Neurology Unit, Stroke Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Via Amendola 2, 42122, Reggio Emilia, Italy.
UOC Neurologia, ASST Papa Giovanni XXIII, Bergamo, Italy.
Adv Exp Med Biol. 2024;1457:125-141. doi: 10.1007/978-3-031-61939-7_7.
Neurological manifestations are frequent in patients with SARS-CoV-2 infection and can be correlated with different pathogenic mechanisms which can be divided into two categories: direct invasion of the central nervous system by the virus and indirect effects deriving from the severity of the systemic infection and by the inflammatory response correlated with cytokine storm. Among the neurological manifestations, acute encephalopathy is very frequent and its nomenclature has recently been updated. The occurrence of a condition of altered mental status, reduced consciousness, delirium up to coma represents an element associated with a greater severity of the infection and mortality both in an Intensive Care Unit setting and in an Emergency Department setting. The tissue damage mechanisms found in COVID-19 patients' encephalopathy and neuroimaging patterns, as well as histopathology, are similar to those described in sepsis-associated encephalopathy, further confirming the role of indirect mechanisms, with no CNS invasion by the virus. The available data have some limitations, notably the underuse of diagnostic neuroimaging techniques in severely affected patients, particularly in the first wave of the pandemic.
神经系统表现是 SARS-CoV-2 感染患者的常见症状，其发病机制可分为两类：病毒直接侵犯中枢神经系统和全身感染严重程度以及细胞因子风暴相关炎症反应的间接影响。在神经系统表现中，急性脑病非常常见，其命名最近已得到更新。意识状态改变、意识降低、谵妄直至昏迷的发生是与感染严重程度和死亡率相关的因素，无论是在重症监护病房还是在急诊科。COVID-19 患者脑病中的组织损伤机制和神经影像学模式以及组织病理学与脓毒症相关性脑病中描述的相似，进一步证实了间接机制的作用，病毒并未侵犯中枢神经系统。现有数据存在一些局限性，尤其是在严重感染患者中，尤其是在大流行的第一波中，诊断性神经影像学技术的应用不足。
