133 CMAAO
CORONA FACTS and MYTH BUSTER Neurology
Dr K K Aggarwal
President CMAAO
With inputs
from Dr Monica Vasudev
955: Update
on Covid-19: IMA-CMAAO Webinar on “Neurological complications in Covid-19”
6th
June, 2020, 4-5pm
Participants
Dr
KK Aggarwal, President CMAAO
Dr
RV Asokan, Hony Secretary General IMA
Dr
Ramesh K Datta, Hony Finance Secretary IMA
Dr
Sanchita Sharma
Faculty
Dr Jyoti Sehgal
Senior
Consultant Neurologist
Medanta
Medicity, Gurgaon
Key points from the
discussion
- These patients
are seen in triage, OPDs or as referrals from ICU from other departments.
- Neurological
manifestations in Covid-19 patients may be of the central nervous system
or peripheral nervous system.
- In CNS, the symptoms
may be mild and nonspecific – headache, vertigo, fatigue, uneasy feeling
or not feeling good.
- Patients with
altered sensorium (irritability, confusional state, seizure-like),
disorientation and encephalopathy are critical patients and admitted to
ICU. These patients do not have symptoms of cough, fever, respiratory
distress.
- There are no
imaging findings on CT scan, their MRI may be normal; mildly high protein;
treatment is symptomatic.
- Many patients
come as stroke (hemiparesis, facial involvement, deficit which is
measurable) in casualty; they are managed as per management of acute
stroke and when hospitalized are subjected to mandatory Covid test.
Ischemic stroke is more common.
- In many
patients, the first report may be negative, but the subsequent repeat test
turns out to be positive.
- Patients can
also present with epilepsy or seizure-like presentation.
- There are
patients who have comorbid neurological conditions like Alzheimer’s,
Parkinson’s, multiple sclerosis, motor neuron disease, who have altered
sensorium or have stopped doing their daily activities for the last few
days.
- Patients also
have peripheral nervous presentation, which can be anosmia, different
sensation of smell, Bell’s palsy (infranuclear).
- Patients in ICU,
patients on ventilators present with critical illness polyneuropathy or
critical illness myopathy.
- Patients who are
on immunosuppressants like MS, myasthenia are more prone to disease
relapses even if earlier were stable on low dose medication.
- Treatment is
supportive; protection of staff and HCW; dedicated corridors and floors;
dedicated CT scan machine. Once the report is negative, the family is also
counseled and shifted to non-Covid ward.
- High d-dimer may
be indicative of Covid stroke.
- LMWH is reserved
for bed ridden patients (hemiplegia, paraplegia, transverse myelitis, GBS)
as DVT prophylaxis.
- Neurological
care in Covid: We have become more historical – good clinical and visual
history is helping to make a clinical diagnosis as there is fear of
examination; fewer investigations and more of clinical judgment;
hospitalization is discouraged; relying on families and relatives as
caregivers
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