Romero-Sánchez Carlos Manuel, Díaz-Maroto Inmaculada, Fernández-Díaz Eva, Sánchez-Larsen Álvaro, Layos-Romero Almudena, García-García Jorge, González Esther, Redondo-Peñas Inmaculada, Perona-Moratalla Ana Belén, Del Valle-Pérez José Antonio, Gracia-Gil Julia, Rojas-Bartolomé Laura, Feria-Vilar Inmaculada, Monteagudo María, Palao María, Palazón-García Elena, Alcahut-Rodríguez Cristian, Sopelana-Garay David, Moreno Yóscar, Ahmad Javaad, Segura Tomás
From the Department of Neurology, Complejo Hospitalario Universitario de Albacete, Castilla-La Mancha, Spain.
Neurology. 2020 Aug 25;95(8):e1060-e1070. doi: 10.1212/WNL.0000000000009937. Epub 2020 Jun 1.
The coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019. Neurologic symptoms have been reported as part of the clinical spectrum of the disease. We aimed to determine whether neurologic manifestations are common in hospitalized patients with COVID-19 and to describe their main characteristics.
We systematically reviewed all patients diagnosed with COVID-19 admitted to the hospital in a Spanish population during March 2020. Demographic characteristics, systemic and neurologic clinical manifestations, and complementary tests were analyzed.
Of 841 patients hospitalized with COVID-19 (mean age 66.4 years, 56.2% men), 57.4% developed some form of neurologic symptom. Nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were present mostly in the early stages of infection. Anosmia (4.9%) and dysgeusia (6.2%) tended to occur early (60% as the first clinical manifestation) and were more frequent in less severe cases. Disorders of consciousness occurred commonly (19.6%), mostly in older patients and in severe and advanced COVID-19 stages. Myopathy (3.1%), dysautonomia (2.5%), cerebrovascular diseases (1.7%), seizures (0.7%), movement disorders (0.7%), encephalitis (n = 1), Guillain-Barré syndrome (n = 1), and optic neuritis (n = 1) were also reported, but less frequent. Neurologic complications were the main cause of death in 4.1% of all deceased study participants.
Neurologic manifestations are common in hospitalized patients with COVID-19. In our series, more than half of patients presented some form of neurologic symptom. Clinicians need to maintain close neurologic surveillance for prompt recognition of these complications. The mechanisms and consequences of severe acute respiratory syndrome coronavirus type 2 neurologic involvement require further studies.
自2019年12月以来，2019冠状病毒病（COVID-19）已在全球范围内传播。神经系统症状已被报告为该疾病临床谱的一部分。我们旨在确定神经系统表现在COVID-19住院患者中是否常见，并描述其主要特征。
我们系统回顾了2020年3月期间西班牙人群中所有确诊为COVID-19并入院的患者。分析了人口统计学特征、全身和神经系统临床表现以及辅助检查。
在841例COVID-19住院患者中（平均年龄66.4岁，男性占56.2%），57.4%出现了某种形式的神经系统症状。非特异性症状如肌痛（17.2%）、头痛（14.1%）和头晕（6.1%）大多出现在感染早期。嗅觉丧失（4.9%）和味觉障碍（6.2%）往往较早出现（60%为首发临床表现），且在病情较轻的病例中更常见。意识障碍常见（19.6%），主要发生在老年患者以及COVID-19的重症和晚期阶段。还报告了肌病（3.1%）、自主神经功能障碍（2.5%）、脑血管疾病（1.7%）、癫痫发作（0.7%）、运动障碍（0.7%）、脑炎（1例）、吉兰-巴雷综合征（1例）和视神经炎（1例），但频率较低。神经系统并发症是所有死亡研究参与者中4.1%的主要死亡原因。
神经系统表现在COVID-19住院患者中很常见。在我们的系列研究中，超过一半的患者出现了某种形式的神经系统症状。临床医生需要密切进行神经系统监测，以便及时识别这些并发症。严重急性呼吸综合征冠状病毒2型神经系统受累的机制和后果需要进一步研究。
