Martins Mariana, Pereira Ana, Teixeira André, Lima Diana, Lopes Nuno, Amaral-Silva Marta, Seixo Isabel, Miguéns Ana Catarina
Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de Lisboa Central, Lisbon, PRT.
Cureus. 2022 Dec 18;14(12):e32655. doi: 10.7759/cureus.32655. eCollection 2022 Dec.
The clinical presentation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection can range from mild or moderate disease (80% of the cases) to severe disease (15%) requiring oxygen support, and critical disease (5%), associated with acute respiratory distress syndrome and admission to the intensive care unit (ICU). In critically ill patients, prone positioning can be used to optimize oxygenation. Although there is a favourable response to this strategy, being a life-saving measure, additional associated complications may appear, including compressive neuropathies. Despite respiratory affection being more common, SARS-CoV-2 infection can also attack other systems and can, under certain conditions, affect the central or peripheral nervous system. It has been described that neurological manifestations can result from the neuroinvasive properties of the SARS-CoV-2 or as an indirect consequence of multiorgan dysfunction.
We intend to report the patients who presented with neurological complications associated with coronavirus disease 2019 (COVID-19) and/or complications of its treatment, followed in our physical and rehabilitation medicine (PRM) service.
A retrospective analysis of patients admitted to the PRM ward with outpatient consultation in the context of post-COVID-19 status between April 2020 and November 2021 (the period of the highest prevalence of infection) was carried out. Patients with neurological complications after SARS-CoV-2 infection and consequently a decline in previous functionality were identified.
Thirteen patients (23.6%) admitted to the PRM ward had peripheral neurological complications, documented by electroneuromyography, including Guillain-Barré syndrome, sensory-motor polyneuropathy, peroneal nerve injury, femoral nerve injury, and lumbar plexus injury. The neurological complications of the patients followed in a post-COVID-19 consultation were also evaluated. Eight patients (20%) reported neurological sequelae. Five patients presented peripheral nerve damage (peroneal, accessory, ulnar, and recurrent laryngeal) of undefined aetiology, diagnosed after the acute phase of hospitalization. Two patients had COVID-19 infection followed by ischemic stroke (vertebrobasilar and middle cerebral artery), requiring hospitalization in the acute phase. One patient had COVID-19 infection followed by longitudinal myelitis, with positive anti-myelin oligodendrocyte glycoprotein (MOG). All patients required follow-up by the rehabilitation team with partial recovery of deficits.
All patients admitted to the PRM ward with neurological manifestations had critical disease and symptoms compatible with peripheral nervous system involvement. Patients admitted to the PRM consultation had different levels of viral disease severity and had sequelae related to peripheral and central nervous system disorders. Identifying the aetiology of these injuries is essential for us to act on their prevention, particularly with regard to indirect complications, such as compressive neuropathies. It will be necessary to maintain the follow-up of these patients to understand the evolution of the neurological consequences associated with COVID-19.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染的临床表现范围广泛，从轻症或中症疾病（80%的病例）到需要氧疗的重症疾病（15%）以及危重症疾病（5%），后者与急性呼吸窘迫综合征和入住重症监护病房（ICU）相关。在危重症患者中，俯卧位可用于优化氧合。尽管该策略有良好效果，是一种挽救生命的措施，但可能会出现其他相关并发症，包括压迫性神经病变。尽管呼吸道受累更为常见，但SARS-CoV-2感染也可侵袭其他系统，在某些情况下，还会影响中枢或周围神经系统。据描述，神经表现可能源于SARS-CoV-2的神经侵袭特性，或是多器官功能障碍的间接后果。
我们打算报告在我们的物理医学与康复医学（PRM）科室就诊的、出现与2019冠状病毒病（COVID-19）相关的神经并发症和/或其治疗并发症的患者情况。
对2020年4月至2021年11月（感染流行率最高的时期）在PRM病房因COVID-19后状态进行门诊咨询而入院的患者进行回顾性分析。确定了SARS-CoV-2感染后出现神经并发症并导致先前功能下降的患者。
入住PRM病房的13名患者（23.6%）存在周围神经并发症，经肌电图记录，包括吉兰-巴雷综合征、感觉运动性多发性神经病、腓总神经损伤、股神经损伤和腰丛损伤。还评估了在COVID-19后咨询中随访的患者的神经并发症。8名患者（20%）报告有神经后遗症。5名患者出现病因不明的周围神经损伤（腓总神经、副神经、尺神经和喉返神经），在住院急性期后确诊。2名患者感染COVID-19后发生缺血性中风（椎基底动脉和大脑中动脉），急性期需要住院治疗。1名患者感染COVID-19后发生纵向脊髓炎，抗髓鞘少突胶质细胞糖蛋白（MOG）呈阳性。所有患者均需康复团队随访，部分功能缺损有所恢复。
入住PRM病房有神经表现的所有患者均患有危重症疾病，症状与周围神经系统受累相符。在PRM咨询中就诊的患者有不同程度的病毒病严重程度，存在与周围和中枢神经系统疾病相关的后遗症。确定这些损伤的病因对于我们采取预防措施至关重要，特别是对于间接并发症，如压迫性神经病变。有必要对这些患者进行随访，以了解与COVID-19相关的神经后果的演变情况。
