Department of Neurology, Centre Hospitalier de Saint-Denis, Hôpital Delafontaine, Saint-Denis, France.
Department of Infectious Diseases, Bichat-Claude Bernard Hospital, Assistance-Publique Hôpitaux de Paris, Paris, France; Université de Paris, IAME, INSERM, Paris, France.
Clin Microbiol Infect. 2021 Mar;27(3):458-466. doi: 10.1016/j.cmi.2020.11.005. Epub 2020 Nov 13.
To provide an overview of the spectrum, characteristics and outcomes of neurologic manifestations associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
We conducted a single-centre retrospective study during the French coronavirus disease 2019 (COVID-19) epidemic in March-April 2020. All COVID-19 patients with de novo neurologic manifestations were eligible.
We included 222 COVID-19 patients with neurologic manifestations from 46 centres in France. Median (interquartile range, IQR) age was 65 (53-72) years and 136 patients (61.3%) were male. COVID-19 was severe or critical in 102 patients (45.2%). The most common neurologic diseases were COVID-19-associated encephalopathy (67/222, 30.2%), acute ischaemic cerebrovascular syndrome (57/222, 25.7%), encephalitis (21/222, 9.5%) and Guillain-Barré syndrome (15/222, 6.8%). Neurologic manifestations appeared after the first COVID-19 symptoms with a median (IQR) delay of 6 (3-8) days in COVID-19-associated encephalopathy, 7 (5-10) days in encephalitis, 12 (7-18) days in acute ischaemic cerebrovascular syndrome and 18 (15-28) days in Guillain-Barré syndrome. Brain imaging was performed in 192 patients (86.5%), including 157 magnetic resonance imaging (70.7%). Among patients with acute ischaemic cerebrovascular syndrome, 13 (22.8%) of 57 had multiterritory ischaemic strokes, with large vessel thrombosis in 16 (28.1%) of 57. Brain magnetic resonance imaging of encephalitis patients showed heterogeneous acute nonvascular lesions in 14 (66.7%) of 21. Cerebrospinal fluid of 97 patients (43.7%) was analysed, with pleocytosis found in 18 patients (18.6%) and a positive SARS-CoV-2 PCR result in two patients with encephalitis. The median (IQR) follow-up was 24 (17-34) days with a high short-term mortality rate (28/222, 12.6%).
Clinical spectrum and outcomes of neurologic manifestations associated with SARS-CoV-2 infection were broad and heterogeneous, suggesting different underlying pathogenic processes.
概述与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）感染相关的神经系统表现的谱、特征和结局。
我们在 2020 年 3 月至 4 月法国的冠状病毒病 2019（COVID-19）流行期间进行了一项单中心回顾性研究。所有新发神经系统表现的 COVID-19 患者均符合入选标准。
我们纳入了来自法国 46 个中心的 222 例 COVID-19 伴神经系统表现的患者。中位（四分位距，IQR）年龄为 65（53-72）岁，136 例（61.3%）为男性。102 例（45.2%）COVID-19 患者为重症或危重症。最常见的神经系统疾病是 COVID-19 相关性脑病（67/222，30.2%）、急性缺血性脑血管综合征（57/222，25.7%）、脑炎（21/222，9.5%）和吉兰-巴雷综合征（15/222，6.8%）。神经系统表现出现在 COVID-19 首发症状后，COVID-19 相关性脑病中位（IQR）延迟 6（3-8）天，脑炎中位（IQR）延迟 7（5-10）天，急性缺血性脑血管综合征中位（IQR）延迟 12（7-18）天，吉兰-巴雷综合征中位（IQR）延迟 18（15-28）天。192 例患者（86.5%）进行了脑部影像学检查，包括 157 例磁共振成像（MRI）。急性缺血性脑血管综合征患者中，57 例中有 13 例（22.8%）为多部位缺血性脑卒中，57 例中有 16 例（28.1%）为大血管血栓形成。脑炎患者的脑 MRI 显示 21 例中有 14 例（66.7%）存在异质性急性非血管性病变。97 例患者的脑脊液（CSF）进行了分析，18 例（18.6%）患者有白细胞增多，2 例脑炎患者的 SARS-CoV-2 PCR 结果阳性。中位（IQR）随访时间为 24（17-34）天，短期死亡率较高（28/222，12.6%）。
与 SARS-CoV-2 感染相关的神经系统表现的临床谱和结局广泛且具有异质性，提示存在不同的潜在发病机制。
