#Two #Rare Neurologic Conditions Linked to #COVID-19

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Two rare neurologic conditions in patients hospitalized with COVID-19 add more evidence that unusual neurologic manifestations can arise in patients infected with the virus.

A 50-year-old man developed Miller Fisher syndrome and a 39-year-old man developed polyneuritis cranialis.

Both are variants of Guillain-Barré syndrome (GBS), which physicians in China and Italy also linked to COVID-19 infection, as previously reported by Medscape Medical News.

In both cases, physicians made the diagnoses based on abnormal eye examinations. The two patients responded to treatment and improved over 2 weeks, with only the 50-year-old featuring residual symptoms of anosmia and ageusia.

The report was published online April 17 in Neurology.

The 50-year-old man was admitted to an emergency room with a temperature of 99.9°F (37.7°C). He reported two days of vertical diplopia, perioral paresthesias, and gait instability. His neurologic examination showed intact cognitive function and language.

Five days earlier he developed a cough, malaise, headache, low back pain, fever, anosmia, and ageusia.

His neuro-ophthalmologic examination showed right hypertropia in all fields of gaze, severe limitations to the adduction and downgaze movements of his right eye, and left eye nystagmus on left gaze. These findings were consistent with right internuclear ophthalmoparesis and right fascicular oculomotor palsy.

He responded to intravenous (IV) immunoglobulin therapy and was discharged home 2 weeks after admission.

The 39-year-old man was admitted to the emergency room with acute onset diplopia and ageusia. Three days earlier he had presented with diarrhea, a low-grade fever and in generally poor condition, without any headache, respiratory symptoms, or dyspnea.

He showed esotropia of 10 prism diopters at distance and 4 prism diopters at near, severe abduction deficits in both eyes, and fixation nystagmus, with the upper gaze more impaired, all consistent with bilateral abducens palsy.

The patient was discharged home and treated symptomatically with acetaminophen and telemedicine monitoring “due to a complete hospital saturation with COVID-19 patients,” write the researchers, led by Consuelo Gutiérrez-Ortiz, MD, PhD, Hospital Universitario Príncipe de Asturias, Madrid, Spain, write.

Two weeks later, he had made a complete neurologic recovery with no ageusia, complete eye movements, and normal deep tendon reflexes.

“Fisher syndrome and polyneuritis cranialis in these two patients with the SARS-CoV-2 infection could be simply coincidental. However, taking into account the temporal relationship, we feel that COVID-19 might have been responsible for the development of these two neurological pictures,” the authors note.

European Regional Development Funds (FEDER) supported this research.

Neurology. Published online April 17, 2020. Abstract

Autism risk linked to fever during pregnancy

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Prenatal exposure to maternal fever during the second trimester raised odds of autism spectrum disorder by 40 per cent.

Fever during pregnancy may raise the risk for autism spectrum disorder (ASD), according to a new study published in Molecular Psychiatry. ASD risk was increased by 34 per cent when mothers reported fever at any time during pregnancy, and by 40 per cent in the second trimester. Risk of ASD was increased by over 300 per cent among children of women who reported three or more fevers after the 12th week of pregnancy.

Risks were minimally mitigated when women used acetaminophen for fever in the second trimester. Although there were no cases of ASD when mothers used ibuprofen, the sample was too small to draw conclusions.

Analysis did not indicate an association between risk and maternally-reported symptoms of infection in individual organ systems. An ongoing study is testing blood samples collected at mid-pregnancy and at birth to explore the possible role of specific infectious agents.

“Our results suggest a role for gestational maternal infection and innate immune responses to infection in the onset of at least some cases of autism spectrum disorder,” said first author Mady Hornig, associate professor of epidemiology and director of translational research at Columbia University.