背景:COVID-19患者可以以头痛的形式出现神经系统表现,头晕,失足,肌痛,周围神经病变,急性脑血管病,和脑病。神经参与可能是由于病毒引起的脑缺氧,脑部感染,或免疫反应。我们旨在描述COVID-19患者的神经系统表现,并研究他们的神经影像学发现和疾病转归。
方法:这项研究是单中心的,回顾性,谢赫沙克布特医疗城(SSMC)的观察性研究,阿布扎比,阿联酋。纳入2020年3月至5月间诊断为COVID-19的患者,这些患者具有神经病理学特征,有或没有COVID-19的呼吸道表现。电子记录被研究了年龄,性别,住院时间,详细的神经表现,COVID-19,炎症标志物的病史或有记录的伴随发热和呼吸道特征,神经影像学,进展,和疾病结果。
结果:10个民族的33例患者出现神经系统表现。平均(范围)年龄为51.4(21-86)岁。24人有合并症,和18没有先前或伴随的呼吸道症状。10例患者出现脑病并表现出行为/感觉改变:7例出现肌炎,8有中风,和4例癫痫发作,4例周围神经和颅神经受累。平均(平均)住院时间为11.4天(1-38),在中风患者中观察到最长。15例患者(45%)死亡,3例(9%)残留无力。血清铁蛋白,CRP,在严重疾病组中,降钙素原较高,且与死亡风险相关.22张脑部图像中有12张显示异常,包括出血,梗塞,小血管缺血,和水肿。年龄较大的死亡风险较高,但根据潜在的神经病理学没有差异。
结论:出现神经系统受累的COVID-19患者有更高的死亡风险,年龄较大和较高的炎症标志物会加重死亡风险。神经病理学的类型似乎并不影响死亡的风险。
BACKGROUND: COVID-19 patients can present with neurological manifestations in the form of headache, dizziness, hyposmia, myalgia, peripheral neuropathy, acute cerebrovascular disease, and encephalopathy. Neurological involvement could be due to virus-induced brain hypoxia, brain infection, or immune reaction. We aim to describe the neurological presentation of COVID-19 patients and study their neuroimaging findings and disease outcome.
METHODS: The study is a single-centre, retrospective, observational study in Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, UAE. Patients diagnosed with COVID-19 between March and May 2020 who presented with neuropathological features with or without respiratory manifestations of COVID-19 were enrolled. Electronic records were studied for age, sex, duration of hospitalization, detailed neurological presentation, history or documented concomitant fever and respiratory features of COVID-19, inflammatory markers, neuroimaging, progress, and disease outcome.
RESULTS: Thirty-three patients of 10 nationalities presented with neurological manifestations. Mean (range) age was 51.4 (21-86) years. Twenty-four had comorbidities, and 18 had no prior or concomitant respiratory symptoms. Ten patients presented with encephalopathy and exhibited altered behavior/sensorium: 7 presented with myositis, 8 with stroke, and 4 with seizures, and 4 had peripheral and cranial nerve involvement. The mean (average) duration of hospital stay was 11.4 days (1-38) with the longest observed in stroke patients. Fifteen patients (45%) died and 3 (9%) had residual weakness. Serum ferritin, CRP, and procalcitonin were higher in the severe disease group and correlated with risk of death. Twelve of 22 brain images showed abnormalities including haemorrhage, infarcts, small vessel ischemia, and oedema. Risk of death was higher in older age but did not differ based on the underlying neuropathology.
CONCLUSIONS: COVID-19 patients who present with neurological involvement have a higher risk of mortality which is aggravated by older age and higher inflammatory markers. The type of neurological pathology does not seem to influence the risk of mortality.