Karri Madhavi

Abstract

Tuberculosis of the nervous system constitutes about 10% of total cases and is more common in developing countries like India. Varied clinical presentations, ranging from meningoencephalitis, tuberculoma, multiple cranial palsies to myelo-radiculitis, are noted. Here we highlight central sleep apnoea as an acute presentation, which is unusual in a neurological setting. Here, we present a 49-year old male, presented with acute onset of excessive daytime sleepiness for two weeks. Clinically he had no focal deficits. MRI brain plain and contrast showed multiple conglomerate ring-enhancing lesions with vasculitic infarcts consistent with tuberculosis. CSF analysis was normal apart from slightly elevated protein. He was initiated on steroids and anti-tuberculous therapy. Hypersomnia as an acute and solitary neurological presentation secondary to subacute infections is a rarity. Apart from vascular insults, infections like tuberculosis needed to be considered as one of the differentials. Early evaluation helps in prevention of associated complications and improve the quality of life.   Keywords: Central sleep apnoea, Excessive Daytime Sleepiness, Tuberculosis

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Abstract

Background: A novel coronavirus (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2). This pandemic has been globally alarming in the current period. Several neurological manifestations are reported occurring with the infection. Guillain barre syndrome (GBS) or acute onset inflammatory polyradiculoneuropathy has been among the frequent manifestations observed among them. Objectives: To know the pattern and outcome of GBS in COVID-19 affected individuals. Methods and Methods: We have taken six individuals admitted with flaccid quadriparesis in the last two months. All were affected recently by COVID 19 infection, which RT PCR of the nasopharyngeal swab confirmed. The study participants have undergone nerve conduction studies and have been diagnosed with Guillain Barre syndrome using Brighton criteria. We did cerebrospinal fluid (CSF) analysis after admission. We initiated all patients on Intravenous immunoglobulin according to body weight (2g/kg divided over five days). We used the Barthel index score to assess the outcome of the individuals. Results: We observed a mean duration of 18.25 days between the COVID-19 infection and the onset of symptoms. Apart from motor quadriparesis and sensory symptoms being in common, we also noticed cranial nerves and autonomic involvement. We made the diagnosis using the nerve conduction studies and Brighton criteria. After initiating intravenous immunoglobulin, all patients had a good outcome, and quality of life was better after two months of follow up. Conclusion: Guillain Barre syndrome is one of the neurological manifestations of COVID-19 and has a dramatic response with intravenous immunoglobulin and better outcome with treatment.   Keywords: Guillain Barre syndrome, COVID19 infection, Intravenous immunoglobulin, Barthel index

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