Thread by @AltafSaadiMD

Dr. Mukerji kicking off @MGHNeurology #grandrounds on #COVID19 and neurology by reviewing @JAMA_current series- neurological complications started early in course of disease, most common: dizziness, headaches, impaired consciousness, stroke, then neuromuscular.

Neuro symptoms in 45.5% in severe #COVID19, 30.2% in mild COVID. But newer studies suggest this is an underestimate.

Dr. Chwalisz differentiates between minor vs major neurological symptoms #COVID19 #neurology:

Olfactory dysfxn described in ~60-75% of smell & taste disturbances. Here a series from Iran, has been documented in other series. Dr. Chwalisz discusses mechanism- likely transient involving chemical environment of neuron rather than neuronal damage. medrxiv.org/content/10.110…

Headache in #COVID19. In Wuhan, found to be early symptom with cough, throat pain, chest CT findings developing several days later. #grandrounds

Reviewing recent @NEJM correspondence - reminder CSF SARS-CoV2 test not validated. nejm.org/doi/full/10.10…

Noting vascular dysfunction in #COVID19 patients and cytokine storm as two additional mechanisms for Neuro #COVID19 complications. Some centers reporting spikes in optic neuritis and demyelination, not yet extensively reported in the literature.

Neuromuscular complications: skeletal muscle injury/ rhabdo, GBS, and other common neuromuscular implications (eg critical illness myopathy)

In this @JAMANeuro paper, 10.7% of total #COVID19 patients developed signs of skeletal muscle injury. 20% of those with severe illness vs 5% of those with mild illness. jamanetwork.com/journals/jaman…

Viral myositis most likely etiology vs cytokine storm. Viral myositis most common in children. Seen with flu A/B, Coxsackie, EBV, adeno, others. In adults, it’s more severe with generalized or proximal muscle weakness. Most common complication acute renal failure (14-46%).

Documentation of GBS and Miller fisher syndrome: n.neurology.org/content/early/…

Thinking also about hypoK myopathy (from diarrhea due to #COVID19), drug-related myopathies (azithromycin + statins, steroids, hydroxychloroquine- but chronic use causes myopathy not short term use), and critical illness myopathy/ ICU-related weakness. #neurology

Recovery rate from critical illness myopathy is quite high within 3-6months, most common form is combination of myopathy + polyneuropathy (sensorimotor, axonal). Shout out to Dr. Paloma Gonzalez Perez for the neuromuscular overview @MGHNeurology #grandrounds.

So grateful for @MGHNeurology on such an informative #GrandRounds. Tried my best to live tweet but it was hard to keep up with all the information!