MUSCULOSKELETAL RADIOLOGY / CASE REPORT
Magnetic resonance neurography findings in three critically ill COVID-19 patients with new onset of extremity peripheral neuropathy
1
Department of Radiology, Northwestern University Feinberg School of Medicine, United States
Submission date: 2020-11-18
Final revision date: 2020-12-22
Acceptance date: 2020-12-23
Publication date: 2021-06-28
Pol J Radiol, 2021; 86: 394-400
KEYWORDS
TOPICS
ABSTRACT
Introduction:
Coronavirus-19 (COVID-19) is most commonly associated with respiratory syndromes, although patients are presenting more frequently with neurological symptoms. When they occur, neurological conditions most commonly involve the central nervous system, and peripheral nervous system effects, particularly in the extremities, have been less commonly described. The mechanisms of peripheral neuropathy in critically ill patients with COVID-19 are likely to be multifactorial, and extremity peripheral nerve imaging in these cases has not been well described.
Case presentation:
In this case series, we describe the magnetic resonance neurography (MRN) findings in 3 critically ill patients who presented with new onset of peripheral neuropathies in the extremities, and we discuss possible common mechanisms of nerve injury, including the role of position-related nerve injury.
Conclusions:
MRN can be useful in identifying and localizing peripheral nerve abnormalities in the extremities of COVID-19 patients, and patients who are placed in the prone position during ventilation may be more susceptible to these injuries.
Coronavirus-19 (COVID-19) is most commonly associated with respiratory syndromes, although patients are presenting more frequently with neurological symptoms. When they occur, neurological conditions most commonly involve the central nervous system, and peripheral nervous system effects, particularly in the extremities, have been less commonly described. The mechanisms of peripheral neuropathy in critically ill patients with COVID-19 are likely to be multifactorial, and extremity peripheral nerve imaging in these cases has not been well described.
Case presentation:
In this case series, we describe the magnetic resonance neurography (MRN) findings in 3 critically ill patients who presented with new onset of peripheral neuropathies in the extremities, and we discuss possible common mechanisms of nerve injury, including the role of position-related nerve injury.
Conclusions:
MRN can be useful in identifying and localizing peripheral nerve abnormalities in the extremities of COVID-19 patients, and patients who are placed in the prone position during ventilation may be more susceptible to these injuries.
REFERENCES (20)
1.
“Home Page” Johns Hopkins Coronavirus Resource Center, Johns Hopkins University & Medicine, November 15, 2020. Available at: https://coronavirus.jhu.edu.
2.
Russell B, Moss C, Rigg A, et al. Anosmia and ageusia are emerging as symptoms in patients with COVID-19: what does the current evidence say? Ecancermedicalscience 2020; 14: ed98.
3.
Malik GR, Wolfe AR, Soriano R, et al. Injury-prone: peripheral nerve injuries associated with prone positioning for COVID-19-related acute respiratory distress syndrome. Br J Anaesth 2020; 125: e478-e480.
4.
Fernandez CE, Franz CK, Ko JH, et al. Imaging review of peripheral nerve injuries in patients with COVID-19. Radiology 2021; 298: E117-E130.
5.
Walling AD, Dickson G. Guillain-Barre syndrome. Am Fam Physician 2013; 87: 191-197.
6.
Dalakas MC. Guillain-Barre syndrome: the first documented COVID-19-triggered autoimmune neurologic disease: more to come with myositis in the offing. Neurol Neuroimmunol Neuroinflamm 2020; 7: e781.
7.
van der Meché FG, van Doorn PA. Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy: immune mechanisms and update on current therapies. Ann Neurol 1995; 37 (Suppl 1): S14-S31.
8.
Hadden RD, Cornblath DR, Hughes RA, et al. Electrophysiological classification of Guillain-Barré syndrome: clinical associations and outcome. Plasma Exchange/Sandoglobulin Guillain-Barré Syndrome Trial Group. Ann Neurol 1998; 44: 780-788.
9.
Byun WM, Park WK, Park BH, et al. Guillain-Barre syndrome: MR imaging findings of the spine in eight patients. Radiology 1998; 208: 137-141.
10.
Zhou Ch, Wu L, Ni F, et al. Critical illness polyneuropathy and myopathy: a systematic review. Neural Regen Res 2014; 9: 101-110.
11.
Latronico N, Bolton CF. Critical illness polyneuropathy and myopathy: a major cause of muscle weakness and paralysis. Lancet Neurol 2011; 10: 931-941.
12.
Dinh A, Carlier R, Descatha A. Intensive critical illness myopathy and whole body MRI. Care Med 2016; 42: 587.
13.
Coppieters MW, Van de Velde M, Stappaerts KH. Positioning in anesthesiology: toward a better understanding of stretch-induced perioperative neuropathies. Anesthesiology 2002; 97: 75-81.
14.
Welch MB, Brummett CM, Welch TD, et al. Perioperative peripheral nerve injuries: a retrospective study of 380,680 cases during a 10-year period at a single institution. Anesthesiology 2009; 111: 490-497.
15.
Kamel I, Barnette R. Positioning patients for spine surgery: avoiding uncommon position-related complications. World J Orthop 2014; 5: 425-443.
16.
Golestani-Eraghi M, Mahmoodpoor A. Early application of prone position for management of Covid-19 patients. J Clin Anesth 2020; 66: 109917.
18.
Jorgensen SCJ, Kebriaei R, Dresser LD. Remdesivir: review of pharmacology, pre-clinical data, and emerging clinical experience for COVID-19. Pharmacotherapy 2020; 40: 659-671.
19.
Zhang Y, Kong X, Zhao Q, et al. Enhanced MR neurography of the lumbosacral plexus with robust vascular suppression and improved delineation of its small branches. Eur J Radiol 2020; 129: 109128.
20.
Harrell AD, Johnson D, Samet J, et al. With or without? A retrospective analysis of intravenous contrast utility in magnetic resonance neurography. Skeletal Radiol 2020; 49: 577-584.
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