Department of Neurology, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Woloska street 137, 02-507 Warsaw, Poland.
Department of Cardiac Rehabilitation, Central Clinical Hospital of the Ministry of Internal Affairs and Administration, Woloska Street 137, 02-507 Warsaw, Poland.
Neurol Neurochir Pol. 2021;55(2):195-201. doi: 10.5603/PJNNS.a2021.0011. Epub 2021 Feb 2.
Since the emergence of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) in Wuhan, China, it has been extensively studied by many scientists. Susceptibility to SARS-CoV-2 infection is shown by people of all ages, especially those with different comorbidities. Our goal was to describe the clinical characteristics, treatment, course, and outcome of COVID-19 in patients with pre-existing neurological disorders.
We retrospectively studied 70 patients with COVID-19 and previous neurological diseases who were treated in the Central Clinical Hospital of the Ministry of the Interior and Administration from 16 March to 15 June 2020. Demographic data, symptoms, image data, laboratory results, treatment methods and results, clinical signs and symptoms of patients hospitalised due to CNS diseases with COVID-19 were collected.
The average age of hospitalised patients was 72, and the majority (63%) were women (44/70). The most common neurological disease was dementia, which was present in almost a third of patients (30.76%), followed by ischaemic stroke (24.61%). Chest imaging showed the presence of interstitial changes in 47% (33) of patients. Laboratory tests revealed increased total blood cells, increased levels of C-reactive protein, procalcitonin, D-dimers, liver indicator markers and IL-6 in the most severely affected patients. The treatment of patients was focused on monitoring their clinical condition, and supporting respiratory inefficiency with passive oxygen therapy and mechanical ventilation. According to the guidelines of the Hospital Therapeutic Committee, pharmacological treatment (Arechin®, Kaletra®) was introduced in cases without contraindications. In patients with moderate COVID-19, antimalarial or antiviral agents were applied (78%). 30% of our observed patients died during the hospitalisation.
We studied a select group of patients (elderly, with comorbidities, and moderate or severe COVID-19 course). Pre-existing neurological disorders were additionally associated with a poorer prognosis and a high fatality rate (30%). Dementia and CNS vascular disorder were the most frequent pre-existing neurological conditions. The neurological symptoms of COVID-19 were various. We observed impaired consciousness, dizziness, headache, nausea, myalgia, psychomotor agitation and slowness, delirium, and psychoses. Further analysis is needed to elucidate the incidence of COVID-19 neurological complications.
自 2019 年新型冠状病毒病（COVID-19）在中国武汉由严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）引发以来，许多科学家对其进行了广泛研究。SARS-CoV-2 感染的易感性表现在各个年龄段的人群中，尤其是患有不同合并症的人群。我们的目标是描述患有先前存在的神经障碍的 COVID-19 患者的临床特征、治疗、病程和转归。
我们回顾性研究了 2020 年 3 月 16 日至 6 月 15 日期间在内政部中央临床医院接受治疗的 70 名患有 COVID-19 和先前神经疾病的患者。收集了人口统计学数据、症状、影像学数据、实验室结果、治疗方法和结果、因 COVID-19 导致中枢神经系统疾病而住院的患者的临床体征和症状。
住院患者的平均年龄为 72 岁，其中大多数（63%）为女性（44/70）。最常见的神经疾病是痴呆症，几乎有三分之一的患者（30.76%）患有该疾病，其次是缺血性中风（24.61%）。胸部影像学显示 47%（33 人）的患者存在间质性改变。实验室检查显示，病情最严重的患者的总血细胞计数、C 反应蛋白、降钙素原、D-二聚体、肝标志物和白细胞介素 6 水平升高。患者的治疗重点是监测其临床状况，并通过被动吸氧治疗和机械通气来支持呼吸效率低下。根据医院治疗委员会的指南，在没有禁忌症的情况下引入了药理学治疗（Arechin®、Kaletra®）。在病情中等的 COVID-19 患者中，应用了抗疟药或抗病毒药物（78%）。我们观察到 30%的患者在住院期间死亡。
我们研究了一组特定的患者（老年人、有合并症、病情中度或重度 COVID-19）。先前存在的神经障碍与预后较差和高死亡率（30%）相关。痴呆症和中枢神经系统血管疾病是最常见的先前存在的神经疾病。COVID-19 的神经症状多种多样。我们观察到意识障碍、头晕、头痛、恶心、肌痛、精神运动激越和迟缓、谵妄和精神病。需要进一步分析以阐明 COVID-19 神经系统并发症的发生率。
