Neurological reasons for consultation and hospitalization during the COVID-19 pandemic
Neurological reasons for consultation and hospitalization during the COVID-19 pandemic
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DOI：
10.1007/s10072-020-04714-w
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发表时间：
2020-09-15
影响因子：
3.3
通讯作者：
Gomez-Beldarrain, Marian
中科院分区：
文献类型：
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作者：
Garcia-Monco, Juan Carlos;Cabrera-Muras, Antonio;Gomez-Beldarrain, Marian
背景COVID-19疾病影响神经系统，并导致患者在入院时和大流行高峰期住院期间的神经科咨询增加。方法本研究纳入了临床和实验室诊断为COVID-19并需要神经科会诊的患者，或在大流行高峰期2个月内入院时出现神经系统问题并导致诊断为SARS-CoV-2感染的患者。分析人口统计学和临床变量。结果共纳入35例患者。入院时的神经系统表现导致14名患者（40%）诊断为COVID-19。住院期间最常见的就诊原因为卒中（11例）、脑病（7例）、癫痫发作（6例）和神经病（5例），其次为晕厥（2例）、偏头痛（1例）、嗅觉丧失（1例）、重症肌病（1例）和残余构音障碍加重（1例）。除神经病变外，最常见的神经功能障碍与严重疾病相关。脑病和癫痫患者的D-二聚体和铁蛋白值明显升高，甚至高于中风患者。8例脑脊液标本经RT-PCR检测均为阴性。结论神经功能障碍是COVID-19患者的一个显著而严重的负担，它们可能是导致高比例患者诊断为病毒感染的主要症状。直接的病毒机制的证据很少，但不同表现的发病机制仍然是谜。
Background COVID-19 disease affects the nervous system and led to an increase in neurological consults for patients at admission and through the period of hospitalization during the peak of the pandemic. Methods Patients with clinical and laboratory diagnosis of COVID-19 that required a neurologic consultation or those who presented with neurological problems on admission that led to a diagnosis of SARS-CoV-2 infection during a 2-month period at the peak of the pandemic were included in this study. Demographic and clinical variables were analyzed. Results Thirty-five patients were included. The presenting neurologic manifestations on admission led to the diagnosis of COVID-19 in 14 patients (40%). The most common reasons for consultation during the hospitalization period were stroke (11), encephalopathy (7), seizures (6), and neuropathies (5) followed by a miscellaneous of syncope (2), migraine (1), anosmia (1), critical illness myopathy (1), and exacerbation of residual dysarthria (1). The most common neurological disturbances were associated with severe disease except for neuropathies. Patients with encephalopathies and seizures had markedly increased D-dimer and ferritin values, even higher than stroke patients. RT-PCR was performed in 8 CSF samples and was negative in all of them. Conclusion Neurological disturbances represent a significant and severe burden in COVID-19 patients, and they can be the presenting condition that leads to the diagnosis of the viral infection in a high percentage of patients. Evidence of direct viral mechanisms was scarce, but the pathogenesis of the diverse manifestations remains enigmatic.