Upper Extremity Neuropathies Following Severe COVID-19 Infection: A Multicenter Case Series

OBJECTIVE: The purpose of the study is to examine presentation, injury patterns, and clinical course, for COVID-19-related peripheral nerve injury following me-chanical ventilation. -METHODS: A multicenter retrospective study of patients with COVID-19 complicated by acute respiratory distress syndrome (ARDS) that required mechanical ventilation was -ndertaken. Patient records were reviewed for intensive care unit and intubation characteristics, prone or lateral decubitus positioning, and the onset of neuropathy diagnosis. -RESULTS: Between September 2020 and January 2022,11 patients were diagnosed with peripheral neuropathy, including 9 with brachial plexopathy following COVID-19 infection. Each patient developed ARDS requiring me-chanical ventilation for a median of 39 days. Six patients (54.5%) underwent prone positioning and 1 lateral decu-bitus. Neuropathies involved 5 brachial pan-plexopathies, 2 incomplete brachial plexopathies, 2 lower trunk plexo-pathies, 1 radial neuropathy, and 1 bilateral ulnar neurop-athy. At a mean follow-up of 10.2 months, patients with brachial pan-plexopathies demonstrated signs of reinner-vation proximally, and 1 resolved to a radial mono-neuropathy; however, the majority have demonstrated minimal clinical improvements. -CONCLUSIONS: Our series demonstrates that peripheral neuropathies and especially brachial plexopathies have occurred following mechanical ventilation for ARDS-related COVID-19 infections. Contrary to prior COVID-19 studies, only 54.5% of these patients underwent prone positioning. Aside from a traumatic disturbance of prone positioning, the increased incidence of neuropathy may involve an atraumatic effect of COVID-19 via direct invasion of nerves, autoantibody targeting of nervous tissue, or hypercoagulation-induced microthrombotic angiopathy.