Azim Dua, Nasim Sundus, Kumar Sohail, Hussain Azhar, Patel Sundip
Internal Medicine, Dow University of Health Sciences, Karachi, PAK.
Internal Medicine, Dow Medical College and Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK.
Cureus. 2020 Jun 24;12(6):e8790. doi: 10.7759/cureus.8790.
First identified in November 2019 in Hubei Province, the coronavirus disease of 2019 (COVID-19) caused by SARS-CoV-2 soon spread worldwide to become a global health pandemic. The COVID-19 preferentially damages the respiratory system that produces symptoms such as fever, cough, and shortness of breath. However, the infection often tends to disseminate to involve various organ systems. Recent evidence indicates that SARS-CoV-2 can cause significant neurological damage and resultant neurological symptoms and complications. Here, we provide a comprehensive and thorough review of original articles, case reports, and case series to delineate the possible mechanisms of nervous system invasion and damage by SARS-CoV-2 and subsequent consequences. We divided the neurological manifestations into three categories: (1) Central Nervous System involvement, (2) Peripheral Nervous System manifestations, and (3) Skeletal Muscle Injury. Headache and dizziness were found to be the most prevalent symptoms followed by impaired consciousness. Among the symptoms indicating peripheral nervous system invasion, anosmia and dysgeusia were commonly reported. Skeletal muscle injury predominantly presents as myalgia. In addition, encephalitis, myelitis, cerebrovascular disease, Guillain-Barre syndrome, and Miller Fischer syndrome were among the commonly noted complications. We also emphasized the association of pre-existing comorbidities with neurological manifestations. The aim of this review is to provide a deeper understanding of the potential neurological implications to help neurologists have a high index of clinical suspicion allowing them to manage the patient appropriately.
2019年11月在湖北省首次发现，由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）很快在全球范围内传播，成为一场全球健康大流行。COVID-19优先损害呼吸系统，产生发热、咳嗽和呼吸急促等症状。然而，感染往往倾向于扩散至累及多个器官系统。最近的证据表明，SARS-CoV-2可导致严重的神经损伤以及由此产生的神经症状和并发症。在此，我们对原始文章、病例报告和病例系列进行全面而深入的综述，以阐明SARS-CoV-2侵袭和损害神经系统的可能机制以及后续后果。我们将神经表现分为三类：（1）中枢神经系统受累，（2）周围神经系统表现，以及（3）骨骼肌损伤。发现头痛和头晕是最常见的症状，其次是意识障碍。在表明周围神经系统侵袭的症状中，嗅觉丧失和味觉障碍较为常见。骨骼肌损伤主要表现为肌痛。此外，脑炎、脊髓炎、脑血管疾病、吉兰-巴雷综合征和米勒-费希尔综合征是常见的并发症。我们还强调了既往合并症与神经表现之间的关联。本综述的目的是更深入地了解潜在的神经影响，以帮助神经科医生提高临床怀疑指数，从而能够对患者进行适当的管理。
