Introduction

Neurological complications of SARS-CoV-2 disease have received growing attention, but only few studies have described to date clinical and neurophysiological findings in COVID patients during their stay in intensive care units (ICUs). Here, we neurophysiologically assessed the presence of either critical illness neuropathy (CIP) or myopathy (CIM) in ICU patients.

Materials and Methods

Patients underwent a neurophysiological assessment, including bilateral examination of the median, ulnar, deep peroneal and tibial motor nerves and of the median, ulnar, radial and sural sensory nerves. Needle electromyography (EMG) was performed for both distal and proximal muscles of the lower and upper limbs. In order to differentiate CIP from CIM, Direct Muscle Stimulation (DMS) was applied either to the deltoid or tibialis anterior muscles. Peak to peak amplitudes and onset latencies of the responses evoked by DMS (DMS_amp, DMS_lat) or by motor nerve stimulation (MNS_amp, MNS_lat) were compared. The ratio MNS_amp to DMS_amp (NMR) and the MNS_lat to DMS_lat difference (NMD: MNS_lat − DMS_lat) were also evaluated.

Results

Nerve conduction studies showed a sensory-motor polyneuropathy with axonal neurogenic pattern, as confirmed by needle EMG. Both MNS_amp and NMR were significantly reduced when compared to controls (p < 0.0001), whereas MNS_lat and NMD were markedly increased (p = 0.0049).

Conclusions

We have described COVID patients in the ICU with critical illness neuropathy (CIP). COVID-related CIP could have implications for the functional recovery and rehabilitation strategies.

中文翻译：

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重症 COVID-19 中的危重疾病神经病变：病例系列

介绍

SARS-CoV-2 疾病的神经系统并发症越来越受到关注，但迄今为止，只有少数研究描述了 COVID 患者在重症监护病房 (ICU) 住院期间的临床和神经生理学发现。在这里，我们从神经生理学上评估了重症监护神经病 (CIP) 或肌病 (CIM) 在 ICU 患者中的存在。

材料和方法

患者接受了神经生理学评估，包括对正中神经、尺神经、腓深部和胫神经运动神经以及正中、尺神经、桡神经和腓肠感觉神经的双侧检查。对下肢和上肢的远端和近端肌肉进行针状肌电图 (EMG)。为了区分 CIP 和 CIM，直接肌肉刺激 (DMS) 应用于三角肌或胫骨前肌。比较了由 DMS（DMS _amp，DMS _lat）或运动神经刺激（MNS _amp，MNS _lat）引起的反应的峰峰值幅度和起始潜伏期。MNS _amp与 DMS _amp (NMR) 和 MNS _lat与 DMS的比率还评估了_纬度差异（NMD：MNS _lat  - DMS _lat）。

结果

神经传导研究显示有轴突神经源性模式的感觉运动多发性神经病，如针 EMG 所证实。与对照组相比，MNS _amp和 NMR 均显着降低 ( p  < 0.0001)，而 MNS _lat和 NMD 显着增加 ( p  = 0.0049)。

结论

我们已经描述了 ICU 中患有危重疾病神经病变 (CIP) 的 COVID 患者。COVID 相关的 CIP 可能对功能恢复和康复策略产生影响。