Neurologic manifestations in hospitalized patients with COVID-19 The ALBACOVID registry
Neurologic manifestations in hospitalized patients with COVID-19 The ALBACOVID registry
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DOI：
10.1212/wnl.0000000000009937
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发表时间：
2020-08-25
期刊：
影响因子：
9.9
通讯作者：
Segura, Tomas
中科院分区：
文献类型：
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作者：
Romero-Sanchez, Carlos Manuel;Diaz-Maroto, Inmaculada;Segura, Tomas
目的2019年12月以来，新型冠状病毒病（COVID-19）在全球范围内蔓延。神经系统症状已被报道为该疾病临床谱的一部分。我们的目的是确定神经系统表现在COVID-19住院患者中是否常见，并描述其主要特征。方法：我们系统地回顾了2020年3月西班牙人群中所有被诊断为COVID-19的住院患者。分析患者的人口学特征、系统和神经学临床表现以及辅助试验。结果841例新冠肺炎住院患者（平均年龄66.4岁，男性56.2%）中，57.4%出现某种形式的神经系统症状。非特异性症状如肌痛（17.2%）、头痛（14.1%）和头晕（6.1%）主要出现在感染的早期阶段。嗅觉缺失（4.9%）和语言障碍（6.2%）倾向于早期出现（60%为首发临床表现），在较轻的病例中更为常见。意识障碍常见（19.6%），主要发生在老年患者和重症和晚期患者。肌病（3.1%）、自主神经障碍（2.5%）、脑血管疾病（1.7%）、癫痫发作（0.7%）、运动障碍（0.7%）、脑炎（n = 1）、格林-巴利综合征（n = 1）和视神经炎（n = 1）也有报道，但发生率较低。神经系统并发症是死亡的主要原因，占所有死亡研究参与者的4.1%。结论新型冠状病毒肺炎住院患者有常见的神经系统表现。在我们的研究中，超过一半的患者表现出某种形式的神经系统症状。临床医生需要保持密切的神经系统监测，以便及时识别这些并发症。严重急性呼吸综合征冠状病毒2型累及神经系统的机制和后果有待进一步研究。
Objective The coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019. Neurologic symptoms have been reported as part of the clinical spectrum of the disease. We aimed to determine whether neurologic manifestations are common in hospitalized patients with COVID-19 and to describe their main characteristics. Methods We systematically reviewed all patients diagnosed with COVID-19 admitted to the hospital in a Spanish population during March 2020. Demographic characteristics, systemic and neurologic clinical manifestations, and complementary tests were analyzed. Results Of 841 patients hospitalized with COVID-19 (mean age 66.4 years, 56.2% men), 57.4% developed some form of neurologic symptom. Nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were present mostly in the early stages of infection. Anosmia (4.9%) and dysgeusia (6.2%) tended to occur early (60% as the first clinical manifestation) and were more frequent in less severe cases. Disorders of consciousness occurred commonly (19.6%), mostly in older patients and in severe and advanced COVID-19 stages. Myopathy (3.1%), dysautonomia (2.5%), cerebrovascular diseases (1.7%), seizures (0.7%), movement disorders (0.7%), encephalitis (n = 1), Guillain-Barre syndrome (n = 1), and optic neuritis (n = 1) were also reported, but less frequent. Neurologic complications were the main cause of death in 4.1% of all deceased study participants. Conclusions Neurologic manifestations are common in hospitalized patients with COVID-19. In our series, more than half of patients presented some form of neurologic symptom. Clinicians need to maintain close neurologic surveillance for prompt recognition of these complications. The mechanisms and consequences of severe acute respiratory syndrome coronavirus type 2 neurologic involvement require further studies.