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0FEATURES OF CLINICAL AND NEUROLOGICAL CHARACTERISTICS OF POLYNEUROPATHIES OF CORONOVIRUS ETIOLOGY
1Madjidova Y.N., 2Amridinova F.Sh., 3Shadiev G.N.
1,2,3Tashkent Pediatrics Medical Institute https://doi.org/10.5281/zenodo.11409209
Abstract. In light of the global COVID-19 pandemic, more and more people are experiencing various morbid manifestations associated with coronavirus infection [2,5,6,7,8]. This infection is characterized by extreme aggressiveness and the ability to cause various complications from many organs and systems of the human body [1,18]. At present, scientists emphasize the impact of the new coronavirus infection on various lesions of the nervous system (NS) [3,4,17,19]. This is due to the fact that even though the coronavirus is not considered to be initially tropic to the cells of the nervous system, a significant risk of formation of various neurological disorders, including dysimmune polyneuropathies (PNP), has been confirmed in this infection. Which is an etiologically heterogeneous group of nosologies with autoimmune damage of the peripheral nervous system (PNS) [10,11,12,13]. PNS damage can occur both during the active phase of infection and after recovery from COVID-19. The main causes ofpolyneuropathies are inflammation and damage to nerve cells, and exposure of nerves to the systemic inflammatory response [6,7,8,9,14,15].
Keywords: polyneuropathies, heterogeneous, neurological disorders, morbid manifestations, somatic status, glucocorticosteroids.
Purpose of the study: Study and treatment of patients after Covid 19 with complication of polyneuropathy.
Material and methods. 165 patients aged from 40 to 70 years (mean age - 51,4±2,8 years), 93 (56,4%) women, 72 men (43,6%) participated in the study(pic1). In parallel with the general somatic status we emphasized the neurological manifestations of COVID-19.
Distribution of patients by gender and age
Age of patients men women total
abs. % abs. % abs. %
40-60 years old 42 25,45 49 29,7 91 55,1
60-70 years old 30 18,18 44 26,6 74 44,9
Total: 72 43,6 93 56,3 36 100
Study Results. As shown in two systematic reviews, clinical manifestations of polyneuropathy in patients with COVID-19 occur on day 14 (interquartile range 7-20 days) and after 11.5 days (7.7-16.0 days). It is likely that the treatment used to treat patients with COVID-19 and glucocorticosteroids can modify the timing of polyneuropathy development, positively influencing its course and consequences.
Guillain-Barre syndrome, an immune-mediated acute polyradiculoneuropathy, occupies a special place among complications of the peripheral nervous system in patients with coronavirus infection [17]. This syndrome is currently the most common cause of acute peripheral tetraparesis and paralysis [9,10].
Since the onset of the COVID-9 pandemic, cases of Guillain-Barre syndrome have been reported in association with this infectious disease [14,16].
Guillain-Barre syndrome (GBS) is a rare but serious autoimmune disease that affects the peripheral nervous system and can lead to paralysis and sensory disturbances. Symptoms of GBS include muscle weakness, numbness, pain, and loss of control over movements [15]. COVID-19, caused by the SARS-CoV-2 coronavirus, can also affect the body's nervous system and immune system, which may increase the risk of Guillain-Barre syndrome in some patients. The mechanism for the development of GBS in COVID-19 may be related to an immune imbalance that leads to the attack of myelin (nerve sheath) by immune cells. This leads to peripheral nerve damage and the onset of GBS symptoms [11,13].
Of the 165 patients who were included in this study, 17 infected patients were diagnosed with Guillain-Barre syndrome. The development of Guillain-Barre syndrome was most often observed approximately 2 weeks after the onset of COVID-19 symptoms. This syndrome was characterized by the gradual development of limb paralysis with sensory and autonomic dysfunction; 2 patients also had facial nerve involvement (pic2)
Picture 2
The most common diagnosis was acute inflammatory demyelinating polyneuropathy (48%, or 79 of 165 cases), while axonal variants (acute motor axonal neuropathy and acute motor-sensory axonal neuropathy) were found in 17% of cases (pic 3.)
Total acute inflammatory axonal variants
derrry«Wijrtwig polyneuropathy
Picture 3
After analyzing the individual symptom complexes, the following results were found. The most common symptom was lower extremity weakness (in 54% of cases, representing 89 of 165 patients), followed by sensory symptoms (in 40% of cases; 66 patients, including two with sensory ataxia).
Symptoms associated with cranial nerve damage were observed in 15% of cases (24 patients).
90 3D 70 GO 50 40 30 20 10 O
bwr extremity leiwy ly-njIciTii cranial ntryc damage
m liTir l|
Picture 4.
It was also noted that patients with COVID-19 and polyneuropathy are relatively less likely to have myalgias and radiculopathies (14.2%), which are reported in about 2/3 of patients with polyneuropathy without COVID-19
Conclusions. Thus, COVID-19 contributes to the development of neurological disorders already at the early stages of the disease in the form of lesions of the central and peripheral nervous system. In this regard, all patients with COVID-19 need to consult a neurologist in the dynamics of treatment in order to avoid the development of severe neurological complications.
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