PDF(Pubmed)
Abstract：
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can affect any part of the neuraxis. Many neurological conditions have been attributed to be caused by SARS-CoV-2, namely encephalopathy (acute necrotizing encephalopathy and encephalopathy with reversible splenial lesions), seizures, stroke, cranial nerve palsies, meningoencephalitis, acute disseminated encephalomyelitis (ADEM), transverse myelitis (long and short segment), Guillain-Barré syndrome (GBS) and its variants, polyneuritis cranialis, optic neuritis (ON), plexopathy, myasthenia gravis (MG), and myositis. The pathophysiology differs depending on the time frame of presentation. In patients with concomitant pulmonary disease, for instance, acute neurological illness appears to be caused by endotheliopathy and cytokine storm. Autoimmunity and molecular mimicry are causative for post-coronavirus disease 2019 (COVID-19)-sequelae. It has not yet been shown that the virus can penetrate the central nervous system (CNS) directly. This review aims to describe the disease and root pathogenic cause of the various neurological manifestations of COVID-19. We searched Pubmed/Medline and Google Scholar using the keywords \"SARS-CoV-2\" and \"neurological illness\" for articles published between January 2020 and November 2022. Then, we used the SWIFT-Review (Sciome LLC, North Carolina, United States), a text-mining workbench for systematic review, to classify the 1383 articles into MeSH hierarchical tree codes for articles on various parts of the nervous system, such as the CNS, peripheral nervous system, autonomic nervous system, neuromuscular junction, sensory system, and musculoskeletal system. Finally, we reviewed 152 articles in full text. SARS-CoV-2 RNA has been found in multiple brain areas without any histopathological changes. Despite the absence of in vivo virions or virus-infected cells, CNS inflammation has been reported, especially in the olfactory bulb and brain stem. SARS-CoV-2 genomes and proteins have been found in affected individuals\' brain tissues, but corresponding neuropathologic changes are seldom found in these cases. Additionally, viral RNA can rarely be identified in neurological patients\' CSF post hoc SARS-CoV-2 infection. Most patients with neurological symptoms do not have active viral replication in the nervous system and infrequently have typical clinical and laboratory characteristics of viral CNS infections. Endotheliopathy and the systemic inflammatory response to SARS-CoV-2 infection play a crucial role in developing neuro-COVID-19, with proinflammatory cytokine release mediating both pathological pathways. The systemic inflammatory mediators likely activate astrocytes and microglia across the blood-brain barrier, indirectly affecting CNS-specific immune activation and tissue injury. The management differs according to co-morbidities and the neurological disorder.
摘要：
严重急性呼吸道综合症冠状病毒2（SARS-CoV-2）可以影响神经轴的任何部分。许多神经系统疾病被认为是由SARS-CoV-2引起的，即脑病（急性坏死性脑病和伴有可逆性脾脏病变的脑病）。癫痫发作,中风,颅神经麻痹,脑膜脑炎,急性播散性脑脊髓炎（ADEM），横贯性脊髓炎（长和短节），格林-巴利综合征(GBS)及其变种,颅骨多神经炎，视神经炎(ON),丛神经病,重症肌无力（MG），和肌炎。病理生理学根据呈现的时间框架而不同。在合并肺部疾病的患者中，例如,急性神经系统疾病似乎是由内皮病和细胞因子风暴引起的。自身免疫和分子模仿是2019年冠状病毒病（COVID-19）后遗症的病因。尚未证明该病毒可以直接穿透中枢神经系统（CNS）。这篇综述旨在描述COVID-19各种神经系统表现的疾病和根本原因。我们使用关键字“SARS-CoV-2”和“神经系统疾病”搜索了Pubmed/Medline和GoogleScholar，以查找2020年1月至2022年11月之间发表的文章。然后，我们使用了SWIFT-Review(SciomeLLC，北卡罗来纳州,美国),用于系统审查的文本挖掘工作台，将1383篇文章分类为MeSH层次树代码，用于神经系统各个部分的文章，比如中枢神经系统，周围神经系统,自主神经系统,神经肌肉接头，感官系统，和肌肉骨骼系统.最后,我们回顾了全文152篇文章。SARS-CoV-2RNA已在多个大脑区域发现，没有任何组织病理学变化。尽管没有体内病毒体或病毒感染的细胞，中枢神经系统炎症已被报道，尤其是嗅球和脑干.SARS-CoV-2基因组和蛋白质已在受影响的个体脑组织中发现，但在这些病例中很少发现相应的神经病理变化。此外,在SARS-CoV-2感染后，神经系统患者的CSF中很少能鉴定出病毒RNA。大多数具有神经系统症状的患者在神经系统中没有活跃的病毒复制，并且很少具有病毒性CNS感染的典型临床和实验室特征。内皮病和SARS-CoV-2感染的全身炎症反应在神经COVID-19的发展中起关键作用，促炎细胞因子释放介导两种病理途径。全身性炎症介质可能通过血脑屏障激活星形胶质细胞和小胶质细胞，间接影响CNS特异性免疫激活和组织损伤。管理根据合并症和神经系统疾病而有所不同。
