Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA.
Department of Neurosurgery, Tulane Medical Center, New Orleans, Louisiana, USA; Department of Neurosurgery, Ochsner Clinic Foundation, New Orleans, Louisiana, USA.
World Neurosurg. 2020 Jul;139:344-354. doi: 10.1016/j.wneu.2020.04.222. Epub 2020 May 6.
The coronavirus disease of 2019 (COVID-19), which is caused by infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has recently been designated a pandemic by the World Health Organization, affecting 2.7 million individuals globally as of April 25, 2020, with more than 187,000 deaths. An increasing body of evidence has supported central nervous system involvement.
We conducted a review of the reported data for studies concerning COVID-19 pathophysiology, neurological manifestations, and neuroscience provider recommendations and guidelines.
Central nervous system manifestations range from vague nonfocal complaints to severe neurological impairment associated with encephalitis. It is unclear whether the neurological dysfunction results from direct viral injury or systemic disease. The virus could affect brainstem pathways that lead to indirect respiratory dysfunction, in addition to direct pulmonary injury. Necessary adaptations in patient management, triage, and diagnosis are evolving in light of the ongoing scientific and clinical findings.
The present review has consolidated the current body of data regarding the neurological impact of coronaviruses, discussed the reported neurological manifestations of COVID-19, and highlighted the recommendations for patient management. Specific recommendations pertaining to clinical practice for neurologists and neurosurgeons have also been provided.
由严重急性呼吸系统综合征冠状病毒 2（SARS-CoV-2）感染引起的 2019 年冠状病毒病（COVID-19）最近被世界卫生组织（WHO）定为大流行，截至 2020 年 4 月 25 日，全球已有超过 270 万人受到影响，死亡人数超过 18.7 万。越来越多的证据支持涉及中枢神经系统的感染。
我们对有关 COVID-19 病理生理学、神经系统表现以及神经科医生建议和指南的报告数据进行了综述。
中枢神经系统表现从模糊的非局灶性症状到与脑炎相关的严重神经功能障碍不等。目前尚不清楚神经功能障碍是由病毒直接损伤还是全身疾病引起的。该病毒可能会影响导致间接呼吸功能障碍的脑干通路，除了直接的肺部损伤。根据正在进行的科学和临床发现，患者管理、分诊和诊断的必要调整正在不断发展。
本综述整合了有关冠状病毒对神经系统影响的现有数据，讨论了 COVID-19 的报告神经系统表现，并强调了患者管理的建议。还提供了针对神经科医生和神经外科医生的具体临床实践建议。
