Department of Neurology, The Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen), Shenzhen, China.
J Neurol. 2023 Oct;270(10):4617-4631. doi: 10.1007/s00415-023-11912-x. Epub 2023 Aug 13.
To investigate the clinical manifestations, treatment and prognosis of COVID-19-associated central nervous system (CNS) complications.
In this single-centre observation study, we recruited patients with COVID-19-associated CNS complications at the neurology inpatient department of the Eighth Affiliated Hospital, Sun Yat-Sen University (Futian, Shenzhen) from Dec 2022 to Feb 2023. Patients were analysed for demographics, clinical manifestations, cerebrospinal fluid properties, electroencephalographic features, neuroimaging characteristics, and treatment outcome. All patients were followed-up at 1 and 2 months after discharge until Apr 2023.
Of the 12 patients with COVID-19-associated CNS complications, the CNS symptoms occur between 0 days and 4 weeks after SARS-CoV-2 infection. The most common CNS symptoms were memory deficits (4/12, 33%), Unresponsiveness (4/12, 33%), mental and behavioural disorders (4/12, 33%). Seven of 12 cases can be categorized as probable SARS-CoV-2 encephalitis, and 5 cases can be described as brainstem encephalitis, acute disseminated encephalomyelitis, optic neuritis, multiple sclerosis or tremor probably associated with SARS-CoV-2 infection. Six patients received antiviral therapy, and 11 patients received glucocorticoid therapy, of which 3 patients received human immunoglobulin synchronously. Nine patients recovered well, two patients had residual neurological dysfunction, and one patient passed away from complications associated with tumor.
In this observational study, we found that the inflammatory or immune-related complications were relatively common manifestations of COVID-19-associated CNS complications, including different phenotypes of encephalitis and CNS inflammatory demyelinating diseases. Most patients recovered well, but a few patients had significant neurological dysfunctions remaining.
探讨 COVID-19 相关中枢神经系统（CNS）并发症的临床表现、治疗和预后。
在这项单中心观察性研究中，我们招募了 2022 年 12 月至 2023 年 2 月期间中山大学附属第八医院（深圳福田）神经内科住院的 COVID-19 相关 CNS 并发症患者。对患者的人口统计学、临床表现、脑脊液特性、脑电图特征、神经影像学特征和治疗结果进行分析。所有患者均在出院后 1 个月和 2 个月进行随访，直至 2023 年 4 月。
在 12 例 COVID-19 相关 CNS 并发症患者中，CNS 症状出现在 SARS-CoV-2 感染后 0 天至 4 周之间。最常见的 CNS 症状是记忆缺陷（4/12，33%）、反应迟钝（4/12，33%）、精神和行为障碍（4/12，33%）。12 例中有 7 例可归类为可能的 SARS-CoV-2 脑炎，5 例可描述为脑干脑炎、急性播散性脑脊髓炎、视神经炎、多发性硬化症或震颤可能与 SARS-CoV-2 感染相关。6 例患者接受了抗病毒治疗，11 例患者接受了糖皮质激素治疗，其中 3 例同时接受了人免疫球蛋白治疗。9 例患者恢复良好，2 例患者遗留神经功能障碍，1 例患者因肿瘤相关并发症死亡。
在这项观察性研究中，我们发现炎症或免疫相关并发症是 COVID-19 相关 CNS 并发症的相对常见表现，包括不同表型的脑炎和 CNS 炎症性脱髓鞘疾病。大多数患者恢复良好，但少数患者仍存在明显的神经功能障碍。
