背景:与SARS-CoV-2感染相关的神经系统疾病是一项临床挑战,因为它们涵盖了广泛的神经系统,并且可能在诊断COVID-19之前发生。
方法:在这个单中心回顾性病例系列中,在2020年3月15日至5月15日期间,收集了来自巴黎地区学术中心医学部的SARS-CoV-2感染相关急性神经系统疾病患者的医疗记录.SARS-CoV-2的诊断是通过鼻咽拭子中的特异性RT-PCR或基于循环血清IgG抗体来确定的。
结果:26例被诊断为SARS-CoV-2感染的患者出现神经系统疾病:脑炎(N=8),脑病(N=6),脑血管事件(缺血性卒中N=4和静脉血栓形成N=2),其他中枢神经系统(CNS)疾病(N=4),和格林-巴利综合征(N=2)。SARS-CoV-2的诊断在神经系统疾病发作后平均延迟1.6天,特别是在脑炎3.9天的情况下,脑病1.0天,和脑血管事件2.7天。
结论:我们的研究证实,COVID-19可以产生广泛的神经系统疾病。由于COVID-19的神经系统表现通常发生在SARS-COV-2感染诊断前几天,临床医生应采取预防措施,如病人隔离和任何新入院的口罩,以避免医院感染。RT-PCR中的抗SARS-CoV2抗体检测SARSCoV-2阴性疑似病例有助于后验确认非典型COVID-19表现的诊断。
BACKGROUND: Neurological disorders associated with SARS-CoV-2 infection represent a clinical challenge because they encompass a broad neurological spectrum and may occur before the diagnosis of COVID-19.
METHODS: In this monocentric retrospective
case series, medical records from patients with acute neurological disorders associated with SARS-CoV-2 infection from medicine departments of an academic center in Paris area were collected between March 15th and May 15th 2020. Diagnosis of SARS-CoV-2 was ascertained through specific RT-PCR in nasopharyngeal swabs or based on circulating serum IgG antibodies.
RESULTS: Twenty-six patients diagnosed with SARS-CoV-2 infection presented with neurological disorders: encephalitis (N=8), encephalopathy (N=6), cerebrovascular events (ischemic strokes N=4 and vein thromboses N=2), other central nervous system (CNS) disorders (N=4), and Guillain-Barré syndrome (N=2). The diagnosis of SARS-CoV-2 was delayed on average 1.6 days after the onset of neurological disorder, especially in
case of encephalitis 3.9 days, encephalopathy 1.0 day, and cerebrovascular event 2.7 days.
CONCLUSIONS: Our study confirms that COVID-19 can yield a broad spectrum of neurological disorders. Because neurological presentations of COVID-19 often occur a few days before the diagnosis of SARS-COV-2 infection, clinicians should take preventive measures such as patient isolation and masks for any new admission to avoid nosocomial infections. Anti-SARS-CoV2 antibody detection in RT-PCR SARS CoV-2 negative suspected cases is useful to confirm a posteriori the diagnosis of atypical COVID-19 presentations.