Peripheral neuropathy and radicular leg pain emerging in patients recovering from COVID-19 infection

Öz

Aim: COVID-19, first recognized in late 2019, has a broad neurological footprint. Beyond diffuse myalgia, some patients report focal pain. This study aimed to describe an atypical clinical presentation of unilateral radicular leg pain mimicking lumbar discopathy after COVID-19 recovery. Material and Methods: We retrospectively reviewed neurosurgery outpatient records (2019–2022) for patients ≥16 years with PCR-confirmed COVID-19 who developed new unilateral lower-limb radicular pain 3–7 days after completion of COVID-19 treatment. Exclusion criteria were prior radicular pain, intervertebral disc disease, spinal stenosis, spondylolisthesis, spinal tumor/trauma, prior interventions, and any structural explanation on imaging. Results: Thirteen patients (mean age 51.3 ± 8.4 years) were included. Acute-phase diffuse myalgia resolved within ~1 week, but unilateral radicular pain persisted after recovery. Neurological examination showed preserved strength and reflexes; anterior-thigh hypoesthesia occurred in 5 patients. Median/peroneal/tibial motor studies were normal and prolonged superficial peroneal sensory latency in 5 patients. Lumbar MRI showed no disc herniation, stenosis, or facet pathology. Median VAS decreased from 7 at presentation to 2 at 6 months (p = 0.003) under conservative therapy (gabapentin + NSAID). Baseline and follow-up laboratory parameters remained within reference ranges. Conclusion: In patients with new unilateral sciatica-like pain after COVID-19 and negative lumbar MRI, clinicians should consider a non-compressive, post-infectious radicular phenotype.

Anahtar Kelimeler

• COVID-19
• Radicular pain
• Neuropathy
• Peripheral nerve

COVID-19 enfeksiyonundan iyileşen hastalarda ortaya çıkan periferik nöropati ve radiküler bacak ağrısı

Öz

Amaç: 2019’un sonlarında tanımlanan COVID-19’un nörolojik yelpazesi geniştir. Diffüz miyaljinin ötesinde, bazı hastalarda fokal ağrılar bildirilmiştir. Bu çalışma, COVID-19 iyileşmesini takiben lomber diskopatiyi taklit eden tek taraflı radiküler bacak ağrısı gibi atipik bir sunumu tanımlamayı amaçladı. Gereç ve Yöntemler: 2019–2022 yılları arasında beyin cerrahisi polikliniğinde takipli, PCR ile doğrulanmış COVID-19 hastaları (≥16 yaş) geriye dönük incelendi. COVID-19 tedavisinin tamamlanmasından 3–7 gün sonra ortaya çıkan yeni tek taraflı alt ekstremite radiküler ağrısı olan olgular dâhil edildi. Dışlama ölçütleri arasında önceden radiküler ağrı öyküsü, intervertebral disk hastalığı, spinal stenoz, spondilolistezis, spinal tümör/travma, önceki girişimler ve görüntüleme ile açıklanabilen herhangi bir yapısal neden vardı. Bulgular: Toplam 13 hasta (ortalama yaş 51,3 ± 8,4 yıl) dâhil edildi. Akut dönemdeki diffüz miyalji ~1 hafta içinde geriledi, ancak tek taraflı radiküler ağrı iyileşme sonrası devam etti. Nörolojik muayenede kas gücü ve derin tendon refleksleri korundu; anteriyor uylukta hipoestezi 5 hastada saptandı. Median/peroneal/tibial motor iletiler normaldi; yüzeyel peroneal duyusal latans 5 hastada uzundu. Lomber MRG’de herni, stenoz veya faset patolojisi izlenmedi. VAS medyanı başvuruda 7 iken 6. ayda 2’ye geriledi (p = 0,003); tedavi konservatif (gabapentin + NSAİİ) idi. Başlangıç ve izlem laboratuvar değerleri referans aralığında kaldı. Sonuç: COVID-19 sonrası yeni gelişen, siyatalji benzeri ağrı ve negatif lomber MRG bulunan hastalarda, kompresyonla açıklanamayan post-infeksiyöz radiküler bir fenotip düşünülmelidir.

Anahtar Kelimeler

• COVID-19
• Radicular ağrı
• Neuropathy
• Periferik sinir

Kaynakça

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