DOI: 10.1212/CPJ.0000000000000910 Neurology: Clinical ......2020/07/23 · reporting a visual analogue scale (VAS) for pain of 10 in 10 (10/10). Treatment was adjusted (duloxetine,
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Neurology: Clinical Practice Publish Ahead of PrintDOI: 10.1212/CPJ.0000000000000910
DIAS 1
Acute inflammatory painful polyradiculoneuritis: An uncommon presentation related to COVID-19
Francisco Antunes Dias, MD, MSc1; Ana Luiza Nunes Cunha, MD, MSc1; Patrícia Maria Pedrosa Pantoja, MD1; Carolina Lavigne Moreira, MD, MSc1; Pedro José Tomaselli, MD, PhD1; Maria Clara Zanon Zotin, MD, MSc2,3; Francisco Antônio Colleto, MSc1; Soraia Ramos Cabette Fabio MD, PhD4; Octavio M. Pontes-Neto, MD, PhD1; Wilson Marques Júnior, MD, PhD1 1Department of Neurosciences and Behavioral Sciences, Hospital das Clínicas – Ribeirão Preto Medical School, University of São Paulo; Ribeirão Preto, SP, Brazil 2Department of Radiology, Hospital das Clínicas – Ribeirão Preto Medical School, University of São Paulo; Ribeirão Preto, SP, Brazil 3Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA 4Hospital da Unimed Ribeirão Preto, Ribeirão Preto, SP, Brazil
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DIAS 8 REFERENCES 1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323(11):1061-1069. doi:10.1001/jama.2020.1585. 2. Mao L, Jin H, Wang M, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020 Apr 10 (Epub ahead of print). doi:10.1001/jamaneurol.2020.1127. 3. Moriguchi T, Harii N, Goto J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis. 2020;94:55-58. doi: 10.1016/j.ijid.2020.03.062. 4. Toscano G, Palmerini F, Ravaglia S, et al. Guillain–Barré syndrome associated with SARS-CoV-2. N Engl J Med 2020 Apr 17 (Epub ahead of print). doi: 10.1056/NEJMc2009191. 5. Pfefferkorn T, Dabitz R, von Wernitz-Keibel T, et al. Acute polyradiculoneuritis with locked-in syndrome in a patient with Covid-19. J Neurol. 2020 May 12 (Epub ahead of print). doi: 10.1007/s00415-020-09897-y. 6. Yuki N, Chan AC, Wong AHY, et al. Acute painful autoimmune neuropathy: a variant of Guillain-Barré syndrome. Muscle Nerve 2018;57(2):320-324. doi: 10.1002/mus.25738. 7. Grave C, Boucheron P, Rudant J, et al. Seasonal influenza vaccine and Guillain-Barré syndrome: A self-controlled case series study. Neurology 2020;94(20):e2168-e2179. doi: 10.1212/WNL.0000000000009180.
Figure. Lumbosacral MRI and chest CT. A) T1-weighted postcontrast axial with fat suppression reveals enhancement of bilateral L5 roots (black arrows); B) T2-weighted coronal with fat suppression shows hyperintensity of bilateral L5 nerves (white arrows). C) Chest computed tomography with bilateral ground-glass opacities.
Table. Nerve conduction studies.
NERVE CMAP SNAP L A1 A2 A3 CV1-2 CV2-3 Fw A CV R median 3.0 13.9 13.5 13.1 55,1 68.8 26.3 28.5 54.3 L median 3.1 9.2 7.9 7.5 62.0 54.8 26.1 23.4 56.3 R ulnar 2.2 7.5 6.7 6.4 64.6 65.7 26.0 12.3 61.0 L ulnar 2.6 7.8 6.9 6.3 62.3 55.9 25.8 14.8 55.3 R peroneiro 4.6 4.24 4.03 3.97 41.4 44.4 48.3 7.7 40.1 L peroneiro 4.4 4.67 4.21 4.19 45.8 43.9 44.3 6.7 45.0 R tibialis posterior 4.2 12.6 11.2 - 50.6 - 45.4 4.7 55.6 L tibialis posterior 3.9 16.2 10.4 - 43.6 - 44.5 5.9 59.5
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