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1.
Artigo em Inglês | MEDLINE | ID: mdl-32730915

RESUMO

In December 2019, the first case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) infection was reported. In only few weeks it has caused a global pandemic, with mortality reaching 3.4%, mostly due to a severe pneumonia. However, the impact of SARS-CoV-2 virus on the central nervous system (CNS) and mental health outcomes remains unclear. Previous studies have demonstrated the presence of other types of coronaviruses in the brain, especially in the brainstem. There is evidence that the novel coronavirus can penetrate CNS through the olfactory or circulatory route as well as it can have an indirect impact on the brain by causing cytokine storm. There are also first reports of neurological signs in patients infected by the SARS-Cov-2. They show that COVID-19 patients have neurologic manifestations like acute cerebrovascular disease, conscious disturbance, taste and olfactory disturbances. In addition, there are studies showing that certain psychopathological symptoms might appear in infected patients, including those related to mood and psychotic disorders as well as post-traumatic stress disorder. Accumulating evidence also indicates that the pandemic might have a great impact on mental health from the global perspective, with medical workers being particularly vulnerable. In this article, we provide a review of studies investigating the impact of the SARS-CoV-2 on the CNS and mental health outcomes. We describe neurobiology of the virus, highlighting the relevance to mental disorders. Furthermore, this article summarizes the impact of the SARS-CoV-2 from the public health perspective. Finally, we present a critical appraisal of evidence and indicate future directions for studies in this field.


Assuntos
Infecções por Coronavirus/psicologia , Transtornos Mentais/psicologia , Saúde Mental , Pneumonia Viral/psicologia , Betacoronavirus , Encéfalo/virologia , Infecções por Coronavirus/complicações , Humanos , Transtornos Mentais/complicações , Transtornos Mentais/etiologia , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Resultado do Tratamento
2.
Biomedica ; 40(Supl. 2): 173-179, 2020 10 30.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33152201

RESUMO

Coronaviruses cause respiratory and gastrointestinal disorders in animals and humans. The current SARS-CoV-2, the COVID-19 infectious agent, belongs to a subgroup called betacoronavirus including the SARS-CoV and MERS-CoV responsible for epidemics in 2002 and 2012, respectively. These viruses can also infect the nervous system due to their affinity for the human angiotensin-converting enzyme 2 (ACE2) expressed in neurons and glial cells. Infections with SARS-CoV, MERS-CoV, and now SARS-CoV-2 also produce neurological signs such as acute cerebrovascular disease, impaired consciousness, and muscle injury, as well as dizziness, hypogeusia, hyposmia, hypoxia, neuralgia, and hypoxic encephalopathy. For this reason, close attention should be paid to the neurological manifestations of COVID-19 patients.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Coronavírus da Síndrome Respiratória do Oriente Médio/patogenicidade , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Vírus da SARS/patogenicidade , Síndrome Respiratória Aguda Grave/complicações , Líquido Cefalorraquidiano/virologia , Transtornos Cerebrovasculares/etiologia , Transtornos da Consciência/etiologia , Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Previsões , Humanos , Doenças Musculoesqueléticas/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Síndrome do Desconforto Respiratório do Adulto/etiologia , Transtornos das Sensações/etiologia , Síndrome Respiratória Aguda Grave/epidemiologia , Latência Viral
3.
Brain Nerve ; 72(10): 1061-1065, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33051393

RESUMO

The pathomechanisms of central nervous system disorders associated with COVID-19 remain unsolved. It is therefore imperative to carry out pathologic, virologic, and molecular analyses of the human brain tissue to understand the neurological manifestations of COVID-19. However, autopsy of COVID-19 poses challenges in terms of infection control. In this short review, the neuropathologic findings of individuals with COVID-19 were summerised and a possible autopsy methodologies to investigate these further were proposed.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Doenças do Sistema Nervoso , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Humanos , Doenças do Sistema Nervoso/etiologia , Neuropatologia , Pneumonia Viral/complicações
4.
PLoS One ; 15(9): e0238159, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32915818

RESUMO

BACKGROUND: COVID-19 is a pandemic disease and questions rise about the coronavirus 2 (Sars-CoV-2) effect on nervous system. This involvement could help explaining the pathogenesis of this condition and lead to novel therapeutic approaches. OBJECTIVE: To assess the occurrence of neurological symptoms in COVID-19 patients during the Italian pandemic outbreak, as reported by physicians. MATERIALS AND METHODS: In the early days of pandemic emergence we developed an online survey open to all Italian clinicians involved in the diagnosis and management of COVID-19 patients. The survey was structured in three sections, with nine different items concerning the presence of different specific clinical abnormalities. Each item was graded from "absent" to "severe" in a 4-point Likert's scale. MAIN OUTCOMES AND MEASURES: Likert's scale data were analyzed by studying the distribution of responses by using medians and bar charts-relative frequencies. Also, in order to analyze differences in symptoms findings depending on the group of specialty, Likert's scale data were combined into two nominal categories ("absent"/"low" and "moderate"/"high"/") and a contingency table chi-square test was used. RESULTS: 126 physicians of 9 different medical specialties, from 10 regions of Italy, filled the online survey. The results show that 87.3% of practitioners reported neurological symptoms. In most cases these were mild and non-specific, but they were severe in a minority of patients. The most common symptoms observed were headache, myalgia and taste and smell abnormalities. Whilst there was no difference between neurologists and non-neurologists, we found that experienced clinicians (defined as clinicians that evaluated more than 30 patients) reported neurological symptoms more frequently than non-expert. CONCLUSIONS: Neurological symptoms have frequently been ported during the Italian COVID-19 pandemic, and thus should be monitored for all affected patients. Whilst some of the disturbances reported may be non-specific and common to other infectious diseases, smell and taste abnormalities might indicate nervous system as entry door for SARS-CoV-2 virus. This interpretation should promote research trials to avoid nervous system involvement.


Assuntos
Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/epidemiologia , Médicos/estatística & dados numéricos , Pneumonia Viral/complicações , Inquéritos e Questionários/estatística & dados numéricos , Infecções por Coronavirus/patologia , Humanos , Incidência , Itália , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/patologia , Pandemias , Pneumonia Viral/patologia , Olfato , Paladar
5.
Medicine (Baltimore) ; 99(36): e21428, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898993

RESUMO

INTRODUCTION: Coronavirus disease (COVID-19) is spreading worldwide. The reported possible neurological symptoms are varied and range from subtle neurologic deficits to unconsciousness. Knowledge regarding the detection, diagnosis, treatment, and follow-up of COVID-19-associated neurological damage is still limited. We report a case of serious neurological damage and mental abnormalities in a patient who was finally confirmed to have COVID-19 based on IgM and IgG antibodies in the cerebrospinal fluid (CSF). PATIENT CONCERNS: A 68-year-old man had slight flu-like symptoms and transient loss of consciousness in early February. Exaggerated unconsciousness and deteriorating mental abnormalities occurred over the next month without severe respiratory symptoms. Craniocerebral computed tomography showed normal results, but antibodies against severe acute respiratory syndrome coronavirus 2 were 100 times higher in the CSF than in the serum; tests for viral ribonucleic acid showed negative results with both a nasopharyngeal swab and CSF sample. DIAGNOSIS: COVID-19 pneumonia was diagnosed based on symptoms and positive results for IgM and IgG in the CSF. INTERVENTIONS: Antiviral, fluid, and nutritional support were administered for 30 days before admission without obvious improvement. A further 18 days of routine antiviral therapy, immunoglobulin therapy (10 g per day for 5 days), and antipsychotic drug treatment were administered. OUTCOMES: The patient's neurological and mental abnormalities were greatly ameliorated. He was discharged with mild irritability, slight shaking of the hands, and walking fatigue. These symptoms have persisted up to our last follow-up (May 4, 2020). CONCLUSION: We believe this is the first case involving neural system injury in a patient who confirmed COVID-19 based on CSF antibody test results. Negative ribonucleic acid test results, strong positivity for antibodies, and high protein levels in the CSF suggest the possibility of autoimmune encephalitis secondary to COVID-19. This case highlights additional novel symptoms of COVID-19, and these data are important for the assessment and follow-up of COVID-19 patients.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/imunologia , Transtornos Mentais/etiologia , Doenças do Sistema Nervoso/etiologia , Pneumonia Viral/complicações , Pneumonia Viral/imunologia , Idoso , Antivirais/uso terapêutico , Betacoronavirus , Infecções por Coronavirus/líquido cefalorraquidiano , Infecções por Coronavirus/terapia , Humanos , Imunização Passiva/métodos , Imunoglobulina G/líquido cefalorraquidiano , Imunoglobulina M/líquido cefalorraquidiano , Masculino , Pandemias , Pneumonia Viral/líquido cefalorraquidiano , Pneumonia Viral/terapia
6.
J Neurol Sci ; 417: 117085, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-32871412

RESUMO

INTRODUCTION: Coronavirus disease-19 (COVID-19) pandemic continues to grow all over the world. Several studies have been performed, focusing on understanding the acute respiratory syndrome and treatment strategies. However, there is growing evidence indicating neurological manifestations occur in patients with COVID-19. Similarly, the other coronaviruses (CoV) epidemics; severe acute respiratory syndrome (SARS-CoV-1) and Middle East respiratory syndrome (MERS-CoV) have been associated with neurological complications. METHODS: This systematic review serves to summarize available information regarding the potential effects of different types of CoV on the nervous system and describes the range of clinical neurological complications that have been reported thus far in COVID-19. RESULTS: Two hundred and twenty-five studies on CoV infections associated neurological manifestations in human were reviewed. Of those, 208 articles were pertinent to COVID-19. The most common neurological complaints in COVID-19 were anosmia, ageusia, and headache, but more serious complications, such as stroke, impairment of consciousness, seizures, and encephalopathy, have also been reported. CONCLUSION: There are several similarities between neurological complications after SARS-CoV-1, MERS-CoV and COVID-19, however, the scope of the epidemics and number of patients are very different. Reports on the neurological complications after and during COVID-19 are growing on a daily basis. Accordingly, comprehensive knowledge of these complications will help health care providers to be attentive to these complications and diagnose and treat them timely.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Transtornos da Consciência/etiologia , Doenças dos Nervos Cranianos/etiologia , Encefalite Viral/etiologia , Humanos , Imagem por Ressonância Magnética , Doenças Musculares/etiologia , Neuroimagem , Doenças do Sistema Nervoso Periférico/etiologia , Convulsões/etiologia , Síndrome Respiratória Aguda Grave/complicações , Acidente Vascular Cerebral/etiologia
7.
Mol Neurobiol ; 57(12): 5263-5275, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32869183

RESUMO

Similar to its predecessors, coronavirus disease 2019 (COVID-19) exhibits neurotrophic properties, which lead to progression of neurologic sequelae. Besides direct viral invasion to the central nervous system (CNS), indirect CNS involvement through viral-mediated immune response is plausible. Aberrant immune pathways such as extreme release of cytokines (cytokine storm), autoimmunity mediated by cross-reactivity between CNS components and viral particles, and microglial activation propagate CNS damage in these patients. Here, we review the currently available evidence to discuss the plausible immunologic pathways that may contribute to the development of COVID-19 neurological complications, namely Alzheimer's disease, Parkinson's disease, stroke, multiple sclerosis, Guillain-Barre syndrome, seizure, and brainstem involvement.


Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Animais , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Tronco Encefálico/fisiopatologia , Tronco Encefálico/virologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/imunologia , Efeito Citopatogênico Viral , Surtos de Doenças , Síndrome de Guillain-Barré/etiologia , Síndrome de Guillain-Barré/imunologia , Humanos , Camundongos , Esclerose Múltipla/etiologia , Esclerose Múltipla/imunologia , Proteínas do Tecido Nervoso/fisiologia , Doenças do Sistema Nervoso/imunologia , Doenças Neurodegenerativas/etiologia , Doenças Neurodegenerativas/imunologia , Neuroglia/patologia , Neuroglia/virologia , Neurônios/patologia , Neurônios/virologia , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/imunologia , Receptores Virais/fisiologia , Insuficiência Respiratória/etiologia , Insuficiência Respiratória/fisiopatologia , Convulsões/etiologia , Convulsões/imunologia , Síndrome Respiratória Aguda Grave/complicações , Síndrome Respiratória Aguda Grave/epidemiologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/imunologia
8.
J Neurosci Res ; 98(12): 2376-2383, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32869376

RESUMO

Manifestation of neurological symptoms in certain patients of coronavirus disease-2019 (COVID-19) has warranted for their virus-induced etiogenesis. SARS-CoV-2, the causative agent of COVID-19, belongs to the genus of betacoronaviruses which also includes SARS-CoV-1 and MERS-CoV; causative agents for severe acute respiratory syndrome (SARS) in 2002 and Middle East respiratory syndrome (MERS) in 2012, respectively. Studies demonstrating the neural invasion of SARS-CoV-2 in vivo are still scarce, although such characteristics of certain other betacoronaviruses are well demonstrated in the literature. Based on the recent evidence for the presence of SARS-CoV-2 host cell entry receptors in specific components of the human nervous and vascular tissue, a neural (olfactory and/or vagal), and a hematogenous-crossing the blood-brain barrier, routes have been proposed. The neurological symptoms in COVID-19 may also arise as a consequence of the "cytokine storm" (characteristically present in severe disease) induced neuroinflammation, or co-morbidities. There is also a possibility that, there may be multiple routes of SARS-CoV-2 entry into the brain, or multiple mechanisms can be involved in the pathogenesis of the neurological symptoms. In this review article, we have discussed the possible routes of SARS-CoV-2 brain entry based on the emerging evidence for this virus, and that available for other betacoronaviruses in literature.


Assuntos
Betacoronavirus/metabolismo , Barreira Hematoencefálica/metabolismo , Encéfalo/metabolismo , Infecções por Coronavirus/metabolismo , Doenças do Sistema Nervoso/metabolismo , Nervo Olfatório/metabolismo , Pneumonia Viral/metabolismo , Animais , Barreira Hematoencefálica/virologia , Encéfalo/virologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/transmissão , Humanos , Doenças do Sistema Nervoso/etiologia , Nervo Olfatório/virologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/transmissão
9.
JAMA ; 324(11): 1058-1067, 2020 09 15.
Artigo em Inglês | MEDLINE | ID: mdl-32930759

RESUMO

Importance: There is wide variability among emergency medical systems (EMS) with respect to transport to hospital during out-of-hospital cardiac arrest (OHCA) resuscitative efforts. The benefit of intra-arrest transport during resuscitation compared with continued on-scene resuscitation is unclear. Objective: To determine whether intra-arrest transport compared with continued on-scene resuscitation is associated with survival to hospital discharge among patients experiencing OHCA. Design, Setting, and Participants: Cohort study of prospectively collected consecutive nontraumatic adult EMS-treated OHCA data from the Resuscitation Outcomes Consortium (ROC) Cardiac Epidemiologic Registry (enrollment, April 2011-June 2015 from 10 North American sites; follow-up until the date of hospital discharge or death [regardless of when either event occurred]). Patients treated with intra-arrest transport (exposed) were matched with patients in refractory arrest (at risk of intra-arrest transport) at that same time (unexposed), using a time-dependent propensity score. Subgroups categorized by initial cardiac rhythm and EMS-witnessed cardiac arrests were analyzed. Exposures: Intra-arrest transport (transport initiated prior to return of spontaneous circulation), compared with continued on-scene resuscitation. Main Outcomes and Measures: The primary outcome was survival to hospital discharge, and the secondary outcome was survival with favorable neurological outcome (modified Rankin scale <3) at hospital discharge. Results: The full cohort included 43 969 patients with a median age of 67 years (interquartile range, 55-80), 37% were women, 86% of cardiac arrests occurred in a private location, 49% were bystander- or EMS-witnessed, 22% had initial shockable rhythms, 97% were treated by out-of-hospital advanced life support, and 26% underwent intra-arrest transport. Survival to hospital discharge was 3.8% for patients who underwent intra-arrest transport and 12.6% for those who received on-scene resuscitation. In the propensity-matched cohort, which included 27 705 patients, survival to hospital discharge occurred in 4.0% of patients who underwent intra-arrest transport vs 8.5% who received on-scene resuscitation (risk difference, 4.6% [95% CI, 4.0%- 5.1%]). Favorable neurological outcome occurred in 2.9% of patients who underwent intra-arrest transport vs 7.1% who received on-scene resuscitation (risk difference, 4.2% [95% CI, 3.5%-4.9%]). Subgroups of initial shockable and nonshockable rhythms as well as EMS-witnessed and unwitnessed cardiac arrests all had a significant association between intra-arrest transport and lower probability of survival to hospital discharge. Conclusions and Relevance: Among patients experiencing out-of-hospital cardiac arrest, intra-arrest transport to hospital compared with continued on-scene resuscitation was associated with lower probability of survival to hospital discharge. Study findings are limited by potential confounding due to observational design.


Assuntos
Reanimação Cardiopulmonar/métodos , Serviços Médicos de Emergência , Parada Cardíaca Extra-Hospitalar/terapia , Transporte de Pacientes , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Alta do Paciente , Pontuação de Propensão , Análise de Sobrevida
10.
Clin Neurol Neurosurg ; 197: 106173, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32877769

RESUMO

People with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, COVID-19, can have neurological problems including headache, anosmia, dysgeusia, altered mental status (AMS), ischemic stroke with or without large vessel occlusion, and Guillen-Barre Syndrome. Louisiana was one of the states hit hardest by the pandemic with just over 57,000 laboratory-confirmed cases of COVID-19 by the end of June 2020. We reviewed the electronic medical records (EMR) of patients hospitalized during the peak of the pandemic, March 1st through March 31st, to document the type and frequency of neurological problems seen in patients with COVID-19 at presentation to the emergency room. Secondary aims were to determine: 1) the frequency of neurological complaints during the hospital stay; 2) whether the presence of any neurological complaint at presentation or any of the individual types of neurological complaints at admission predicted three separate outcomes: death, length of hospital stay, or the need for intubation; and 3) if the presence of any neurological complaint or any of the individual types of neurological complaints developed during hospital stay predicted the previous three outcomes. A large proportion of our sample (80 %) was African American and had hypertension (79 %). Out of 250 patients, 56 (22 %) patients died, and 72 (29 %) patients required intubation. Thirty-four (14 %) had a neurological chief complaint at presentation; the most common neurological chief complaints in the entire sample were altered mental status (AMS) (8 %), headache (2 %), and syncope (2 %). We used a competing risk model to determine whether neurological symptoms at presentation or during hospital stay were predictors of prolonged hospital stay and death. To establish whether neurological symptoms were associated with higher odds of intubation, we used logistic regression. Age was the only significant demographic predictor of death and hospital stay. The HR (95 %CI) for remaining in the hospital for a ten-year increase in age was 1.2, (1.1, 1.3, p < 0.0001), and for death was 1.3, (1.1, 1.5, p < 0.01). There were no demographic characteristics, including age or comorbidities predictive of intubation. Adjusting for age, patients who at presentation had neurological issues as their chief complaint were at significantly increased risk for remaining in the hospital, HR = 1.7, (1.1,2.5, p = 0.0001), and dying, HR = 2.1(1.1,3.8, p = 0.02), compared to patients without any neurological complaint. Of the individual admission complaints, AMS was associated with a significantly prolonged hospital stay, HR = 1.8, (1.0-3.3, p = 0.05). Patients that required dialysis or intubation or had AMS during hospitalization had more extended hospital stays. After adjusting for age, dialysis, and intubation, patients with AMS during hospital stay had a HR of 1.6, (1.1, 2.5, p = 0.01) for remaining in the hospital. Patients who had statistically significant higher odds of requiring intubation were those who presented with any neurological chief complaint, OR = 2.8 (1.3,5.8, p = 0.01), or with headaches OR = 13.3 (2.1,257.0, p = 0.008). Patients with AMS during the hospital stay, as well as those who had seizures, were more likely to need intubation. In the multivariate model, dialysis, OR = 4.9 (2.6,9.4, p < 0.0001), and AMS, OR = 8.8 (3.9,21.2, p < 0.0001), were the only independent predictors of intubation. Neurological complaints at presentation and during the hospital stay are associated with a higher risk of death, prolonged hospital stay, and intubation. More work is needed to determine whether the cause of the neurological complaints was direct CNS involvement by the virus or the other systemic complications of the virus.


Assuntos
Infecções por Coronavirus/fisiopatologia , Intubação Intratraqueal/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Doenças do Sistema Nervoso/fisiopatologia , Pneumonia Viral/fisiopatologia , Adulto , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/terapia , Serviço Hospitalar de Emergência , Grupo com Ancestrais do Continente Europeu , Feminino , Cefaleia/etiologia , Cefaleia/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Doenças do Sistema Nervoso/etiologia , Nova Orleans , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Pneumonia Viral/terapia , Prognóstico , Modelos de Riscos Proporcionais , Respiração Artificial , Convulsões/etiologia , Convulsões/fisiopatologia , Estado Epiléptico/etiologia , Estado Epiléptico/fisiopatologia , Acidente Vascular Cerebral/etiologia , Acidente Vascular Cerebral/fisiopatologia , Síncope/etiologia , Síncope/fisiopatologia
12.
Neurol Sci ; 41(10): 2671-2674, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32734396

RESUMO

INTRODUCTION: The relationship between dyspnea and COVID-19 is unknown. In COVID-19 patients, the higher prevalence of neurological symptoms and the lack of dyspnea may suggest common underlying pathogenetic mechanisms. The aim of this preliminary study is to address whether there is a lack of dyspnea in COVID-19 patients and if there is a relationship between neurological symptoms and the perception of dyspnea. METHODS: A structured interview regarding the occurrence of subjective neurological symptoms was performed and coupled with a questionnaire about the intensity and qualities of dyspnea. Respiratory rate (RR) and an arterial blood gas on room air were concurrently evaluated. RESULTS: Twenty-two patients (age 68.4 ± 13.9 years, 13 males and 9 females) were included and divided into two groups according to the Borg dyspnea scale: dyspneic patients BU ≥ 1(DYSP) and non-dyspneic patients BU < 1 (NDYSP). The prevalence of dyspnea overall was 31.8%. The prevalence of neurological symptoms, dyspnea descriptors, RR, pH, PaCO2, PaO2, or lactate was similar between groups. CONCLUSION: This study confirms that the prevalence of dyspnea is low in non-severe COVID-19 patients, but contrary to our hypothesis of a relationship between shortness of breath and neurological symptoms, we have not been able to find any evidence of an impairment in dyspnea perception, either in the DYSP or NDYSP group.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Autoavaliação Diagnóstica , Dispneia/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Percepção , Pneumonia Viral/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Gasometria/métodos , Gasometria/psicologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/psicologia , Dispneia/etiologia , Dispneia/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/psicologia , Pandemias , Pneumonia Viral/complicações , Pneumonia Viral/psicologia
13.
Arq Neuropsiquiatr ; 78(8): 494-500, 2020 08 03.
Artigo em Inglês | MEDLINE | ID: mdl-32756734

RESUMO

BACKGROUND: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. OBJECTIVE: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. METHODS: This retrospective study was carried out at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. RESULTS: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). CONCLUSIONS: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.


Assuntos
Infecções por Coronavirus/diagnóstico , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/diagnóstico , Encaminhamento e Consulta/estatística & dados numéricos , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Número de Leitos em Hospital , Hospitais Universitários , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Neurologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Estudos Retrospectivos
14.
Med Sci (Paris) ; 36(8-9): 775-782, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32755537

RESUMO

The recent emergence of a new coronavirus, SARS-CoV-2, responsible for COVID-19, is a new warning of the risk to public health represented by viral zoonoses and in particular by coronaviruses. Mainly described as being able to infect the upper and lower respiratory tract, coronaviruses can also infect the central and peripheral nervous systems as many other respiratory viruses, such as influenza or respiratory syncytial virus. Viral infections of the nervous system are a major public health concern as they can cause devastating illnesses up to death, especially when they occur in the elderly, who are more susceptible to these infections. Knowledge concerning the pathophysiology of recently emerging coronaviruses (MERS-CoV, SARS-CoV and SARS-CoV-2) and how they reach the central nervous system are very sketchy and the work in progress aims in particular to better understand their biology and the mechanisms associated with neurological damage. In this review we will discuss the current state of knowledge on the neurotropism of human coronaviruses and the associated mechanisms by developing in particular the latest data concerning SARS-CoV-2.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/complicações , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Animais , Transporte Biológico , Técnicas de Laboratório Clínico , Doenças Transmissíveis Emergentes , Coronaviridae/patogenicidade , Coronaviridae/fisiologia , Coronaviridae/ultraestrutura , Infecções por Coronaviridae/complicações , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/fisiopatologia , Humanos , Sistema Nervoso/virologia , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/terapia , Doenças do Sistema Nervoso/virologia , Especificidade de Órgãos , Pneumonia Viral/diagnóstico , Pneumonia Viral/fisiopatologia , Tropismo Viral , Virulência , Replicação Viral , Zoonoses
16.
Medicine (Baltimore) ; 99(34): e21783, 2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32846808

RESUMO

BACKGROUND: Scalp acupuncture is remarkable in improving neurological dysfunction of ischemic stroke patients. This study aims to systematically evaluate the efficacy and safety of scalp acupuncture in improving neurological dysfunction of ischemic stroke patients. METHODS: Randomized controlled trials of scalp acupuncture against ischemic stroke patients will be searched in PubMed, Web of Science, Embase, Cochrane Library, the Chongqing VIP Chinese Science and Technology Periodical Database, Chinese Biological and Medical database, China National Knowledge Infrastructure, and Wanfang database from inception to July, 2020. Two researchers will perform data extraction and risk of bias assessment independently. Statistical analysis will be conducted in RevMan 5.3. RESULTS: This study will summarize the present evidence by exploring the efficacy and safety of scalp acupuncture in improving neurological dysfunction in ischemic stroke patients. CONCLUSIONS: The findings of the study will help to determine potential benefits of scalp acupuncture against ischemic stroke at different stage. OSF REGISTRATION NUMBER: DOI 10.17605/OSF.IO/T26P8.


Assuntos
Terapia por Acupuntura/métodos , Doenças do Sistema Nervoso/terapia , Reabilitação do Acidente Vascular Cerebral/métodos , Acidente Vascular Cerebral/terapia , Terapia por Acupuntura/efeitos adversos , Isquemia Encefálica/complicações , Humanos , Metanálise como Assunto , Doenças do Sistema Nervoso/etiologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Projetos de Pesquisa , Couro Cabeludo , Acidente Vascular Cerebral/complicações , Revisões Sistemáticas como Assunto
17.
Rinsho Shinkeigaku ; 60(9): 631-635, 2020 Sep 29.
Artigo em Japonês | MEDLINE | ID: mdl-32779602

RESUMO

We report a 62-year-old female with rheumatoid meningitis. She presented with mental disorder, loss of consciousness, generalized seizures, and cognitive impairment. Brain MRI demonstrated high intensity lesions and abnormal enhancement along the left frontal and parietal sulci. Her serum and cerebrospinal fluid were positive for anti-cyclic citrullinated peptides (CCP) antibody, and the antibody index of cerebrospinal fluid anti-CCP antibody increased, which led us to suspect rheumatoid meningitis. Her symptoms improved immediately by methylpredonisolone pulse therapy and anti-CCP antibody turned negative in cerebrospinal fluid. However, she revealed arthritis with the reduction of betamethasone and was diagnosed as rheumatoid arthritis. We suggest that the elevation of antibody index of cerebrospinal fluid anti-CCP antibody is useful in the diagnosis of rheumatoid meningitis preceding neurological symptoms without arthritis, and anti-CCP antibody in cerebrospinal fluid may be helpful as the evaluation of the treatment.


Assuntos
Artrite Reumatoide/complicações , Artrite Reumatoide/diagnóstico , Autoanticorpos/líquido cefalorraquidiano , Meningite/diagnóstico , Meningite/etiologia , Doenças do Sistema Nervoso/etiologia , Peptídeos Cíclicos/imunologia , Artrite Reumatoide/tratamento farmacológico , Biomarcadores/líquido cefalorraquidiano , Feminino , Humanos , Meningite/tratamento farmacológico , Metilprednisolona/administração & dosagem , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/tratamento farmacológico , Pulsoterapia , Resultado do Tratamento
18.
Mol Neurobiol ; 57(12): 4921-4928, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32813238

RESUMO

The global pandemic of novel coronavirus disease 2019 (COVID-19) has taken the entire human race by surprise and led to an unprecedented number of mortalities worldwide so far. Current clinical studies have interpreted that angiotensin-converting enzyme 2 (ACE2) is the host receptor for severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2). In addition, ACE2 is the major component of the renin-angiotensin system. ACE2 deteriorates angiotensin II, a peptide that is responsible for the promotion of stroke. The downregulation of ACE2 further activates an immunological cascade. Thus, researchers need to explore and examine the possible links between COVID-19 and ischemic stroke (IS). Human ACE2 expression level and pattern in various tissues might be decisive for the vulnerability, symptoms, and treatment outcomes of the SARS-CoV-2 infection. The swift increase in the knowledge of SARS-CoV-2 has given creditable evidence that SARS-CoV-2 infected patients also encounter neurological deficits. As the SARS-CoV-2 binds to ACE2, it will hamper the activity of ACE2 in providing neuroprotection, especially in the case of stroke patients. Due to the downregulation of ACE2, the inflammatory response is activated in the ischemic penumbra. The COVID-19 pandemic has affected people with various pre-existing diseases, including IS, in such a way that these patients need special care and attention for their survival. Several clinical trials are currently ongoing worldwide as well as many other projects are in different stages of conceptualization and planning to facilitate the effective management of stroke patients with COVID-19 infection.


Assuntos
Betacoronavirus , Isquemia Encefálica/etiologia , Infecções por Coronavirus/fisiopatologia , Pandemias , Pneumonia Viral/fisiopatologia , Sistema Renina-Angiotensina/fisiologia , Acidente Vascular Cerebral/etiologia , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Barreira Hematoencefálica , Isquemia Encefálica/epidemiologia , Isquemia Encefálica/imunologia , Isquemia Encefálica/fisiopatologia , Quimiotaxia de Leucócito , Comorbidade , Infecções por Coronavirus/complicações , Infecções por Coronavirus/epidemiologia , Síndrome da Liberação de Citocina/etiologia , Síndrome da Liberação de Citocina/fisiopatologia , Citocinas/fisiologia , Encefalite Viral/complicações , Encefalite Viral/fisiopatologia , Hemodinâmica , Humanos , Inflamação , Modelos Imunológicos , Modelos Neurológicos , Insuficiência de Múltiplos Órgãos/etiologia , Insuficiência de Múltiplos Órgãos/fisiopatologia , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Peptidil Dipeptidase A/fisiologia , Pneumonia Viral/complicações , Pneumonia Viral/epidemiologia , Receptores Virais/fisiologia , Risco , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/imunologia , Acidente Vascular Cerebral/fisiopatologia
19.
Am J Emerg Med ; 38(9): 1760-1766, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32739845

RESUMO

BACKGROUND: This study intended to find out how association between response time interval (RTI) and good neurological outcome is affected by bystander CPR. We hypothesized that bystander CPR will ensure positive effect in relationship between RTI and clinical outcome. METHODS: A retrospective, observational study was made with Pan-Asian Resuscitation Outcome Study data from January 2009 to December 2016. Six cities from four Asian countries were selected. EMS-treated, non-traumatic witnessed out-of-hospital cardiac arrest (OHCA) cases were included. General demographic data, prehospital cardiac arrest details and clinical outcome were collected and analyzed according to whether bystander CPR was performed. Good neurological outcome and survival discharge were primary and secondary outcomes. RESULTS: A total of 13,245 OHCA cases were analyzed. Median EMS response time intervals were 6 min, regardless of bystander CPR. Dividing into RTI time range by 3 min, good neurological outcome and survival discharge were only significant in 3 to 6 minutes group (adjusted odds ratio [AOR] 1.42, 1.17-1.73 95% confidence interval [CI] and AOR 1.31, 1.15-1.51 95% CI) in non-bystander CPR group but in bystander CPR group significant RTI time range was 3 to 9 min (AOR 2.02, 1.82, 1.62-2.52, 1.48-2.25 95% CI for primary, AOR 1.66, 1.43, 1.41-1.96, 1.22-1.67 95% CI for secondary). CONCLUSIONS: As response time interval increased, slower deterioration of good neurological outcome and survival discharge was shown in cardiac arrest patients with bystander CPR performed. If bystander CPR is provided, RTI time range showing significant neurological outcome and survival improvement seems to be relatively lengthened.


Assuntos
Reanimação Cardiopulmonar , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/prevenção & controle , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/terapia , Tempo para o Tratamento , Idoso , Idoso de 80 Anos ou mais , Ásia , Serviços Médicos de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
20.
Intensive Care Med ; 46(10): 1863-1872, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32816098

RESUMO

PURPOSE: An ongoing outbreak of coronavirus disease 2019 (COVID-19) emerged in Wuhan since December 2019 and spread globally. However, information about critically ill patients with COVID-19 is still limited. We aimed to describe the clinical characteristics and outcomes of critically ill patients with COVID-19 and figure out the risk factors of mortality. METHODS: We extracted data retrospectively regarding 733 critically ill adult patients with laboratory-confirmed COVID-19 from 19 hospitals in China through January 1 to February 29, 2020. Demographic data, symptoms, laboratory values, comorbidities, treatments, and clinical outcomes were collected. The primary outcome was 28-day mortality. Data were compared between survivors and non-survivors. RESULTS: Of the 733 patients included in the study, the median (IQR) age was 65 (56-73) years and 256 (34.9%) were female. Among these patients, the median (IQR) APACHE II score was 10 (7 to 14) and 28-day mortality was 53.8%. Respiratory failure was the most common organ failure (597 [81.5%]), followed by shock (20%), thrombocytopenia (18.8%), central nervous system (8.6%) and renal dysfunction (8%). Multivariate Cox regression analysis showed that older age, malignancies, high APACHE II score, high D-dimer level, low PaO2/FiO2 level, high creatinine level, high hscTnI level and low albumin level were independent risk factors of 28-day mortality in critically ill patients with COVID-19. CONCLUSION: In this case series of critically ill patients with COVID-19 who were admitted into the ICU, more than half patients died at day 28. The higher percentage of organ failure in these patients indicated a significant demand for critical care resources.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/mortalidade , Estado Terminal , Unidades de Terapia Intensiva , Pneumonia Viral/complicações , Pneumonia Viral/mortalidade , Idoso , Betacoronavirus , China/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Surtos de Doenças , Feminino , Humanos , Nefropatias/epidemiologia , Nefropatias/etiologia , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Modelos de Riscos Proporcionais , Insuficiência Respiratória/epidemiologia , Insuficiência Respiratória/etiologia , Estudos Retrospectivos , Fatores de Risco , Choque/epidemiologia , Choque/etiologia , Trombocitopenia/epidemiologia , Trombocitopenia/etiologia
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