Ermis Ummehan, Rust Marcus Immanuel, Bungenberg Julia, Costa Ana, Dreher Michael, Balfanz Paul, Marx Gernot, Wiesmann Martin, Reetz Kathrin, Tauber Simone C, Schulz Jörg B
Department of Neurology, RWTH University Hospital, Aachen, Germany.
Department of Pneumonology and Internal Intensive Care Medicine, RWTH University Hospital, Aachen, Germany.
Neurol Res Pract. 2021 Mar 12;3(1):17. doi: 10.1186/s42466-021-00116-1.
The SARS-Coronavirus-2 (SARS-CoV-2) invades the respiratory system, causing acute and sometimes severe pulmonary symptoms, but turned out to also act multisystematically with substantial impact on the brain. A growing number of studies suggests a diverse spectrum of neurological manifestations. To investigate the spectrum of symptoms, we here describe the neurological manifestations and complications of patients with proven SARS-CoV-2 infection who have been hospitalized at the RWTH University Hospital Aachen, Germany.
Between March and September 2020, we evaluated common symptoms, clinical characteristics, laboratory (including cerebrospinal fluid (CSF) analysis), radiological, and electroencephalography (EEG) data from 53 patients admitted with a positive SARS-CoV-2 polymerase chain reaction (PCR). We used the Montreal Cognitive Assessment Test (MoCA) to screen for cognitive impairment, when feasible. We compared critically ill and non-critically ill patients categorized according to the presence of Acute Respiratory Distress Syndrome (ARDS).
Major clinical neurological features of hospitalized COVID-19 patients were coordination deficits (74%), cognitive impairment (61.5%), paresis (47%), abnormal reflex status (45%), sensory abnormalities (45%), general muscle weakness and pain (32%), hyposmia (26%), and headache (21%). Patients with ARDS were more severely affected than non-ADRS patients. 29.6% of patients with ARDS presented with subarachnoid bleedings, and 11.1% showed ischemic stroke associated with SARS-CoV-2 infection. Cognitive deficits mainly affected executive functions, attention, language, and delayed memory recall. We obtained cerebrospinal fluid (CSF) by lumbar puncture in nine of the 53 patients, none of which had a positive SARS-CoV-2 PCR.
In line with previous findings, our results provide evidence for a range of SARS-CoV-2-associated neurological manifestations. 26% of patients reported hyposmia, emphasizing the neuro-invasive potential of SARS-CoV-2, which can enter the olfactory bulb. It can therefore be speculated that neurological manifestations may be caused by direct invasion of the virus in the CNS; however, PCR did not reveal positive intrathecal SARS-CoV-2. Therefore, we hypothesize it is more likely that the para-infectious severe pro-inflammatory impact of COVID-19 is responsible for the neurological deficits including cognitive impairment. Future studies with comprehensive longitudinal assessment of neurological deficits are required to determine potential long-term complications of COVID-19.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）侵袭呼吸系统，导致急性且有时严重的肺部症状，但结果显示它也会对多个系统产生影响，对大脑有重大影响。越来越多的研究表明存在多种神经学表现。为了研究症状范围，我们在此描述了在德国亚琛工业大学医院住院的确诊SARS-CoV-2感染患者的神经学表现和并发症。
在2020年3月至9月期间，我们评估了53例SARS-CoV-2聚合酶链反应（PCR）呈阳性的住院患者的常见症状、临床特征、实验室检查（包括脑脊液（CSF）分析）、影像学检查和脑电图（EEG）数据。在可行的情况下，我们使用蒙特利尔认知评估测试（MoCA）来筛查认知障碍。我们比较了根据急性呼吸窘迫综合征（ARDS）的存在分类的重症和非重症患者。
住院的COVID-19患者的主要临床神经学特征为协调障碍（74%）、认知障碍（61.5%）、轻瘫（47%）、反射状态异常（45%）、感觉异常（45%）、全身肌肉无力和疼痛（32%）、嗅觉减退（26%）和头痛（21%）。ARDS患者比非ARDS患者受影响更严重。29.6%的ARDS患者出现蛛网膜下腔出血，11.1%的患者出现与SARS-CoV-2感染相关的缺血性中风。认知缺陷主要影响执行功能、注意力、语言和延迟记忆回忆。我们对53例患者中的9例进行了腰椎穿刺获取脑脊液（CSF），其中无一例SARS-CoV-2 PCR呈阳性。
与先前的研究结果一致，我们的结果为一系列与SARS-CoV-2相关的神经学表现提供了证据。26%的患者报告有嗅觉减退，强调了SARS-CoV-2的神经侵袭潜力，它可进入嗅球。因此，可以推测神经学表现可能是由病毒直接侵袭中枢神经系统引起的；然而，PCR并未显示鞘内SARS-CoV-2呈阳性。因此，我们假设更有可能是COVID-19的感染后严重促炎影响导致了包括认知障碍在内的神经功能缺损。需要进行全面纵向评估神经功能缺损的未来研究，以确定COVID-19潜在的长期并发症。
