and increased T2 hyperintensity of right sciatic nerve (white arrow). (E, F) MRI neurogram demonstrates increased T2 hyperintensity seen in the roots of the brachial plexus bilaterally (white arrows) in the same patient. (G) Intraoperative photos pre- (left) and post-surgical decompression (right) of the posterior interosseous branch of the radial nerve at the Arcade of Frohse. Abbreviations: FLAIR - fluid-attenuated inversion recovery