Kim Jee Eun, Heo Jae Hyeok, Kim Hye Ok, Song Sook Hee, Park Sang Soon, Park Tai Hwan, Ahn Jin Young, Kim Min Ky, Choi Jae Phil
Department of Neurology, Seoul Medical Center, Seoul, Korea.
Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea.
J Clin Neurol. 2017 Jul;13(3):227-233. doi: 10.3988/jcn.2017.13.3.227.
Middle East respiratory syndrome (MERS) has a high mortality rate and pandemic potential. However, the neurological manifestations of MERS have rarely been reported since it first emerged in 2012.
We evaluated four patients with laboratory-confirmed MERS coronavirus (CoV) infections who showed neurological complications during MERS treatment. These 4 patients were from a cohort of 23 patients who were treated at a single designated hospital during the 2015 outbreak in the Republic of Korea. The clinical presentations, laboratory findings, and prognoses are described.
Four of the 23 admitted MERS patients reported neurological symptoms during or after MERS-CoV treatment. The potential diagnoses in these four cases included Bickerstaff's encephalitis overlapping with Guillain-Barré syndrome, intensive-care-unit-acquired weakness, or other toxic or infectious neuropathies. Neurological complications did not appear concomitantly with respiratory symptoms, instead being delayed by 2-3 weeks.
Neuromuscular complications are not rare during MERS treatment, and they may have previously been underdiagnosed. Understanding the neurological manifestations is important in an infectious disease such as MERS, because these symptoms are rarely evaluated thoroughly during treatment, and they may interfere with the prognosis or require treatment modification.
中东呼吸综合征（MERS）死亡率高且具有大流行潜力。然而，自2012年首次出现以来，MERS的神经学表现鲜有报道。
我们评估了4例经实验室确诊的中东呼吸综合征冠状病毒（CoV）感染患者，这些患者在MERS治疗期间出现了神经并发症。这4例患者来自2015年韩国爆发疫情期间在一家指定医院接受治疗的23例患者队列。描述了其临床表现、实验室检查结果及预后。
23例入院的MERS患者中有4例在MERS-CoV治疗期间或之后出现神经症状。这4例患者的潜在诊断包括与吉兰-巴雷综合征重叠的比克斯特费尔德脑炎、重症监护病房获得性肌无力或其他中毒性或感染性神经病。神经并发症并非与呼吸道症状同时出现，而是延迟2至3周出现。
MERS治疗期间神经肌肉并发症并不罕见，且此前可能未得到充分诊断。了解神经学表现对于MERS等传染病很重要，因为这些症状在治疗期间很少得到全面评估，可能会干扰预后或需要调整治疗方案。
