Scoppettuolo Pasquale, Borrelli Serena, Naeije Gilles
Department of Neurology, Centre Hospitalier du Valais Romand, Sion, Switzerland.
Department of Neurology, CHU-Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
Brain Behav Immun Health. 2020 May;5:100094. doi: 10.1016/j.bbih.2020.100094. Epub 2020 Jun 6.
Reports of neurological involvement during Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection course are increasingly described. The aim of this review is to provide a clinical approach of SARS-CoV-2 neurological complications based on the direct or indirect (systemic/immune-mediated) role of the SARS-CoV-2 in their genesis.
A review of the current literature has been carried out up to May 20th 2020 according to the PRISMA guidelines. All case series and reports of adult neurological manifestations associated to SARS-CoV-2 published in English were considered. Review and fundamental research studies on Coronaviruses neuroinvasive potential were analyzed to support pathogenic hypothesis and possible underlying mechanisms. Clinical patterns were subdivided into three groups according to putative underlying mechanisms: direct invasion of central or peripheral nervous system, systemic disorders leading to acute CNS injuries and post-infectious neurological syndromes (PINS).
Sixteen case series and 26 case reports for a total of 903 patients were identified presenting with neurological involvement during SARS-CoV-2 infection. Hypo/anosmia and dys/ageusia were found in 826 patients and mainly attributed to direct viral invasion. Cerebrovascular complications occurred in 51 patients and related to viral infection associated systemic inflammation. PINS were described in only 26 patients. A wide heterogeneity of these reports emerged concerning the extension of the clinical examination and ancillary exams performed.
Neurological complications of SARS-CoV-2 are mainly related to olfactory and gustatory sensory perception disorders through possible direct nervous system invasion while cerebrovascular disease and PINS are rare and due to distinct and indirect pathophysiological mechanisms.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染过程中神经受累的报告越来越多。本综述的目的是基于SARS-CoV-2在其发病机制中的直接或间接（全身/免疫介导）作用，提供一种针对SARS-CoV-2神经并发症的临床处理方法。
根据PRISMA指南，对截至2020年5月20日的当前文献进行了综述。纳入了所有以英文发表的与SARS-CoV-2相关的成人神经表现的病例系列和报告。分析了关于冠状病毒神经侵袭潜力的综述和基础研究，以支持致病假说及可能的潜在机制。根据假定的潜在机制，将临床模式分为三组：中枢或外周神经系统的直接侵袭、导致急性中枢神经系统损伤的全身疾病以及感染后神经综合征（PINS）。
共确定了16个病例系列和26篇病例报告，涉及903例在SARS-CoV-2感染期间出现神经受累的患者。826例患者出现嗅觉减退/嗅觉丧失和味觉障碍/味觉丧失，主要归因于病毒的直接侵袭。51例患者发生脑血管并发症，与病毒感染相关的全身炎症有关。仅26例患者出现PINS。这些报告在临床检查范围和辅助检查方面存在很大差异。
SARS-CoV-2的神经并发症主要与嗅觉和味觉感觉障碍有关，可能是由于病毒直接侵袭神经系统，而脑血管疾病和PINS较为罕见，是由不同的间接病理生理机制引起的。
