Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients.
Neurological symptoms in COVID-19: a cross-sectional monocentric study of hospitalized patients.
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COVID-19的神经系统症状：对住院患者的横断面单中心研究。
DOI：
10.1186/s42466-021-00116-1
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发表时间：
2021-03-12
影响因子：
--
通讯作者：
Schulz JB
中科院分区：
文献类型：
--
作者：
Ermis U;Rust MI;Bungenberg J;Costa A;Dreher M;Balfanz P;Marx G;Wiesmann M;Reetz K;Tauber SC;Schulz JB
SARS-冠状病毒-2（SARS-CoV-2）侵入呼吸系统，引起急性，有时严重的肺部症状，但结果也对大脑产生了重大影响。越来越多的研究表明，神经系统表现的多样性。为了调查症状谱，我们在此描述了在亚琛，德国RWTH大学医院住院的确诊SARS-CoV-2感染患者的神经系统表现和并发症。在2020年3月至9月期间，我们评估了53名SARS-CoV-2聚合酶链反应（PCR）阳性患者的常见症状，临床特征，实验室（包括脑脊液（CSF）分析），放射学和脑电图（EEG）数据。在可行的情况下，我们使用蒙特利尔认知评估测试（莫卡）来筛查认知障碍。我们比较了根据急性呼吸窘迫综合征（ARDS）的存在分类的危重病患者和非危重病患者。住院COVID-19患者的主要临床神经系统特征为协调缺陷（74%）、认知障碍（61.5%）、轻瘫（47%）、反射状态异常（45%）、感觉异常（45%）、全身肌无力和疼痛（32%）、嗅觉减退（26%）和头痛（21%）。ARDS患者比非ADRS患者受影响更严重。29.6%的ARDS患者表现为蛛网膜下腔出血，11.1%的患者表现为与SARS-CoV-2感染相关的缺血性卒中。认知障碍主要影响执行功能、注意力、语言和延迟记忆回忆。我们在53名患者中的9名患者中通过腰椎穿刺获得了脑脊液（CSF），其中没有一名患者具有阳性SARS-CoV-2 PCR。与以前的研究结果一致，我们的研究结果为一系列SARS-CoV-2相关的神经系统表现提供了证据。26%的患者报告了嗅觉减退，强调了SARS-CoV-2的神经侵袭潜力，它可以进入嗅球。因此可以推测，神经系统表现可能是由病毒直接侵入CNS引起的;然而，PCR未显示鞘内SARS-CoV-2阳性。因此，我们假设COVID-19的副感染性严重促炎影响更可能是神经功能缺损（包括认知障碍）的原因。未来需要对神经功能缺损进行全面纵向评估的研究，以确定COVID-19的潜在长期并发症。在线版本包含补充材料，可通过10.1186/s42466-021-00116-1获得。
The SARS-Coronavirus-2 (SARS-CoV-2) invades the respiratory system, causing acute and sometimes severe pulmonary symptoms, but turned out to also act multisystematically with substantial impact on the brain. A growing number of studies suggests a diverse spectrum of neurological manifestations. To investigate the spectrum of symptoms, we here describe the neurological manifestations and complications of patients with proven SARS-CoV-2 infection who have been hospitalized at the RWTH University Hospital Aachen, Germany. Between March and September 2020, we evaluated common symptoms, clinical characteristics, laboratory (including cerebrospinal fluid (CSF) analysis), radiological, and electroencephalography (EEG) data from 53 patients admitted with a positive SARS-CoV-2 polymerase chain reaction (PCR). We used the Montreal Cognitive Assessment Test (MoCA) to screen for cognitive impairment, when feasible. We compared critically ill and non-critically ill patients categorized according to the presence of Acute Respiratory Distress Syndrome (ARDS). Major clinical neurological features of hospitalized COVID-19 patients were coordination deficits (74%), cognitive impairment (61.5%), paresis (47%), abnormal reflex status (45%), sensory abnormalities (45%), general muscle weakness and pain (32%), hyposmia (26%), and headache (21%). Patients with ARDS were more severely affected than non-ADRS patients. 29.6% of patients with ARDS presented with subarachnoid bleedings, and 11.1% showed ischemic stroke associated with SARS-CoV-2 infection. Cognitive deficits mainly affected executive functions, attention, language, and delayed memory recall. We obtained cerebrospinal fluid (CSF) by lumbar puncture in nine of the 53 patients, none of which had a positive SARS-CoV-2 PCR. In line with previous findings, our results provide evidence for a range of SARS-CoV-2-associated neurological manifestations. 26% of patients reported hyposmia, emphasizing the neuro-invasive potential of SARS-CoV-2, which can enter the olfactory bulb. It can therefore be speculated that neurological manifestations may be caused by direct invasion of the virus in the CNS; however, PCR did not reveal positive intrathecal SARS-CoV-2. Therefore, we hypothesize it is more likely that the para-infectious severe pro-inflammatory impact of COVID-19 is responsible for the neurological deficits including cognitive impairment. Future studies with comprehensive longitudinal assessment of neurological deficits are required to determine potential long-term complications of COVID-19. The online version contains supplementary material available at 10.1186/s42466-021-00116-1.
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影响因子：
5.9
作者：
Dixon L;McNamara C;Gaur P;Mallon D;Coughlan C;Tona F;Jan W;Wilson M;Jones B
通讯作者：
Jones B
影响因子：
9.9
作者：
Frontera, Jennifer A.;Sabadia, Sakinah;Galetta, Steven
通讯作者：
Galetta, Steven
影响因子：
3.7
作者：
Balfanz P;Hartmann B;Müller-Wieland D;Kleines M;Häckl D;Kossack N;Kersten A;Cornelissen C;Müller T;Daher A;Stöhr R;Bickenbach J;Marx G;Marx N;Dreher M
通讯作者：
Dreher M
影响因子：
3
作者：
Galanopoulou, Aristea S.;Ferastraoaru, Victor;Boro, Alexis
通讯作者：
Boro, Alexis
影响因子：
6.4
作者：
Lersy, Francois;Benotmane, Ilies;Kremer, Stephane
通讯作者：
Kremer, Stephane