Mozhdehipanah, Hossein

Qazvin University of Medical Sciences Repository

Arch Iran Med. April 2021;24(4):343Author’s Reply Consider Differentials before Diagnosing AMSAN in COVID-19 PatientsHossein Mozhdehipanah, MD1*1Department of Neurology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran*Corresponding Author: Hossein Mozhdehipanah, MD; Department of Neurology, School of Medicine, Qazvin University of Medical Sciences, Qazvin, Iran. Tel: +98-28-33326031; Fax: +98-28-33342009; Email: hmozhdehipanah@qums.ac.ir10.34172/aim.2021.50doiARCHIVES OFIRANIANMEDICINEThank you for taking the time to review our article.1 Your comments are valuable to us and will help us to revise our future related papers. Below are some points in response to the comments made by you.The patient was admitted to our hospital during the peak stage of COVID-19 in our country. The decision for transferring the patient from ICU to the ward was made by our ICU managing team (including internal medicine specialists and anesthesiologists) because her respiratory situation was improved and she was extubated without any difficulties. Her O2 saturation was 92% with mask at the time we transferred her to the ward. Another reason for this decision was our limited ICU capacity, considering the fact that we had more critical ill patients waiting for a vacant bed in the ICU.As we mentioned in the discussion part, critical illness neuropathy and myopathy usually occur in patients who stay in the ICU for a long time (at least ≥7 days). There are diagnostic criteria for critical illness neuropathy and myopathy. Having difficulties in weaning off of mechanical ventilation is one of the major diagnostic criteria for critical illness myopathy and neuropathy.2 Our patient was in the ICU for only 10 days and did not experience any respiratory deterioration during extubation and after that, during her stay in the ICU.Moreover, patients with critical illness neuropathy and myopathy show signs and symptoms of muscle weakness and paresis while they are in the ICU. Our patient did not show any decreased muscle strength in her limbs during her stay in the ICU.As we discussed in the article, the CSF protein levels are not elevated during the first week in Guillain- Barre syndrome. We obtained CSF and analyzed it for protein in the first week to exclude other differential diagnoses. We intended to repeat the CSF analysis when the disease progressed but unfortunately, it was not possible considering the patient’s situation. We faced several obstacles and limitations during the COVID-19 crisis. An intensive workup (including COVID-19 PCR on CSF samples) was not possible in many cases because of the increasing number of hospitalized patients with SARS-CoV-2 infection. Although COVID-19 PCR on CSF samples would be a very helpful tool to confirm the infection, it might not have a specific impact on our patient’s disease progression and outcome.Again, thank you for your valuable comments.Conflict of Interest DisclosuresNone.Ethical StatementNot applicable.References1. Agha Abbaslou M, Karbasi M, Mozhdehipanah H. A rare axonal variant of Guillain-Barré syndrome as a neurological complication of COVID-19 infection. Arch Iran Med. 2020;23:718-21. doi: 10.34172/aim.2020.93. 2. Shepherd S, Batra A, Lerner DP. Review of critical illness myopathy and neuropathy. The Neurohospitalist. 2017;7(1):41-8. doi: 10.1177/1941874416663279.Open Access http://www.aimjournal.irReceived: November 1, 2020, Accepted: February 7, 2021, ePublished: April 1, 2021Cite this article as: Mozhdehipanah H. Consider differentials before diagnosing AMSAN in COVID-19 patients. Arch Iran Med. 2021;24(4):343. doi: 10.34172/aim.2021.50 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Consider differentials before diagnosing AMSAN in COVID-19 patients

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Consider differentials before diagnosing AMSAN in COVID-19 patients

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