Document Type : Case Report
Authors
1 Physiatrist, department of Physical Medicine and Rehabilitation, Shiraz University of Medical Sciences, Faghihi Hospital, Shiraz, Iran
2 Bone and Joint Diseases Research Center, department of physical medicine and rehabilitation, Shiraz University of Medical Sciences, Shiraz, Iran.
3 Shiraz Geriatric Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
4 Internist, school of medicine department of internal medicine, Shiraz University of Medical Sciences, Shooshtary Hospital, Shiraz, Iran
Abstract
Background: Covid-19 was reported in China for the first time. The most common manifestation of this novel infection is respiratory problems. However, it can also invade both central and peripheral nervous systems. The usual central nervous system complications were dizziness (16.8%) and headache (13.1%). The most common reported symptoms in patients with peripheral nervous system problems were taste impairment (5.6%) and smelling impairment (5.1%) due to olfactory nerve involvement.
Methods: We present a 46-year-old male who was referred to our clinic in Shiraz for electrodiagnosis and better evaluation due to paresthesia and numbness of the right 4th and 5th fingers accompanied by weakness and atrophy of the muscles in the ulnar nerve territory, which occurred during Covid-19 infection in this patient.
Results: Severe partial involvement of the right ulnar nerve at the elbow region was detected in the electrodiagnosis, and findings in the right elbow MRI favored ulnar neuritis.
Conclusion: Focal neuritis of the ulnar nerve (ulnar mononeuropathy) seemed to be a new presentation of peripheral nervous system involvement in COVID-19 disease.
Keywords
- Malekmohammad M, Hashemian S, Afshar BM, Jammati H. Neurological Manifestations of COVID-19: A Case Report. Tanaffos. 2020 Nov; 19(2):160-164.
- Hutchins KL, Jansen JH, Comer AD, Scheer RV, Zahn GS, Capps AE, et al. COVID-19- Associated Bifacial Weakness with Paresthesia Subtype of Guillain-Barre’ Syndrome. AJNR Am J Neuroradiol. 2020 Sep; 41(9): 1707-1711.
- Khatoon F, Prasad K, Kumar V. Neurological manifestations of COVID-19: available evidences and a new paradigm. J Neurovirol. 2020 Oct; 26(5): 619-630.
- Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, et al. Human coronaviruses and other respiratory viruses: underestimated opportunistic pathogens of the central nervous system?. Viruses. 2020 Dec;12(1).14.
- Bohmwald K, Gálvez NMS, Ríos M, Kalergis AM. Neurologic Alterations Due to Respiratory Virus Infections. Front Cell Neurosci 2018 Oct; 12:386.
- Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol 2020 Jun;77(6):1–9.
- Zhou Y, Li W, Wang D, Mao L, Jin H, Li Y, et al. Clinical time course of COVID-19, its neurological manifestation and some thoughts on its management. Stroke Vasc Neurol 2020 Jun;5(2):177-179.
- Fernandez C, Franz C, Jason K, Walter J, Koralnik I, Ahlawat S, et al. Imaging Rewiew of Peripheral Nerve Injuries in Patients with COVID-19. Radiol. 2020 Dec;1;203116.
- Abrams R, Kim B, Markantone D, Reilly K, Mandolfi A, Gitman M, et al. Severe rapidly progressive Guillain- Barre’ syndrome in the setting of acute COVID-19 disease. J Neurovirol. 2020 Oct; 26(5): 797-799.
- Malik G, Wolfe A, Soriano R, Rydberg L, Wolfe L, Deshmukh S, et al. Injury – prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome. Br J Anaesth. 2020 Dec; 125(6): 478-480.
- Cacciavillani M, Salvalaggio A, Briani C. Pure sensory neuralgic amyotrophy in COVID-19 infection. Muscle Nerve. 2021 Jan; 63(1):7-8.
- Harapen B, Joo Yoo H. Neurological symptoms, manifestations and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and coronavirus disease 19 (COVID-19). J Neurol. 2021 Jan; 23: 1-13.
- Zubair A, McAlpine L, Gardin T, Farhadian S, Kuruvilla D, Spudich S. Neuropathogenesis and Neurologic manifestations of the Coronaviruses in the age of Coronavirus disease 2019 A Review. JAMA Neurol. 2020 Aug; 77(8): 1018-1027.
- Thakur V, Ratho R, Kumar P, Bhatia P, Bora I, Mohi G, et al. Multi-Organ Involvement in COVID-19: Beyond Pulmonary Manifestations. J Clin Med. 2021 Feb; 10(3): 446.
- Keyhanian K, Pizzolato Umeton R, Mohit B, Davoudi V, Hajighasemi F, Ghasemi M. SARS-COV-2 and nervous system: From pathogenesis to clinical manifestation. J Neuroimmunol. 2021 Jan 350: 577436.
- Rubin G, Orbach H, Bor N, Rozen N. Tardy Ulnar Nerve Palsy. J Am Acad Orthop Surg. 2019 Oct; 27(19):717-725.