{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:29:21Z","timestamp":1767338961862,"version":"3.41.2"},"reference-count":15,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T00:00:00Z","timestamp":1652659200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Patients with coronavirus disease 2019 (COVID-19) often develop acute respiratory failure and acute respiratory distress syndrome (ARDS) that requires intensive care unit (ICU) hospitalization and invasive mechanical ventilation, associated with a high mortality rate. In addition, many patients fail early weaning attempts, further increasing ICU length of stay and mortality. COVID-19 related ARDS can be complicated by neurological involvement with mechanisms of direct central nervous system (CNS) infection and with overlapping para-infective mechanisms of the peripheral nervous system (PNS). We aimed to evaluate the possible involvement of the brainstem and PNS in patients with COVID-19 related ARDS and difficulty in weaning from mechanical ventilation. We evaluated electroencephalogram (EEG), brainstem auditory evoked potentials (BAEPs), electroneurography of the four limbs and the phrenic nerve in 10 patients with respiratory insufficiency due to SARS-CoV-2. All were admitted to intensive care unit and were facing prolonged weaning from mechanical ventilation. All ten patients showed a mild diffuse non-specific slowing of brain electrical activity on the EEG. Four patients had an acute motor axonal neuropathy with absent or reduced amplitude phrenic nerve CMAP while four patients showed impairment of the BAEPs. A patient with peripheral nerve impairment suggestive of Guillain-Barr\u00e9 syndrome (GBS) underwent an intravenous immunoglobulin (IVIg) cycle that led to an improvement in the weaning process and progressive motor improvement. The inclusion of a comprehensive neurological evaluation in COVID-19 patients in ICU facilitated the early identification and effective management of Nervous System involvement.<\/jats:p>","DOI":"10.3389\/fneur.2022.868538","type":"journal-article","created":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T07:43:08Z","timestamp":1652686988000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Neurophysiological Aspects in SARS-CoV-2\u2013Induced Acute Respiratory Distress Syndrome"],"prefix":"10.3389","volume":"13","author":[{"given":"Eleonora","family":"Vecchio","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Gallicchio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Caporusso","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valentina","family":"Recchia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Didonna","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giancarlo","family":"Pezzuto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luigi","family":"Pisani","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonella","family":"Petruzzellis","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vito","family":"Delmonte","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Filippo","family":"Tamma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2022,5,16]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.3390\/ijerph18041415","article-title":"Neurological sequelae in patients with COVID-19: a histopathological perspective","volume":"18","author":"Fisicaro","year":"2021","journal-title":"Int J Environ Res Public Health."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1061","DOI":"10.1001\/jama.2020.1585","article-title":"Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China","volume":"323","author":"Wang","year":"2020","journal-title":"JAMA."},{"key":"B3","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1001\/jamacardio.2020.1017","article-title":"Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Guo","year":"2020","journal-title":"JAMA Cardiol."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e41","DOI":"10.1111\/ene.14275","article-title":"COVID-19: what if the brain had a role in causing the deaths?","volume":"27","author":"Tassorelli","year":"2020","journal-title":"Eur J Neurol."},{"key":"B5","doi-asserted-by":"publisher","first-page":"552","DOI":"10.1002\/jmv.25728","article-title":"The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients","volume":"92","author":"Li","year":"2020","journal-title":"J Med Virol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1663","DOI":"10.1007\/s10072-020-04487-2","article-title":"Brainstem involvement and respiratory failure in COVID-19","volume":"41","author":"Manganelli","year":"2020","journal-title":"Neurol Sci."},{"key":"B7","doi-asserted-by":"publisher","first-page":"3598","DOI":"10.1007\/s00415-021-10474-0","article-title":"Brainstem clinical and neurophysiological involvement in COVID-19","volume":"268","author":"Bocci","year":"2021","journal-title":"J Neurol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"2702","DOI":"10.1007\/s42399-020-00646-w","article-title":"COVID-19-associated guillain-barre syndrome: atypical para-infectious profile, symptom overlap, and increased risk of severe neurological complications","volume":"2","author":"Kajumba","year":"2020","journal-title":"SN Compr Clin Med."},{"key":"B9","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1136\/jnnp-2014-307815","article-title":"Electrophysiological diagnosis of Guillain\u2013Barr\u00e9 syndrome subtype: could a single study suffice?","volume":"86","author":"Rajabally","year":"2015","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B10","doi-asserted-by":"publisher","first-page":"270","DOI":"10.1038\/s41586-020-2012-7","article-title":"A pneumonia outbreak associated with a new coronavirus of probable bat origin","volume":"579","author":"Zhou","year":"2020","journal-title":"Nature."},{"key":"B11","doi-asserted-by":"publisher","first-page":"995","DOI":"10.1021\/acschemneuro.0c00122","article-title":"Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host-virus interaction, and proposed neurotropic mechanisms","volume":"11","author":"Baig","year":"2020","journal-title":"ACS Chem Neurosci."},{"key":"B12","doi-asserted-by":"publisher","first-page":"e00404","DOI":"10.1128\/JVI.00404-18","article-title":"Axonal transport enables neuron-to-neuron propagation of human coronavirus OC43","volume":"92","author":"Dube","year":"2018","journal-title":"J Virol."},{"key":"B13","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1136\/jnnp-2020-324837","article-title":"Guillain-Barr\u00e9 syndrome and COVID-19: an observational multicentre study from two Italian hotspot regions","volume":"92","author":"Filosto","year":"2021","journal-title":"J Neurol Neurosurg Psychiatry."},{"key":"B14","doi-asserted-by":"publisher","first-page":"598","DOI":"10.1002\/ana.25987","article-title":"Incidence, clinical, risk factors and outcomes of Guillain-Barr\u00e9 in Covid-19","volume":"89","author":"Fragiel","year":"2021","journal-title":"Ann Neurol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"1133","DOI":"10.1007\/s00415-020-10124-x","article-title":"Guillain\u2013Barr\u00e9 syndrome spectrum associated with COVID-19: an up-to-date systematic review of 73 cases","volume":"268","author":"Abu-Rumeileh","year":"2021","journal-title":"J Neurol."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.868538\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,16]],"date-time":"2022-05-16T07:43:13Z","timestamp":1652686993000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2022.868538\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,5,16]]},"references-count":15,"alternative-id":["10.3389\/fneur.2022.868538"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2022.868538","relation":{},"ISSN":["1664-2295"],"issn-type":[{"type":"electronic","value":"1664-2295"}],"subject":[],"published":{"date-parts":[[2022,5,16]]},"article-number":"868538"}}