The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis
Abstract
:1. Introduction
2. Methods and Results
3. Neuroinflammation and Cytokine Storm in SARS-CoV-2 Infection
4. Does Infection of SARS-CoV-2 May Be an Actual Neurodegeneration Agent in MS Patients?
5. Coagulopathy and Microvascular Thrombosis in MS Patients after SARS-CoV-2 Infection
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Ref. | Patient Information | Clinical Symptoms | Neurological Complications | Presumptive Conclusions |
---|---|---|---|---|
[120] | 42-year-old woman without neurodegenerative disease diagnosed Comorbidities: -No data | -Coryza and nasal obstruction | -Clinical attack involving a single anatomical region characteristic of clinically isolated syndrome (CIS) type -Paresthesia of the left upper limb | -There is an association between CNS focal symptoms compatible with demyelinating disease after SARS-COV-2 infection, even in the absence of relevant upper respiratory tract infection signs |
[126] | 28-year-old man without neurodegenerative disease diagnosed Comorbidities: -Glaucoma | -Generalized malaise -Headache | -Binocular diplopia -Anosmia -Right oral numbness -Involuntary eye movements causing oscillopsia -Internuclear ophthalmoplegia -MRI demonstrated both contrast-enhancing and non-enhancing white matter lesions in juxtacortical, periventricular, and infratentorial (right paramedian pons) locations | -The SARS-CoV-2 infection may “unmask” or trigger the MS symptoms even during the acute phase of the infection |
[127] | 40-year-old woman with relapsing-remitting MS (RRMS) disease duration: 9 years Woman was in the postpartum period. Comorbidities: -No data | -Slightly elevated C-reactive protein (CRP) level -Lack of cold symptoms -Increased hemoglobin and hematocrit levels -Mild lumphopenia and granulocytosis | -Motor deficits -Mild ataxia in the right limbs -Focal neurological deficits -paresthesia | -The patient’s neurological deficits may worsening the previous symptoms in the viral context (relapse mimic) -Women with MS in the postpartum period are even more vulnerable to relapses and infections |
[128] | 58-year-old woman with RRMS disease duration: 14 years Comorbidities: -Migraine -Diabetes mellitus -Hypertension -Hyperlipidemia -Obesity -Transient ischemic attack | -Dysgeusia -Seizures -Fever -Dry cough -Dyspnea -Multifocal pneumonia -Lymphocytopenia -Airspace opacities in both lungs -ARDS -Cytokine release syndrome (CRS) -Elevated inflammation parameters (IL-6, CRP, ferritin and lactate dehydrogenase (LDH)) | -Anosmia -Presence of multiple demyelinating lesions -Alterations of the periventricular white matter with similar lesions (at the bulbo–medullary junction and in both cervical and dorsal spinal cord) -Neuromyelitis optica | -Fingolimod-treated MS patient who developed severe COVID-19 recovered after treatment with tocilizumab |
[131] | 42-year-old woman with RRMS disease duration: 20 years Comorbidities: -Major depression -Hypothyroidism -Chronic urinary tract infections -Pulmonary embolism | -Fever -Elevated CRP level -Lymphocytopenia -Dry cough -Dyspnea, -Increased respiratory rate -Tachycardia -Ground-glass opacity in lungs | -Worsening of neurologic symptoms -Decreased sensation -Reduced muscle strength | -Appearance of MS relapses following SARS-CoV-2 infection |
[135] | 24-year-old woman without neurodegenerative disease diagnosed Comorbidities: -no data | -Sore throat -Low-grade fever -Myalgia -No respiratory symptoms -Blurred vision | -Diplopia -Anosmia -Drooping the left lip corner -Paresthesia -Left eyelid drooping -Left eyebrow sagging -active demyelinating plaques in left temporal and right frontal brain areas | -The appearance of demyelinating changes similar to those seen in MS following the SARS-CoV-2 infection |
[133] | 54-year old woman without neurodegenerative disease diagnosed Comorbidities: -Anterior communicating artery aneurysm (treated surgically 20 years before) | -Headache -Momentary loss of consciousness -Unrest -Interstitial pneumonia -moderate lymphocytopenia -Severe normocapnic hypoxia -seizure | -Anosmia -Ageusia -High Glasgow Coma Scale (GCS) score—12 (normal range 3–15; 12—indicates severe focal sensorimotor deficits -Brain MRI revealed newly diagnosed demyelinating lesions (alterations of the periventricular white matter, hyperintense in T2 weighted image (T2WI), at the bulbo–medullary junction and in both the cervical and dorsal spinal cord) | -SARS-CoV-2-induced delayed immune response -SARS-CoV-2 can induce brain and spine demyelinating lesions -SARS-CoV-2 may lead to a systemic inflammatory response syndrome (SIRS)-like immune disorder |
[134] | 29-year-old woman without neurodegenerative disease diagnosed Comorbidities: -asthma -Rhinoconjunctivitis | -Papillitis -Bilateral Hoffmann’s sign | -Orbital MRI confirmed a right-sided optic nerve lesion with significant contrast enhancement -Brain MRI showed sparse supratentorial periventricular demyelinating lesions -presence of oligoclonal IgG bands in the cerebrospinal fluid (CSF) -Worsening in both visual field defect and visual acuity -Pyramidal tract dysfunction -Hyperflexia in the lower limbs | -Presence of demyelinating disease in the form of optic neuritis following SARS-CoV-2 infection |
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Dziedzic, A.; Saluk-Bijak, J.; Miller, E.; Niemcewicz, M.; Bijak, M. The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis. Int. J. Mol. Sci. 2021, 22, 1804. https://doi.org/10.3390/ijms22041804
Dziedzic A, Saluk-Bijak J, Miller E, Niemcewicz M, Bijak M. The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis. International Journal of Molecular Sciences. 2021; 22(4):1804. https://doi.org/10.3390/ijms22041804
Chicago/Turabian StyleDziedzic, Angela, Joanna Saluk-Bijak, Elzbieta Miller, Marcin Niemcewicz, and Michal Bijak. 2021. "The Impact of SARS-CoV-2 Infection on the Development of Neurodegeneration in Multiple Sclerosis" International Journal of Molecular Sciences 22, no. 4: 1804. https://doi.org/10.3390/ijms22041804