bagcilar training and research hospital

Author Of 2 Presentations

COVID-19 Late Breaking Abstracts

LB1206 - Sars-Cov-2 infection releated inflammatory and demyelinating disease; a brief case series (ID 2055)

Speakers
Presentation Number
LB1206
Presentation Topic
COVID-19

Abstract

Background

Coronavirus disease 2019 (COVID-19) is typically manifested by fever and respiratory symptoms caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although SARS-CoV-2 is a respiratory infection agent, various neurological syndromes have been reported with central and peripheral nervous system involvement, which may be associated with COVID-19. Most recently, a case diagnosed with multiple sclerosis (MS) after an optic neuritis (ON) attack associated with COVID-19 infection has been published.

Objectives

In this case series we would like to to discuss the posibility of COVID-19-associated inflammatory / demyelinating disease.

Methods

We present 3 new cases admitted to our clinic with various neurological findings that all cases were affected by COVID-19. Imaging studies have shown that inflammatory / demyelinizing lesions appeared in different areas of the central nervous system which were accepted as an atypical demyelinating spectrum associated with SARS-CoV-2.

Results

Case 1

A 28-year-old man presented with left hemiparesia. Brain magnetic resonance imaging (MRI) showed hyperintense lesions adjacent to the lateral ventricles on T2-weighting with diffusion restriction and contrast enhancement. Chest CT scan was compatible with viral pneumonia and nasopharyngeal swab with a realtime polymerase chain reaction (RT-PCR) test resulted positively for SARS-CoV-2. After management of the infection, intravenous methylprednisolone (IVMP) treatment was given to the patient and neurological deficits were fully recovered.

Case 2

An 18-year-old woman presented with severe acute visual loss in the left eye and retrobulbar ON was diagnosed. Brain and cervical spine MRI showed multiple demyelinating lesions without gadolinium enhancement. SARS-CoV-2 PCR analysis of nasopharyngeal swab and immunological testing for IgG was negative whereas she was positive for IgM, compatible for a possible active infection. She was started on IVMP and despite completion to 10 days, recovery was only achieved by 70%.

Case 3

A 48-year-old man presented with right hemiparesia. He was hospitalized with the diagnosis of Covid-19 10 days ago. Brain MRI showed T2- FLAIR hyperintense lesions in the supratentorial area and posterior fossa with diffusion restriction and contrast enhancement. Control MRI after 2 months revealed that the lesions significantly regressed spontanously and complete recovery was observed in neurological deficits.

Conclusions

With increasing experience, it has been understood that the SARS-CoV-2 also has a neurotropic effect. These 3 cases suggest that the virus plays a role in the clinical onset of the inflammatory / demyelinating disease. The responsible mechanism here is probably not as a result of direct infectious effect of the virus rather a trigger role in autoimmune processes like other viral agents. Further long-term studies relating to the pathophysiology of COVID-19 is warranted.

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COVID-19 Late Breaking Abstracts

LB1232 - Managing Multiple sclerosis patients diagnosed with COVID-19 infection; into the field of unknown (ID 2112)

Speakers
Presentation Number
LB1232
Presentation Topic
COVID-19

Abstract

Background

Treatments that have been proven to positively change the natural course of Multiple sclerosis (MS) and are widely used in the clinical practice are defined as immunosuppressant or immunomodulatory treatments. Oral, subcutaneous or infusion therapies is based on selective modulation or suppression of certain cells, cell subtypes or interleukins of the immune system. İt's accepted that they increase susceptibility to infections at certain rates. The Covid-19 outbreak, which has been declared a global pandemic, has affected large populations in many countries since January 2020. It is a matter of curiosity about how the patients with MS and those under immunomodulatory treatment, will be affected in this pandemic.

Objectives

We aim to detect the patients with COVID-19 diagnosis among the patients who are followed up with MS diagnosis, whether under immunomodulatory treatment or not and to evaluate how the disease process develops, how the diagnosis of MS and the preventive treatment used affect the disease process.

Methods

The patients who are followed up with the diagnosis of demyelinating disease/MS in our Multiple Sclerosis and Demyelinating Disorders outpatient clinic of the Department of Neurology of the Istanbul Bagcilar Training and Research Hospital were included in this study. Patients were contacted via phone or e-mail or were evaluated in the outpatient and inpatient clinics. A questionnaire was conducted about contact with a person who had a positive test result for COVID-19, symptoms of COVID-19, application to a health care facility, possible/definitive diagnosis of COVID-19, and treatment. Thus, patients diagnosed with COVID-19 were identified, and their clinical features and their treatment were summarized.

Results

We are informed that 9 of our patients were diagnosed with COVID-19. While 6 patients were under preventive treatment, 2 patients were followed without treatment and one patient was diagnosed with MS and COVID-19 simultaneously. All of the patients developed mild symptoms associated with COVID-19 and were treated under quarantine under home conditions. Clinical findings of seven patients were found to be compatible with general viral infection findings such as fever, headache, muscle and joint pain. In addition, chest pain and cough complaints compatible with pneumonia were observed in 2 patients. Covid-19 was confirmed by PCR, and preventive treatment of patients was suspended. Covid-19 treatment was started in accordance with the protocol used in our country. No complication related to COVID-19 infection was observed in any patient. After the control tests, the preventive treatment of the patients was resumed. It was determined that most of the patients had other patients in the family.

Conclusions

Based on the information obtained, the measures that can be taken to ensure the continuity of follow-up and treatment of the patients under pandemic conditions are discussed.

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