Miller Fisher Syndrome in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection: A Systematic Review.

BACKGROUND AND PURPOSE: Miller Fisher syndrome (MFS) is a subtype of Guillain-Barré syndrome characterized by the triad of ophthalmoparesis, areflexia, and ataxia. Although cases of MFS have been associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, no studies have synthesized the clinical characteristics of patients with this condition. METHODS: In this rapid systematic review, we searched the PubMed database to identify studies on MFS associated with SARS-CoV-2 infection. RESULTS: This review identified 11 cases, of whom 3 were hospitalized with motor and/or sensory polyneuropathy as the first sign of SARS-CoV-2 infection. SARS-CoV-2 RNA was not detected in analyses of cerebrospinal fluid, suggesting a mechanism of immune-mediated injury rather than direct viral neurotropism. However, antiganglioside antibodies were found in only two of the nine patients tested. It is possible that target antigens other than gangliosides are involved in MFS associated with SARS-CoV-2 infection. CONCLUSIONS: The present patients exhibited clinical improvement after being treated with intravenous immunoglobulin. Although rare, patients with SARS-CoV-2 infection may present neurological symptoms suggestive of MFS. Early recognition of the MFS clinical triad is essential for the timely initiation of treatment.

Carpal tunnel syndrome observed after an arbovirus infection: A preliminary case series report.

PURPOSE: Report a case series study of individuals who, after having a suspected arboviral disease during an epidemic outbreak in north-eastern Brazil, presented symptoms of acroparesthesia. METHODS: A retrospective evaluation of patients with acroparesthesia undertaken between December 2015 and October 2016 following a clinical picture suggestive of an arboviral infection. RESULTS: Clinical and electrophysiological data were obtained from 29 individuals. 13% were male. All presented a main complaint of numbness in the hands, with 86% presenting bilateral symptoms. The symptoms started within 60 days of the clinical picture in 62% of cases. The electrophysiological study demonstrated CTS in 54 median nerves. It was classified as mild in 24.1% of cases, moderate in 32.7%, severe in 24.1%, very severe in 6.8% and extremely severe in 5.1%. CONCLUSION: The best explanation for the presence of acroparesthesia following an arboviral infection may be the narrowing of the carpal tunnel caused by the inflammatory joint process usually observed in cases of chikungunya infection. CLINICAL RELEVANCE: This is the first study with electrophysiological data that associates arboviral infection with CTS.

Evaluation of muscle strength, balance and functionality of individuals with type 2 Charcot-Marie-Tooth Disease.

BACKGROUND: Charcot-Marie-Tooth (CMT) disease is part of a group of genetically determined neuropathies. The intrinsic muscles of the feet and legs are affected early in the disease, impacting balance and mobility. RESEARCH QUESTION: The purpose of this study was to evaluate individuals with type 2 Charcot-Marie-Tooth disease to understand how motor changes interfere in balance and function. METHODS: The sample comprised 15 individuals with CMT2 from the same family (CMT2G) and a control group (CG) of healthy individuals matched for age and gender. The CMT individuals were classified using the Charcot-Marie-Tooth Neuropathy Score (CMTNS). Muscle strength of the ankle was assessed using a manual dynamometer. Balance was measured using a stabilometer and Berg's Balance Scale (BBS). Functional performance was measured by the Timed Up and Go Test (TUG). RESULTS: There was a statistically significant difference between the CMT2G and the CG for right side (RS) and left side (LS) muscle strength (dorsiflexors-RS and LS: p < 0,0001; invertors-RS and LS: p < 0.0001; plantarflexors-RS: p < 0.0001; plantarflexors-LS: p = 0.0019; evertors-RS: p = 0.0016; evertors-LS: p<0.0001) in the parameters for the velocity and displacement of center of pressure (CoP) anterior-posterior (AP) in the stabilometry tests with eyes open (EO) and closed (EC) (VCoPAP-EO and VCoPAP-EC: p = 0.0123; DCoPAP-OE: p = 0.0183 and DCoPAP-EC: p = 0.0129), the Berg Balance Scale (p = 0.0066) and the TUG test (p = 0.0003). SIGNIFICANCE: Thus when the severity of the disease is mild the instability is caused by the weakness of the dorsiflexors and plantarflexors. In patients considered moderate/severe, in addition to weakness of the leg muscles, loss of proprioception will contribute to impaired balance.