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Review
. 2021 Feb 14;21(3):9.
doi: 10.1007/s11910-021-01102-5.

Peripheral Nervous System Manifestations Associated with COVID-19

Sasan Andalib  1 , José Biller  2 , Mario Di Napoli  3 , Narges Moghimi  4 , Louise D McCullough  5 , Clio A Rubinos  6 , Christa O'Hana Nobleza  7 , M Reza Azarpazhooh  8 , Luciana Catanese  9 , Isabel Elicer  10 , Mostafa Jafari  11 , Fabrizio Liberati  12 , Claudia Camejo  13 , Michel Torbey  4 , Afshin A Divani  14
Affiliations
Review

Peripheral Nervous System Manifestations Associated with COVID-19

Sasan Andalib et al. Curr Neurol Neurosci Rep. .

Abstract

Purpose of review: The present review discusses the peripheral nervous system (PNS) manifestations associated with coronavirus disease 2019 (COVID-19).

Recent findings: Nerve pain and skeletal muscle injury, Guillain-Barré syndrome, cranial polyneuritis, neuromuscular junction disorders, neuro-ophthalmological disorders, neurosensory hearing loss, and dysautonomia have been reported as PNS manifestations in patients with COVID-19. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19. COVID-19 has shown syndromic complexity. Not only does SARS-CoV-2 affect the central nervous system but also it involves the PNS. The PNS involvement may be due to dysregulation of the immune system attributable to COVID-19. Here we review the broad spectrum of PNS involvement of COVID-19.

Keywords: COVID-19; Peripheral nervous system manifestations; SARS-CoV-2.

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Conflict of interest statement

Sasan Andalib, José Biller, Mario Di Napoli, Narges Moghimi, Louise D McCullough, Clio A. Rubinos, Christa O’Hana Nobleza, M. Reza Azarpazhooh, Luciana Catanese, Isabel Elicer, Mostafa Jafari, Fabrizio Liberati; Claudia Camejo, Michel Torbey, and Afshin A. Divani each declare no potential conflicts of interest.

Figures

Fig. 1
Fig. 1
Diagnostic accuracy of muscle biopsy and electromyography in COVID-19-associated myopathy. Hematoxylin and eosin formalin-fixed and paraffin-embedded tissue sections from multiple biopsies of the left deltoid muscle and the left biceps brachial muscle. Panel a Scattered myofibers undergoing various stages of necrosis, with many atrophic muscular fibers, and nuclear centralization. Panel b An example of myophagocytosis. A macrophage (in blue) is phagocytizing a myofiber. Panel c immunostaining using CD68/PGM1+ antibodies demonstrates that the inflammatory infiltrate is mainly composed of macrophages. Scant lymphocytes B/CD20+ and T/CD3+ with a T-helper immunophenotype (CD4+) as well as CD123+ plasmacytoid dendritic cells were also found (data not shown). Panel d Other non-specific features are focal tissue sclerosis, atrophy, and variation in muscle fiber size. Panel e The electromyogram may be useful early in the diagnostic workup to confirm the presence of a myopathic pattern. Motor nerve conduction study from affected muscle (deltoid) shows compound muscle action potential (CMAP) amplitude reduced, with preserved distal latencies (top), reflecting muscle damage in the face of normal nerve function. Muscles tested by concentric needle (bottom) show short-duration, polyphasic low-amplitude motor unit potentials (MUP). Because each small motor unit is able to generate only a reduced amount of force compared with normal, with little muscle contraction, many MUPs are recruited. EMG traces were kindly supplied by Dr. Flavio Di Stasio, MD, and Dr. Giuliano Gentili, RNT
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