First results of clinical diagnostic analysis of post-COVID peripheral neuropathy

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This analysis of ocular manifestations of the COVID-19 that can occur both in the acute and the post-COVID period focuses on pathological changes associated with hypercoagulation: thrombosis of the central retinal vein, occlusion of the central retinal artery, and decreased peripapillary perfusion. Potential changes in corneal nerve fibers (CNF) associated with coronavirus infection remain poorly understood. Meanwhile, previous studies have shown the possibility of using CNF as biomarkers of polyneuropathy (PNP).

PURPOSE

To study clinical and diagnostic features of post-COVID PNP.

MATERIAL AND METHODS

We examined 9 female patients aged 32 to 51 years who had suffered an infection caused by SARS-CoV-2 of varying severity. The patients were divided into two groups: the first consisted of 6 patients with clinical manifestations of PNP in the form of neuropathic pain, the second — 3 patients without clinical manifestations. Patients of group 1 underwent comprehensive examination including neurological examination, confocal microscopy of the cornea (in vivo CM), electroneuromyography (ENMG) of the nerves of the upper and lower extremities, quantitative sensory testing in the zone of painful sensations, while patients of group 2 only underwent in vivo CM.

RESULTS

All patients of the first group, within 5—40 days after the onset of infection caused by SARS-CoV-2, exhibited symptoms of damage to various parts of the nervous system (peripheral nerves, thoracic spinal roots, trigeminal nerve). The main — and in most cases the only — symptom of the disease was neuropathic pain syndrome. In Guillain-Barré syndrome, for the first time using in vivo CM, the following changes were revealed: enlargement of in Langerhans cells, shortening of CNF and their processes, presence of neuromas.

CONCLUSION

The standard neurological examination of patients with post-COVID neuropathy should be supplemented with special diagnostic methods for assessment of structural and functional state of the peripheral nerves. The in vivo CM method is capable of non-invasive assessment of changes in thin CNF and, with accumulation of empirical data, can be included in the algorithm for diagnosing post-COVID PNP.

Keywords:

coronavirus infection

post-COVID peripheral polyneuropathy

corneal nerve fibers

in vivo confocal microscopy

Authors:

S.E. Avetisov

Krasnov Research Institute of Eye Disease;
I.M. Sechenov First Moscow State Medical University (Sechenov University)

ORCID: 0000-0001-7115-4275

Z.V. Surnina

Krasnov Research Institute of Eye Diseases

ORCID: 0000-0001-5692-1800

L.T. Akhmedzhanova

I.M. Sechenov First Moscow State Medical University (Sechenov University)

S. Georgiev

Research Institute of Eye Diseases

Received:

12.05.2021

Accepted:

14.05.2021

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