COVIDOLOGY – Well coined by Dr Shashank Joshi, Mumbai.
CME INDIA Discussion:
Dr Hemshankar Sharma, Bhagalpur: Today I got trapped in a case of clinically Flaccid quadriplegic, no sensory involvement, and preserved bladder functions. Serum K was 3.7, Lumbar puncture, and csf, inconclusive. History of 3 days duration, no preceding fever or cough, loose stools. Sudden onset.. bilateral lower limb involvement, progressed in next 3 to 4 hours, both upper limbs.. Male 35 yes, no co morbidity. What to do? I gave solumedrol 1 gm iv, Inj. Meganuron. 2 days. Recovery more than 50% to 60%.
Dr Raju Sharma, Jamshedpur: AIPN [Acute Inflammatory polyneuropathy] Quad or lower only?
Dr Hemshankar, Bhagalpur: The things changed today, on 2nd day of admissions, patient having fever. Being suspicious I advised for Rapid Antigen test for SARS CoV2..was POSITIVE..
Dr Raju Sharma, Jamshedpur: Right started Lower then progressed.
Dr Hemshankar, Bhagalpur: I want to make comments, this is my second case, of COVID, presented with features of GBS type. No fever, cough, SOB…
Dr Ashok Kumar, DM Neuro, Ranchi: Reflexes – jerks and Plantars? SLR test to show Radiculitis. For AIDP it is unusually rapid. If, feasible, Nerve conduction test. ECG – dual purpose – to rule low/high Potassium and to look for fixed R-R intervals (fixed heart rate in AIDP/GBS)
Dr A. K. Virmani, Jamshedpur: I’ve seen so many cases of GBS earlier in late 80’s and nineteen when I was in charge of ICU Tata Main Hospital as the Medical Specialist. There was no Covid then. Is it caused by Covid OR he’s just coincidentally positive? Something to ponder about.
Dr D. P. Khaitan, Gaya: We should exclude Hyperkalemia by serum, potassium and if possible during this Covid period also by ECG. In GBS due to the associated autonomic nervous dysfunction there might be the possibility of fixed heart rate with fixed R R interval.
Dr Hemshankar, Bhagalpur: Arefexic, No response of plantars, No radiculitis clinically, ECG normal. T waves normal. NCS not done. The moment Covid positive, referred to Medical College. This I have been teaching in my classes. My concern was only if SARS CoV2, has a presentation, like viral AIDP, or it was incidental!! Really, the ways of ever changing presentation in Covid!!! 3 patients we have observed in Hospital, acute onset, polyarthritis, mimicking RA, but finger spindling not seen. All synovial, big and small, affected, within 2 days of onset. RTPCR positive for SARS CoV2. Incidentally seen or otherwise??
Dr Santosh Singh, DM endo. Patna:
Dr S. K. Goenka, Begusarai: कण कण में….Covid. 🙂
Dr N K Singh: Lots of GBS related COVID cases are being reported in literature. Viral trigger is well known. Now take it as covid induced.
Dr Rajneesh Tyagi, Noaida, UP: I feel although we are finding these associations, we already had encountered them in our practice. Only novel thing which has happened over few months is that we have found a new name i.e. covid(Because we have a testing tool for it now). In future if we isolate another respiratory virus all these associations would be attributed to that.
Dr N K Singh: Maybe.
CME INDIA Learning points:
- We cannot ignore the emerging evidence between COVID and GBS, better to think about it, its treatment needs to be started early.
- While dealing a case of Flu like symptoms and SOB, there is need of through neurological examination.
- Nobody knows which one is doing what. COVID is directly responsible or just a bystander as trigger.
- It is a bidirectional insult, a case of COVID pneumonia, already prone to respiratory failure, GBS may complicate it immensely
- We know that bacterial infections, such as Campylobacter jejuni, a common cause of food poisoning, and a multitude of viral infections including the flu virus, Zika virus and other coronaviruses, 2009 H1N1 virus etc. lead to autoimmune condition. This link is that the body’s own immune response to fight the infection turns on itself and attacks the peripheral nerves.
- When in Rome, think like a Roman. It is true till a prospective study is done.
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