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Título

Parkinsonism following COVID-19 in a Long-COVID cohort – Case Series Report.

Resumo

Introduction: Even though SARS-CoV-2's role in causing Parkinson’s disease (PD) has not yet been confirmed, recent studies describe a possible association between COVID-19 and movement disorders. SARS-CoV-2 invasion of vasculature in the brain may cause multiple outcomes through inflammatory responses that could lead to protein misfolding, a characteristic of neurodegenerative disorders. Objective: This study describes three patients who started parkinsonian symptoms after confirmed diagnosis of COVID-19 infection. Methods: We evaluated a prospective cohort study with patients followed in a post-COVID neurological outpatient clinic, recruited based on positive COVID-19 PCR and post-COVID neurological symptoms. The total sample consisted of 221 patients recruited for the study. Three had a diagnosis compatible with Parkinson’s disease. Results: The first patient, a 44 years-old-female developed mild flu-like symptoms lasting 6 days. One month later, she describes an asymmetric rest tremor. Neurological exam shows facial hypomimia and cogwheel stiffness with bradykinesia in the left upper limb. The second patient, a 57 years-old-man, reported mild flu-like symptoms with anosmia lasting 7 days. The symptoms progressive after 10 days with difficult to count money at his work and difficult walking. On examination he had mild hyposmia and mild bradykinesia with stiffness in the left upper limb. The third patient, a 56 years-old-female had a history of antiphospholipid syndrome. She reported flu-like symptoms lasting 4 days. After 2 months started a rest tremor. Neurological exam disclosed mild cogwhell stiffness with bradykinesia. All the three patients were responsive to levodopa / benzeraside. Discussion: Since the beginning of the pandemic, several neurological manifestations have been described associated with COVID-19. Parkinsonism associated with viral infections has been described with other viruses. Historically, several cases of post-encephalitic parkinsonism were described after the Spanish flu in 1918. The cause of parkinsonism in the present cases has some hypotheses, among which direct viral infection with neurodegeneration, inflammatory mechanism, or multiple hits. Conclusion: Available data does not confirm a clear association between the Covid-19 infection and PD. Parkinsonian symptoms after COVID-19 infection seems to be a rare condition. We propose a possible association between Covid-19 and the development of PD.