School of Medicine, Estácio of Juazeiro do Norte - FMJ/Estácio, Juazeiro do Norte, Ceará, Brazil.
School of Medicine, Universidade Federal do Cariri - UFCA, Barbalha, Ceará, Brazil.
Adv Exp Med Biol. 2021;1353:197-215. doi: 10.1007/978-3-030-85113-2_11.
Although respiratory symptoms predominate in the disease caused by the SARS-Cov-2, the new coronavirus, the related neurological implications increase with numbers of new infected, requiring new tools and sufficient medical apparatus to improve the patients' prognosis. The purpose of this publication is based on the need to clarify the pathophysiological process of COVID-19 from a neurological perspective. The present study aims to review and describe the main neurological aspects associated with SARS-CoV-2, in addition to presenting proposals for conducting and managing these issues.
The MEDLINE (through PubMed) and Scopus databases were used for systematic research on the correlation between COVID-19 and the nervous system. The reference period were publications between May 2005 and July 2020. The temporal delimitation was based on the objective of elucidating the pathophysiology of neurological involvement seen in the current pandemic. Thus, in 2005, we found articles that reported different etiologies and mechanisms of action of the antiphospholipid syndrome, which helped to understand its current association with COVID-19. Other articles from years prior to the current one contributed, in the same sense of linking, with description of associated processes, in articles from 2020, the SARS-CoV-2 infection. The processes described in times before 2020 and currently correlated with cerebral dysfunction of COVID-19 were distribution of angiotensin II receptors in the brain, inflammation associated with the blood-brain barrier imbalance, and brain barrier function. "SARS-CoV-2 and complications," "neurology," "pathogeny of COVID-19," "stroke," and "encephalopathy" were terms included in the research. The relevance of the articles found was based on congruence with the search terms and on availability of the full text.
Recent articles published reported mild neurological symptoms, with, for example, headache and anosmia as part of the set of common symptoms of COVID-19, highlighting the causal link between the disease and neurological complications that may exist during its evolution. It is still unknown whether the neurological clinical expression concomitant with the new coronavirus infection is a consequence or a coincidence. In order to properly treat and monitor these patients from the neurological point of view, it is essential, in times of pandemics, to suspect primary infection by SARS-Cov-2 and diagnose it to proceed with isolation and clinical support.
The neurological implications of COVID-19 range from initial symptoms, such as headache, to serious complications, such as ischemic stroke. Although the pathogenesis of neurological phenomena requires further studies, targeted management of the patient is feasible, considering agility in recognizing the infection. Therefore, medical precaution and clinical reasoning are emphasized when providing services to the patient.
虽然由 SARS-CoV-2（新型冠状病毒）引起的疾病以呼吸道症状为主，但随着感染人数的增加，相关的神经影响也在增加，这需要新的工具和足够的医疗设备来改善患者的预后。本出版物的目的是基于从神经学角度阐明 COVID-19 的病理生理过程的需要。本研究旨在回顾和描述与 SARS-CoV-2 相关的主要神经学方面，并提出处理这些问题的建议。
使用 MEDLINE（通过 PubMed）和 Scopus 数据库对 COVID-19 与神经系统之间的相关性进行系统研究。参考期为 2005 年 5 月至 2020 年 7 月之间的出版物。时间限定基于阐明当前大流行中观察到的神经受累的病理生理学的目标。因此，在 2005 年，我们发现了一些报道抗磷脂综合征不同病因和作用机制的文章，这有助于理解其目前与 COVID-19 的关联。来自当前之前年份的其他文章在同样的联系意义上，与 2020 年 SARS-CoV-2 感染相关的过程描述进行了链接。在 2020 年之前和目前与 COVID-19 相关的大脑功能障碍相关的过程有脑内血管紧张素 II 受体的分布、与血脑屏障失衡相关的炎症以及脑屏障功能。研究中包括了“SARS-CoV-2 和并发症”、“神经病学”、“COVID-19 的发病机制”、“中风”和“脑病”等术语。所发现的文章的相关性基于与搜索词的一致性和全文的可用性。
最近发表的文章报道了轻度神经症状，例如头痛和嗅觉丧失，作为 COVID-19 常见症状的一部分，突出了疾病与神经并发症之间可能存在的因果关系，这些并发症可能在疾病演变过程中出现。目前尚不清楚新冠病毒感染时同时出现的神经临床表现是后果还是巧合。为了从神经学角度对这些患者进行适当的治疗和监测，在大流行期间，必须怀疑 SARS-CoV-2 的原发性感染并进行诊断，以便进行隔离和临床支持。
COVID-19 的神经影响范围从初始症状（如头痛）到严重并发症（如缺血性中风）。虽然神经现象的发病机制需要进一步研究，但可以对患者进行有针对性的管理，考虑到识别感染的敏捷性。因此，在为患者提供服务时，强调医疗预防和临床推理。
