Objective: To describe two patients with post-COVID-19 Parkinson’s disease (PD) and discuss their possible causes.

Background: PD is a neurodegenerative disorder characterized by motor and nonmotor symptoms. SARS-CoV-2’s role in PD symptoms has not yet been confirmed. SARS-CoV-2 invasion of vasculature in the brain may cause multiple damages through inflammatory responses that could lead to protein misfolding, a characteristic of neurodegenerative disorders.

Method: We here described two patients who started PD symptoms after confirmed COVID-19 infection. None of them had past medical history or symptoms suggestive of parkinsonian syndrome (like REM sleep behavior disorder).

Results: The first one is a 44-years-old female patient who developed mild flu-like symptoms lasting 6 days. One month later, she developed asymmetric rest tremor, seeking healthcare. Neurological exam discloses facial hypomimia and cogwheel stiffness with bradykinesia in the left upper limb, fulfilling the criteria for PD. A test with levodopa was performed with significant improvement. The second one is 57-years-old man with a mild flu-like symptoms and anosmia lasting 7 days. From the following 3 days he reported slow movements with his left hand and difficulty waking. On examination he had mild hyposmia and mild bradykinesia and rigidity in the left upper limb. A test with levodopa was performed with good response.

Conclusion: Few cases of PD have described following Covid-19 infection.  Since the beginning of the pandemic, several neurological manifestations have been described associated with COVID-19, including hyposmia, headache, seizures, encephalopathy, cerebrovascular diseases, neuropathies, and parkinsonism. Parkinsonism associated with viral infections has been described with other viruses, such as influenza A and Epstein-Barr. Historically, several cases of post-encephalitic parkinsonism were described after the Spanish flu in 1918. Some hypotheses are proposed about its relationship, among which: direct viral infection causes parkinsonism by structural and functional basal ganglia damage; extensive inflammation or even hypoxic brain injury within the context of an encephalopathy; unmasking of underlying but still non-symptomatic Parkinson’s disease and a trigger for the neurodegenerative process of Parkinson’s disease in subjects with genetic susceptibility.

References: FERINI-STRAMBI, Luigi; SALSONE, Maria, COVID-19 and neurological disorders: are neurodegenerative or neuroimmunological diseases more vulnerable?, Journal of Neurology, v. 268, n. 2, p. 409–419, 2021. PAIVA, Karina Maia et al, Impactos globais da infecção por COVID-19 em pacientes com a doença de Parkinson: uma revisão integrativa, Research, Society and Development, v. 10, n. 1, p. e47310112043, 2021. MENG, Lei; SHEN, Liang; JI, Hong-Fang, Impact of infection on risk of Parkinson’s disease: a quantitative assessment of case-control and cohort studies, Journal of NeuroVirology, v. 25, n. 2, p. 221–228, 2019. SULZER, David, Multiple hit hypotheses for dopamine neuron loss in Parkinson’s disease, Trends in Neurosciences, v. 30, n. 5, p. 244–250, 2007. RAONY, Ícaro et al, Psycho-Neuroendocrine-Immune Interactions in COVID-19: Potential Impacts on Mental Health, Frontiers in Immunology, v. 11, p. 1170, 2020. CILIA, Roberto et al, Effects of COVID ‐19 on Parkinson’s Disease Clinical Features: A COMMUNITY‐BASED CASE‐CONTROL Study, Movement Disorders, v. 35, n. 8, p. 1287–1292, 2020. FASANO, Alfonso et al, Predictors of COVID-19 outcome in Parkinson’s disease, Parkinsonism & Related Disorders, v. 78, p. 134–137, 2020. POSTUMA, Ronald B. et al, MDS clinical diagnostic criteria for Parkinson’s disease, Movement Disorders: Official Journal of the Movement Disorder Society, v. 30, n. 12, p. 1591–1601, 2015. HAYES, Michael T., Parkinson’s Disease and Parkinsonism, The American Journal of Medicine, v. 132, n. 7, p. 802–807, 2019. ROMERO-SÁNCHEZ, Carlos Manuel et al, Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry, Neurology, 2020. MAO, Ling et al, Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China, JAMA Neurology, v. 77, n. 6, p. 683–690, 2020. MORIGUCHI, Takeshi et al, A first case of meningitis/encephalitis associated with SARS-Coronavirus-2, International Journal of Infectious Diseases, v. 94, p. 55–58, 2020. SEDAGHAT, Zahra; KARIMI, Narges, Guillain Barre syndrome associated with COVID-19 infection: A case report, Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia, v. 76, p. 233–235, 2020. MERELLO, Marcelo; BHATIA, Kailash P.; OBESO, Jose A., SARS-CoV-2 and the risk of Parkinson’s disease: facts and fantasy, The Lancet. Neurology, v. 20, n. 2, p. 94–95, 2021. LIMPHAIBOOL, Nattakarn et al, Infectious Etiologies of Parkinsonism: Pathomechanisms and Clinical Implications, Frontiers in Neurology, v. 10, p. 652, 2019. GIORDANO, Antonino et al, COVID-19: can we learn from encephalitis lethargica?, The Lancet. Neurology, v. 19, n. 7, p. 570, 2020. SULZER, David et al, COVID-19 and possible links with Parkinson’s disease and parkinsonism: from bench to bedside, npj Parkinson’s Disease, v. 6, n. 1, p. 18, 2020.

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