Corpus overview


MeSH Disease

Human Phenotype


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    The Incidence of SARS-COV-2 Manifestations in the Central Nervous System: A Rapid Review and Meta-Analysis

    Authors: Verena Mayr; Glechner Anna; Gerald Gartlehner; Irma Klerings; Peter Lackner

    doi:10.21203/ Date: 2020-07-17 Source: ResearchSquare

    Background: Coronavirus disease MESHD 2019 (COVID-19) is caused by SARS-CoV-2 and presents itself mainly as a respiratory tract infection MESHD respiratory tract infection HP. However, reports of associated central nervous system (CNS) manifestations are increasing.Methods: We conducted this rapid review to determine the frequency of CNS manifestations of COVID-19 (CNS symptoms, acute cerebrovascular disease MESHD, and infectious/inflammatory CNS diseases MESHD) and to summarize the current evidence for direct invasion of the CNS by SARS-CoV-2. An information specialist searched Ovid MEDLINE, the CDC: COVID-19 Research Articles Downloadable and WHO COVID-19 Databases, CENTRAL, and on May 13, 2020. Two reviewers screened abstracts and potentially relevant full-text publications independently. The data extraction, assessment of risk of bias,and certainty of evidence using GRADE was done by one reviewer and double-checked by another. If possible and reasonable, a meta-analysis was carried out.Results: We identified 13 relevant studies (four cohort studies, nine case studies) with a total of 866 COVID-19 patients.In a Chinese cohort, dizziness MESHD (16.8%; 36 of 214) and headache MESHD headache HP (13.1%; 28 of 214) were the most common CNS symptoms reported. A meta-analysis of four cohort studies including 851 COVID-19 patients showed an incidence of 3.3% (95% CI: 2.2–4.9) for ischemic stroke HP stroke MESHD (follow-up: one to five weeks). In 13 of 15 encephalitis MESHD encephalitis HP case studies, PCR testing of the cerebrospinal fluid did not detect any virus components.Conclusion: CNS manifestations occur frequently in patients with COVID-19. It is important to integrate neurologists into the multiprofessional COVID-19 treatment team to detect neurological complications early and to treat them correctly. 

    Neurological manifestations associated with COVID-19: a nationwide registry

    Authors: Elodie Meppiel; Nathan Peiffer-Smadja; Alexandra Maury; Imen Bekri; Cecile Delorme; Virginie Desestret; Lucas Gorza; Geoffroy Hautecloque-Raysz; Sophie Landre; Annie Lannuzel; Solene Moulin; Peggy Perrin; Paul Petitgas; Francois Sellal; Adrien Wang; Pierre Tattevin; Thomas de Broucker; - contributors to the NeuroCOVID registry

    doi:10.1101/2020.07.15.20154260 Date: 2020-07-16 Source: medRxiv

    Background: The clinical description of the neurological manifestations in COVID-19 patients is still underway. This study aims to provide an overview of the spectrum, characteristics and outcomes of neurological manifestations associated with SARS-CoV-2 infection MESHD. Methods: We conducted a nationwide, multicentric, retrospective study during the French COVID-19 epidemic in March-April 2020. All COVID-19 patients with de novo neurological manifestations were eligible. Results: We included 222 COVID-19 patients with neurological manifestations from 46 centers throughout the country. Median age TRANS was 65 years (IQR 53-72), and 136 patients (61.3%) were male TRANS. COVID-19 was severe or critical in almost half of the patients (102, 45.2%). The most common neurological diseases MESHD were COVID-19 associated encephalopathy HP (67/222, 30.2%), acute ischemic cerebrovascular syndrome MESHD (57/222, 25.7%), encephalitis MESHD encephalitis HP (21/222, 9.5%), and Guillain-Barre Syndrome MESHD (15/222, 6.8%). Neurological manifestations appeared after first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19 associated encephalopathy HP, 7 (5-10) days in encephalitis MESHD encephalitis HP, 12 (7-18) days in acute ischemic cerebrovascular syndrome MESHD and 18 (15-28) days in Guillain-Barre Syndrome MESHD. Brain imaging was performed in 192 patients (86.5%), including 157 MRI (70.7%). Brain MRI of encephalitis MESHD encephalitis HP patients showed heterogeneous acute non vascular lesion in 14/21 patients (66.7%) with associated small ischemic lesion or microhemorrhages in 4 patients. Among patients with acute ischemic cerebrovascular syndrome MESHD, 13/57 (22.8%) had multi territory ischemic strokes HP strokes MESHD, with large vessel thrombosis MESHD in 16/57 (28.1%). Cerebrospinal fluid was analyzed in 97 patients (43.7%), with pleocytosis in 18 patients (18.6%). A SARS-CoV-2 PCR was performed in 75 patients and was positive only in 2 encephalitis MESHD encephalitis HP patients. Among patients with encephalitis MESHD encephalitis HP, ten out of 21 (47.6%) fully recovered, 3 of whom received corticosteroids (CS). Less common neurological manifestations included isolated seizure MESHD seizure HP (8/222, 3.6%), critical illness MESHD neuropathy (8/222, 3.6%), transient alteration of consciousness (5/222, 2.3%), intracranial hemorrhage MESHD intracranial hemorrhage HP (5/222, 2.3%), acute benign lymphocytic meningitis MESHD meningitis HP (3/222, 1.4%), cranial neuropathy (3/222, 1.4%), single acute demyelinating lesion (2/222, 0.9%), Tapia syndrome MESHD (2/222, 0.9%), cerebral venous thrombosis HP venous thrombosis MESHD (1/222, 0.5%), sudden paraparesis MESHD paraparesis HP (1/222, 0.5%), generalized myoclonus MESHD myoclonus HP and cerebellar ataxia MESHD ataxia HP (1/222, 0.5%), bilateral fibular palsy (1/222, 0.5%) and isolated neurological symptoms ( headache MESHD headache HP, anosmia HP, dizziness MESHD, sensitive or auditive symptoms, hiccups MESHD, 15/222, 6.8%). The median (IQR) follow-up of the 222 patients was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%). Conclusion: Neurological manifestations associated with COVID-19 mainly included CAE, AICS, encephalitis MESHD encephalitis HP and GBS. Clinical spectrum and outcomes were broad and heterogeneous, suggesting different underlying pathogenic processes.

    The clinical spectrum of encephalitis MESHD encephalitis HP in COVID-19 disease MESHD: the ENCOVID multicentre study

    Authors: Andrea Pilotto; Stefano Masciocchi; Irene Volonghi; Elisabetta del Zotto; Eugenio Magni; Valeria De Giuli; Francesca Caprioli; Nicola Rifino; Maria Sessa; Michele Gennuso; Maria Sofia Cotelli; Marinella Turla; Ubaldo Balducci; Sara Mariotto; Sergio Ferrari; Alfonso Ciccone; Fabrizio Fiacco; Alberto Imarisio; Barbara Risi; Alberto Benussi; Emanuele Foca'; Francesca Caccuri; Matilde Leonardi; Roberto Gasparotti; Francesco Castelli; Gianluigi Zanusso; Alessandro Pezzini; Alessandro Padovani

    doi:10.1101/2020.06.19.20133991 Date: 2020-06-20 Source: medRxiv

    Background: Several preclinical and clinical investigations have argued for nervous system involvement in SARS-CoV-2 infection MESHD. Some sparse case reports have described various forms of encephalitis MESHD encephalitis HP in COVID-19 disease MESHD, but very few data have focused on clinical presentations, clinical course, response to treatment and outcomes yet. Objective: to describe the clinical phenotype, laboratory and neuroimaging findings of encephalitis MESHD encephalitis HP associated with SARS-CoV-2 infection MESHD, their relationship with respiratory function and inflammatory parameters and their clinical course and response to treatment. Design: The ENCOVID multicentre study was carried out in 13 centres in northern Italy between February 20th and May 31st, 2020. Only patients with altered mental status and at least two supportive criteria for encephalitis MESHD encephalitis HP with full infectious screening, CSF, EEG, MRI data and a confirmed diagnosis of SARS-CoV-2 infection MESHD were included. Clinical presentation and laboratory markers, severity of COVID-19 disease MESHD, response to treatment and outcomes were recorded. Results: Out of 45 cases screened, twenty-five cases of encephalitis MESHD encephalitis HP positive for SARS-CoV-2 infection MESHD with full available data were included. The most common symptoms at onset TRANS were delirium MESHD delirium HP (68%), aphasia MESHD aphasia HP/ dysarthria MESHD dysarthria HP (24%) and seizures MESHD seizures HP (24%). CSF showed hyperproteinorrachia and/or pleocytosis in 68% of cases whereas SARS-CoV-2 RNA by RT-PCR resulted negative. Based on MRI, cases were classified as ADEM (n=3), limbic encephalitis MESHD encephalitis HP (LE, n=2), encephalitis MESHD encephalitis HP with normal imaging (n=13) and encephalitis MESHD encephalitis HP with MRI alterations (n=7). ADEM and LE cases showed a delayed onset compared to the other encephalitis MESHD encephalitis HP (p=0.001) and were associated with previous more severe COVID-19 respiratory involvement. Patients with MRI alterations exhibited worse response to treatment and final outcomes compared to other encephalitis MESHD encephalitis HP. Conclusions and relevance: We found a wide clinical spectrum of encephalitis MESHD encephalitis HP associated with COVID19 infection MESHD, underlying different pathophysiological mechanisms. Response to treatment and final outcome strongly depended on specific CNS-manifestations.

    The SARSCoV2 spike protein alters barrier function in 2D static and 3D microfluidic in vitro models of the human blood SERO-brain barrier

    Authors: Tetyana P Buzhdygan; Brandon J DeOre; Abigail Baldwin-Leclair; Hannah McGary; Roshanak Razmpour; Peter A Galie; Raghava Potula; Allison M Andrews; Servio Heybert Ramirez

    doi:10.1101/2020.06.15.150912 Date: 2020-06-15 Source: bioRxiv

    As researchers across the globe have focused their attention on understanding SARS-CoV-2, the picture that is emerging is that of a virus that has serious effects on the vasculature in multiple organ systems including the cerebral vasculature. Observed effects on the central nervous system includes neurological symptoms ( headache MESHD headache HP, nausea MESHD nausea HP, dizziness MESHD), fatal microclot formation and in rare cases encephalitis MESHD encephalitis HP. However, our understanding of how the virus causes these mild to severe neurological symptoms and how the cerebral vasculature is impacted remains unclear. Thus, the results presented in this report explored whether deleterious outcomes from the SARS-COV-2 viral spike protein on primary human brain microvascular endothelial cells (hBMVECs) could be observed. First, using postmortem brain tissue, we show that the angiotensin converting enzyme 2 or ACE2 (a known binding target for the SARS-CoV-2 spike protein), is expressed throughout various caliber vessels in the frontal cortex. Additionally, ACE2 was also detectable in primary human brain microvascular endothelial (hBMVEC) maintained under cell culture conditions. Analysis for cell viability revealed that neither the S1, S2 or a truncated form of the S1 containing only the RBD had minimal effects on hBMVEC viability within a 48hr exposure window. However, when the viral spike proteins were introduced into model systems that recapitulate the essential features of the Blood SERO-Brain Barrier (BBB), breach to the barrier was evident in various degrees depending on the spike protein subunit tested. Key to our findings is the demonstration that S1 promotes loss of barrier integrity in an advanced 3D microfluid model of the human BBB, a platform that most closely resembles the human physiological conditions at this CNS interface. Subsequent analysis also showed the ability for SARS-CoV-2 spike proteins to trigger a pro-inflammatory response on brain endothelial cells that may contribute to an altered state of BBB function. Together, these results are the first to show the direct impact that the SARS-CoV-2 spike protein could have on brain endothelial cells; thereby offering a plausible explanation for the neurological consequences seen in COVID-19 patients.

    Neurological Complications of COVID-19: A Systematic Review of Literature

    Authors: Shitiz Sriwastava; Samiksha Srivastava; Saurabh Kataria; Violina Melnic; Amelia Adcock; Zubeda Sheikh

    doi:10.21203/ Date: 2020-06-14 Source: ResearchSquare

    Background: To study the nature and frequency of occurrence of “significant” neurological complications in coronavirus disease MESHD-2019 (COVID-19) via a systematic review of the literature.Methods: We screened all articles resulting from a search of PubMed, Cochrane, Google Scholar and Scopus, using the keywords "COVID-19 and CNS", "SARS-CoV-2 and CNS”, “COVID-19 and neurological manifestation”, “SARS2 and neurological manifestation” and “COVID-19 and Brain” looking for reports of significant neurological manifestations that would potentially have an impact on the outcome.Results: Twenty-six articles met the inclusion criteria. The significant neurological diagnoses reported were stroke MESHD stroke HP, Guillain Barre Syndrome MESHD (GBS) and its variants, encephalitis MESHD encephalitis HP, seizures MESHD seizures HP, acute hemorrhagic necrotizing encephalopathy, acute HP acute disseminated encephalomyelitis MESHD (ADEM) and transverse myelitis MESHD myelitis HP. Although stroke MESHD stroke HP, predominantly ischemic, was observed in ~ 6% of COVID-19 patients from Wuhan, China, mortality in this cohort was 38%. Of the 24 pooled patients with reports of etiology, 17 had large vessel occlusions. GBS occurred in 5/1200 (0.4%) of the COVID-19 cohort from Italy. One of the six reported encephalitis MESHD encephalitis HP cases, the ADEM case and the report of transverse myelitis MESHD myelitis HP do not have data for conclusive diagnosis.Conclusion: The most frequent significant neurological association with COVID-19 is stroke MESHD stroke HP, predominantly ischemic. In a cohort from Wuhan, China, this was as frequent as ~ 6%, with a 38% mortality. Most common reported etiology is large vessel occlusion. Other reported significant neurological complications are GBS/variants, encephalitis MESHD encephalitis HP, seizures MESHD seizures HP and acute hemorrhagic necrotizing encephalopathy HP. The reports of ADEM and transverse myelitis MESHD myelitis HP lacked diagnostically conclusive data.

    Bipallidal Lesions in a COVID-19 Patient: A Case Report and Brief Review of Literature

    Authors: Sudhat Ashok; Kalyan Shastri; L. Beryl Guterman; Lee R. Guterman

    doi:10.21203/ Date: 2020-06-09 Source: ResearchSquare

    BackgroundAltered mentation in COVID-19 patients can be a function of any number of metabolic abnormalities associated with the infection MESHD. Here we present the case of an encephalopathic COVID-19 patient with bilateral globus pallidus lesions. While imaging abnormalities involving basal ganglia have been reported in encephalitis MESHD encephalitis HP caused by neuroinvasive flaviviruses, the bipallidal lesions noted here likely resulted from hypoxic-ischemic brain injury MESHD.Case PresentationA 51-year-old African American woman was found unresponsive at home by her fiancé. She had been complaining of shortness of breath and cough MESHD cough HP for three days. She is a former smoker with past medical history of hypertension MESHD hypertension HP, nephropathy HP, and bipolar disorder. Upon examination, she was alert but nonverbal, following commands inconsistently, and unable to move extremities against gravity. After several minutes, she was able to state her name but kept repeating it in response to all questions. Chest radiograph revealed bilateral lung infiltrates. CT of the head showed hypodensities in bilateral globus pallidi. A non-contrast MRI of the brain showed symmetric restricted diffusion and FLAIR hyperintense signal changes in bilateral globus pallidi. Abnormal SWI signal seen in bilateral globus pallidi likely represents mineralization or hemosiderin. There were no striatal or thalamic lesions. Major intracranial arteries were widely patent.The patient later tested positive for 2019-nCoV using real-time PCR assay, and was transferred to our COVID-19 designated hospital campus. Thereafter, she had waxing and waning mentation. Repeat CT imaging 11 days after the first scan demonstrated resolution of the bipallidal hypodensities. The patient was recently discharged to a subacute rehab facility but is still experiencing confusion MESHD confusion HP.ConclusionsAs we come across neurological manifestations of COVID-19, we believe neuroimaging is likely to play an important role in establishing if central nervous system involvement is invariably due to indirect mechanisms such as metabolic or hypoxic-ischemic brain injury MESHD or if direct neuroinvasive disease MESHD is a possibility, as with certain viruses.

    Unspecific post-mortem findings despite multiorgan 1 viral spread in COVID-19 patients

    Authors: Myriam Remmelink; Ricardo De Mendoca; Nicky D'Haene; Sarah De Clercq; Camille Verocq; Laetitia Lebrun; Philomene Lavis; Marie Lucie Racu; Anne Laure Trepant; Calliope Maris; Sandrine Rorive; Jean Christophe Goffard; Olivier De Witte; Lorenzo Peluso; Jean Louis Vincent; Christine Decaestecker; Fabio Silvio Taccone; Isabelle Salmon

    doi:10.1101/2020.05.27.20114363 Date: 2020-05-28 Source: medRxiv

    Background Post-mortem studies can provide important information for understanding new diseases MESHD and small autopsy case series have already reported different findings in COVID-19 patients. Methods We evaluated whether some specific post-mortem features are observed in these patients and if these changes are related to the presence of the virus in different organs. Complete macroscopic and microscopic autopsies were performed on different organs in 17 COVID-19 non-survivors. Presence of SARS-CoV-2 was evaluated with immunohistochemistry (IHC) in lung samples and with real-time reverse-transcription polymerase chain reaction (RT-PCR) test in lung and other organs. Results Pulmonary findings revealed early-stage diffuse alveolar damage (DAD) in 15 out of 17 patients and microthrombi in small lung arteries in 11 patients. Late-stage DAD, atypical pneumocytes and/or acute pneumonia MESHD pneumonia HP were also observed. Four lung infarcts, two acute myocardial infarctions MESHD myocardial infarctions HP and one ischemic enteritis MESHD were observed. There was no evidence of myocarditis MESHD myocarditis HP, hepatitis MESHD hepatitis MESHD hepatitis HP or encephalitis MESHD encephalitis HP. Kidney evaluation revealed the presence of hemosiderin in tubules or pigmented casts in most patients. Spongiosis and vascular congestion were the most frequently encountered brain lesions. No specific SARS-CoV-2 lesions were observed in any organ. IHC revealed positive cells with a heterogeneous distribution in the lungs of 11 of the 17 (65%) patients; RT-PCR yielded a wide distribution of SARS-CoV-2 in different tissues, with 8 patients showing viral presence in all tested organs (i.e. lung, heart, spleen, liver, colon, kidney and brain). Conclusions In conclusion, autopsies revealed a great heterogeneity of COVID-19-related organ injury and the remarkable absence of any specific viral lesions, even when RT-PCR identified the presence of the virus in many organs.

    COVID-19 impact on consecutive neurological patients admitted to the emergency MESHD department

    Authors: Andrea Pilotto; Alberto Benussi; Ilenia Libri; Stefano Masciocchi; Loris Poli; Enrico Premi; Antonella Alberici; Enrico Baldelli; Sonia Bonacina; Laura Brambilla; Matteo Benini; Salvatore Caratozzolo; Matteo Cortinovis; Angelo Costa; Stefano Cotti Piccinelli; Elisabetta Cottini; Viviana Cristillo; Ilenia Delrio; Massimiliano Filosto; Massimo Gamba; Stefano Gazzina; Nicola Gilberti; Stefano Gipponi; Marcello Giunta; Alberto Imarisio; Paolo Liberini; Martina Locatelli; Francesca Schiano Di Cola; Renata Rao; Barbara Risi; Luca Rozzini; Andrea Scalvini; Veronica Vergani; Irene Volonghi; Nicola Zoppi; Barbara Borroni; Mauro Magoni; Matilde Leonardi; Gainluigi Zanusso; Sergio Ferrari; Sara Mariotto; Alessandro Pezzini; Roberto Gasparotti; Ciro Paolillo; Alessandro Padovani

    doi:10.1101/2020.05.23.20110650 Date: 2020-05-26 Source: medRxiv

    Abstract Objective: Aim of this study was to analyse the impact of COVID-19 on clinical and laboratory findings and outcome of neurological patients consecutively admitted to the emergency MESHD department (ED) of a tertiary hub center. Methods: All adult TRANS patients consecutively admitted to the ED for neurological manifestations from February 20 th through April 30 th 2020 at Spedali Civili of Brescia entered the study. Demographic, clinical, and laboratory data were extracted from medical records and compared between patients with and without COVID-19. Results: Out of 505 consecutively patients evaluated at ED with neurological symptoms, 147 (29.1%) tested positive for SARS-CoV-2. These patients displayed at triage higher values of CRP, AST, ALT, and fibrinogen but not lymphopenia MESHD lymphopenia HP (p<0.05). They were older (73.1 + 12.4 vs 65.1 + 18.9 years, p=0.001) had higher frequency of stroke MESHD stroke HP (34.7% vs 29.3%), encephalitis MESHD encephalitis HP/ meningitis MESHD meningitis HP (9.5% vs 1.9%) and delirium MESHD delirium HP (16.3% vs 5.0%). Compared to patients without COVID, they were more frequently hospitalized (91.2% vs 69.3%, p<0.0001) and showed higher mortality rates (29.7% vs 1.8%, p<0.0.001) and discharge disability, independently from age TRANS. Conclusions: COVID-19 impacts on clinical presentation of neurological disorders, with higher frequency of stroke MESHD stroke HP, encephalitis MESHD encephalitis HP and delirium MESHD delirium HP, and was strongly associated with increased hospitalisation, mortality and disability.

    First Case Of SAR TRANS-Coronavirus-2 Sequencing In The Cerebrospinal Fluid Of A Patient With Suspected CNS Demyelinating Disease MESHD

    Authors: Renan Domingues; Maria Cássia Mendes-Correa; Fernando Brunale Vilela de Moura Leite; Ester Cerdeira Sabino; Ingra M Claro; Noely Evangelista Ferreira; Camila Malta Romano; Jaqueline Goes de Jesus; Daniel Wagner de Castro Lima Santos; Diego Zanotti Salarini; Carlos Senne

    doi:10.21203/ Date: 2020-05-26 Source: ResearchSquare

    The association between coronaviruses and central nervous system (CNS) demyelinating lesions has been previously shown. However, no case has been described of an association between the novel coronavirus (SARS-COV-2) and CNS demyelinating disease MESHD so far. SARS-COV-2 was previously detected in cerebrospinal fluid (CSF) sample of a patient with encephalitis MESHD encephalitis HP. However, the virus identity was not confirmed by deep sequencing of SARS-COV-2 detected in the CSF. Here, we report a case of a patient with mild respiratory symptoms and neurological manifestations compatible with Clinically Isolated Syndrome MESHD. The viral genome of SARS-COV-2 was detected and sequenced in CSF with 99.74 to 100% similarity between the patient virus and worldwide sequences. This report suggests a possible association of SARS COV-2 infection MESHD with neurological symptoms of demyelinating disease MESHD, even in the absence of relevant upper respiratory tract infection MESHD respiratory tract infection HP signs.

    Neurological Involvement of Coronavirus Disease MESHD 2019: A Systematic Review

    Authors: Malik Ghannam; Qasem Alshaer; Mustafa Al-Chalabi; Lara Zakarna; Jetter Robertson; Georgios Manousakis

    doi:10.21203/ Date: 2020-05-23 Source: ResearchSquare

    Background: In December 2019, unexplained cases of pneumonia MESHD pneumonia HP emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease MESHD 2019 (COVID-2019) outbreak, a pandemic. Although the most common presentations of COVID-19 are fever MESHD fever HP, cough MESHD cough HP and shortness of breath, several clinical observations indicate that COVID-19 does affect the central and peripheral nervous system.  Methods: We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 that were evident for neurological involvement.  Results: We were able to identify 82 cases of COVID-19 with neurological complications. The mean age TRANS was 62.28 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n=40) had cerebrovascular insults, 28% (n=23) had neuromuscular disorders, 18.3% of the patients (n=15) had encephalitis MESHD encephalitis HP or encephalopathy HP, and 2.4% (n=2) presented with status epilepticus MESHD status epilepticus HP. Conclusions: Neurological manifestations of COVID-19 infection MESHD are not rare, especially large vessel stroke MESHD stroke HP, Guillain barre syndrome MESHD and meningoencephalitis MESHD. Moving forward, further studies are needed to clarify the prevalence SERO of the neurological complications of COVID-19, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic.

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MeSH Disease
Human Phenotype

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