Mahapure Kiran Sunil, Prabhune Anagha Sudhakar, Chouvhan Aradhana Vijaysinh
Department of Plastic Surgery, KAHER J N Medical College, Belgaum, Karnataka, India.
Department of Neurological Surgery, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India.
Asian J Neurosurg. 2021 Sep 14;16(3):457-469. doi: 10.4103/ajns.AJNS_406_20. eCollection 2021 Jul-Sep.
The objective of this study was to provide an overview of acute disseminating encephalomyelitis, a potential and serious complication of COVID-19.
Three primary databases were used, PubMed, LitCovid, and WHO. The final review articles reported acute disseminated encephalomyelitis (ADEM) in COVID-19-positive patients and were full-text, peer-reviewed articles. Articles which did not have patient data such as studies and articles with unclear inference were excluded.
Out of 21 cases of ADEM, the diagnosis of severe acute respiratory syndrome-coronavirus 2 was confirmed in 18 and suspected in 3. Among the neurological symptoms, altered consciousness was most common (7/21), followed by anosmia (3), paraplegia (3/21), brain stem involvement (3/21), sphincter involvement (2/21), and quadriplegia (1/21). Raised inflammatory markers were most commonly seen in 9/17. Central nervous system imaging was abnormal in 19 cases and unavailable in 2 cases. Fifteen patients were treated with corticosteroids, 11 patients received intravenous immunoglobulin, while 3 patients received convalescent plasma. Two patients needed surgical intervention. Complications included seizures (1), acute kidney injury and septicemic shock (1), raised intracranial pressure (1), and supraventricular tachycardia secondary to hydroxychloroquine (1). One patient recovered completely and one had good recovery with mild deficits. Thirteen patients had incomplete recovery with residual neurological deficit while three patients died as the consequence of the disease.
The physicians and neurosurgeons should be diligent while treating the COVID-19 patients with neurological manifestations and include ADEM as a differential diagnosis and stress on early diagnosis and treatment to reduce mortality and achieve satisfactory clinical outcome.
本研究旨在概述急性播散性脑脊髓炎，这是新型冠状病毒肺炎（COVID-19）一种潜在的严重并发症。
使用了三个主要数据库，即PubMed、LitCovid和世界卫生组织（WHO）。最终纳入的综述文章报道了COVID-19阳性患者的急性播散性脑脊髓炎（ADEM），且为全文、经同行评审的文章。排除没有患者数据的文章，如研究报告和推断不明确的文章。
在21例ADEM病例中，18例确诊感染严重急性呼吸综合征冠状病毒2，3例疑似感染。在神经症状方面，意识改变最为常见（7/21），其次是嗅觉丧失（3例）、截瘫（3/21）、脑干受累（3/21）、括约肌受累（2/21）和四肢瘫（1/21）。炎症标志物升高在9/17中最为常见。19例患者中枢神经系统影像学检查异常，2例未进行该项检查。15例患者接受了皮质类固醇治疗，11例患者接受了静脉注射免疫球蛋白治疗，3例患者接受了康复期血浆治疗。2例患者需要手术干预。并发症包括癫痫发作（1例）、急性肾损伤和感染性休克（1例）、颅内压升高（1例）以及羟氯喹引发的室上性心动过速（1例）。1例患者完全康复，1例恢复良好但有轻度功能缺损。13例患者恢复不完全，留有神经功能缺损，3例患者因病死亡。
在治疗有神经症状的COVID-19患者时，内科医生和神经外科医生应保持警惕，将ADEM列为鉴别诊断，并强调早期诊断和治疗，以降低死亡率并取得满意的临床结果。
