Hassett Catherine E, Frontera Jennifer A
Cerebrovascular Center, Neurological Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Neurology, NYU School of Medicine, New York, New York, USA.
Curr Opin Infect Dis. 2021 Jun 1;34(3):217-227. doi: 10.1097/QCO.0000000000000731.
Central and peripheral nervous system manifestations of coronavirus disease 2019 (COVID-19) have been frequently reported and may cause significant morbidity and mortality. This review details the latest evidence on the neuropathogenesis and neurologic complications of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Commonly reported neurologic complications include toxic-metabolic encephalopathy, acute cerebrovascular disorders, seizures, and anoxic-brain injury. These complications represent secondary injury due to COVID-19 related hypoxia, sepsis, hypercoagulability, or hyperinflammation. Postinfectious complications, such as encephalitis, postinfectious demyelination, and Guillain-Barré syndrome have been reported, but are rare. Recent reports of persistent neurocognitive symptoms highlight the possibility of lasting impairment.
Although some neurologic complications should be treated with standard practices, further investigations are still needed to determine the optimal treatment of COVID-related neurologic complications, such as ischemic stroke. Entering into the next phase of the pandemic, investigations into the long-term neurologic and cognitive impacts of SARS-CoV-2 infection will be needed. Clinicians must have a high clinical suspicion for both acute and chronic neurologic complications among COVID-19 patients.
2019冠状病毒病(COVID-19)的中枢和外周神经系统表现已屡有报道,且可能导致显著的发病率和死亡率。本综述详述了严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染的神经发病机制和神经系统并发症的最新证据。
常见的神经系统并发症包括中毒代谢性脑病、急性脑血管疾病、癫痫发作和缺氧性脑损伤。这些并发症是由COVID-19相关的缺氧、脓毒症、高凝状态或炎症反应过度引起的继发性损伤。已报告有感染后并发症,如脑炎、感染后脱髓鞘和吉兰-巴雷综合征,但较为罕见。近期关于持续性神经认知症状的报告凸显了长期损害的可能性。
尽管一些神经系统并发症应采用标准方法治疗,但仍需进一步研究以确定COVID-19相关神经系统并发症(如缺血性中风)的最佳治疗方法。进入疫情的下一阶段,需要对SARS-CoV-2感染的长期神经和认知影响进行研究。临床医生必须对COVID-19患者的急性和慢性神经系统并发症保持高度临床怀疑。