背景:严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的临床表现范围从轻度或中度疾病(80%的病例)到需要氧气支持的严重疾病(15%),和危重疾病(5%),与急性呼吸窘迫综合征和重症监护病房(ICU)有关。在危重病人,俯卧定位可用于优化氧合。尽管这一战略得到了积极的回应,作为拯救生命的措施,可能会出现其他相关并发症,包括压迫性神经病.尽管呼吸道感染更常见,SARS-CoV-2感染也可以攻击其他系统,在一定条件下,影响中枢或周围神经系统。已经描述了神经系统表现可能是由SARS-CoV-2的神经侵入特性引起的,或者是多器官功能障碍的间接后果。
目的:我们打算报告与2019年冠状病毒病(COVID-19)相关的神经系统并发症和/或其治疗并发症的患者,紧随其后的是我们的物理和康复医学(PRM)服务。
方法:对2020年4月至2021年11月(感染率最高的时期)在COVID-19后状态下接受门诊咨询的PRM病房患者进行了回顾性分析。确定了SARS-CoV-2感染后出现神经系统并发症并因此导致先前功能下降的患者。
结果:进入PRM病房的13例患者(23.6%)患有周围神经并发症,由神经肌电图记录,包括格林-巴利综合征,感觉运动多发性神经病,腓骨神经损伤,股神经损伤,和腰丛损伤.还评估了在COVID-19后咨询中随访的患者的神经系统并发症。8名患者(20%)报告了神经系统后遗症。五名患者出现周围神经损伤(腓骨,附件,尺骨,和喉返)病因不明,住院急性期后诊断。2例患者出现COVID-19感染,随后出现缺血性卒中(椎基底动脉和大脑中动脉),在急性期需要住院治疗。一名患者感染COVID-19,随后出现纵向脊髓炎,抗髓鞘少突胶质细胞糖蛋白(MOG)阳性。所有患者都需要康复小组的随访,部分恢复了缺陷。
结论:所有进入PRM病房的神经系统表现的患者均患有危重疾病,症状与周围神经系统受累相符。接受PRM咨询的患者的病毒性疾病严重程度不同,并且有与周围和中枢神经系统疾病有关的后遗症。确定这些伤害的病因对于我们采取行动预防它们至关重要,特别是关于间接并发症,比如压缩性神经病。有必要保持对这些患者的随访,以了解与COVID-19相关的神经系统后果的演变。
BACKGROUND: The clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can range from mild or moderate disease (80% of the cases) to severe disease (15%) requiring oxygen support, and critical disease (5%), associated with acute respiratory distress syndrome and admission to the intensive care unit (ICU). In critically ill patients, prone positioning can be used to optimize oxygenation. Although there is a favourable response to this strategy, being a life-saving measure, additional associated complications may appear, including compressive neuropathies. Despite respiratory affection being more common, SARS-CoV-2 infection can also attack other systems and can, under certain conditions, affect the central or peripheral nervous system. It has been described that neurological manifestations can result from the neuroinvasive properties of the SARS-CoV-2 or as an indirect consequence of multiorgan dysfunction.
OBJECTIVE: We intend to report the patients who presented with neurological complications associated with coronavirus disease 2019 (COVID-19) and/or complications of its treatment, followed in our physical and rehabilitation medicine (PRM) service.
METHODS: A retrospective analysis of patients admitted to the PRM ward with outpatient consultation in the context of post-COVID-19 status between April 2020 and November 2021 (the period of the highest prevalence of infection) was carried out. Patients with neurological complications after SARS-CoV-2 infection and consequently a decline in previous functionality were identified.
RESULTS: Thirteen patients (23.6%) admitted to the PRM ward had peripheral neurological complications, documented by electroneuromyography, including Guillain-Barré syndrome, sensory-motor polyneuropathy, peroneal nerve injury, femoral nerve injury, and lumbar plexus injury. The neurological complications of the patients followed in a post-COVID-19 consultation were also evaluated. Eight patients (20%) reported neurological sequelae. Five patients presented peripheral nerve damage (peroneal, accessory, ulnar, and recurrent laryngeal) of undefined aetiology, diagnosed after the acute phase of hospitalization. Two patients had COVID-19 infection followed by ischemic stroke (vertebrobasilar and middle cerebral artery), requiring hospitalization in the acute phase. One patient had COVID-19 infection followed by longitudinal myelitis, with positive anti-myelin oligodendrocyte glycoprotein (MOG). All patients required follow-up by the rehabilitation team with partial recovery of deficits.
CONCLUSIONS: All patients admitted to the PRM ward with neurological manifestations had critical disease and symptoms compatible with peripheral nervous system involvement. Patients admitted to the PRM consultation had different levels of viral disease severity and had sequelae related to peripheral and central nervous system disorders. Identifying the aetiology of these injuries is essential for us to act on their prevention, particularly with regard to indirect complications, such as compressive neuropathies. It will be necessary to maintain the follow-up of these patients to understand the evolution of the neurological consequences associated with COVID-19.