Manifestaciones neurológicas en pacientes con diagnóstico de COVID-19
Palabras clave:
COVID-19, coronavirus, SARS-CoV-2, manifestaciones neurológicas
Resumen
Introducción: La aparición de una nueva variante de coronavirus ha desatado en una pandemia relacionada con un síndrome de distrés respiratorio severo por SARS-CoV-2. Las primeras manifestaciones asociadas a este nuevo síndrome eran netamente respiratorias. Sin embargo, con los diferentes estudios se evidenció no solo afectación pulmonar, si no sistémica especialmente a nivel neurológico en donde los pacientes presentan síntomas centrales y periféricos de afectación por coronavirus.
Materiales y Métodos: Se realizó una revisión utilizando base de datos como: PubMed, Scopus, Embase, Cochrane Library, Scielo, incluyendo estudios de tipo observacionales, artículos de revisión, guías clínicas, que evaluaran la presencia de manifestaciones neurológicas en pacientes con diagnóstico de del 2019 al 2021.
Resultados: Se incluyeron 26 artículos donde se observó que las manifestaciones neurológicas inespecíficas tal como la cefalea fue la más común con una presentación de 30%. Las manifestaciones neurológicas específicas se presentan con una frecuencia alrededor de 3% pero con mayor gravedad, incluyendo convulsiones e ictus.
Conclusiones: es una patología donde su principal característica es la sintomatología pulmonar. Sin embargo, algunos pacientes presentan manifestaciones neurológicas específicas las cuales son menos frecuentes, pero tienen un carácter más grave y en contraste las manifestaciones neurológicas inespecíficas que son más frecuentes pero no ponen en riesgo la vida del paciente. Tal sintomatología es crucial al momento de abordar a un paciente con COVID-19 y se debe tener presente las mismas en la atención médica oportuna.
Citas
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2. Ferrarese C, Silani V, Priori A, Galimberti S, Agostoni E, Monaco S, et al. An Italian multicenter retrospective-prospective observational study on neurological manifestations of COVID-19 (NEUROCOVID). Neurol Sci. 2020; 41(6):1355–9. doi: 10.1007/s10072-020-04450-1
3. Lvov DK, Alkhovsky SV. [Source of the COVID-19 pandemic: ecology and genetics of coronaviruses (Betacoronavirus: Coronaviridae) SARS-CoV, SARS-CoV-2 (subgenus Sarbecovirus), and MERS-CoV (subgenus Merbecovirus)]. Vopr Virusol. 2020;65(2):62-70. doi: 10.36233/0507-4088-2020-65-2-62-70
4. Asrani P, Hassan MI. SARS-CoV-2 mediated lung inflammatory responses in host: targeting the cytokine storm for therapeutic interventions. Mol Cell Biochem. 2021;476(2):675-87. doi: 10.1007/s11010-020-03935-z
5. Escalada Pellitero S, Garriga Ferrer-Bergua L. Report of a patient with neurological symptoms as the sole manifestation of SARS-CoV-2 infection. Neurologia (Engl Ed). 2020 May;35(4):271–2. doi: 10.1016/j.nrl.2020.04.010
6. Borroni B, Gazzina S, Dono F, Mazzoleni V, Liberini P, Carrarini C, et al. Diaphragmatic myoclonus due to SARS-CoV-2 infection. Neurol Sci. 2020 ; 41(12):3471-4. doi: 10.1007/s10072-020-04766-y
7. Monti G, Giovannini G, Marudi A, Bedin R, Melegari A, Simone AM, et al. Anti-NMDA receptor encephalitis presenting as new onset refractory status epilepticus in COVID-19. Seizure. 2020; 81:18–20. doi: 10.1016/j.seizure.2020.07.006
8. Matschke J, Lütgehetmann M, Hagel Ch, Sperhake JP, Schröder AS, Edler C, et al. Neuropathology of patients with COVID-19 in Germany: a post-mortem case series. Lancet Neurol. 2020; 19(11):919–29. doi: 10.1016/S1474-4422(20)30308-2
9. Solomon IH, Normandin E, Bhattacharyya S, Mukerji SS, Keller K, Ali AS, et al. Neuropathological features of Covid-19. N Engl J Med. 2020; 383(10):989–92. doi: 10.1056/NEJMc2019373
10. Lee MH, Perl DP, Nair G, Li W, Maric D, Murray H, et al. Microvascular injury in the brains of patients with Covid-19. N Engl J Med. 2021; 384(5):481–3. doi: 10.1056/NEJMc2033369
11. Asrani P, Hasan GM, Sohal SS, Hassan MI. Molecular basis of pathogenesis of coronaviruses: A comparative genomics approach to planetary health to prevent zoonotic outbreaks in the 21st century. OMICS. 2020; 24(11):634–44. doi: 10.1089/omi.2020.0131
12. Delcuve GP, Lakowski TM, Su RCh, Beacon TH, Davie JR. SARS-CoV-2 multifaceted interaction with human host. Part I: What we have learnt and done so far, and the still unknown realities. IUBMB Life. 2020; 72(11):2313-30. doi: 10.1002/iub.2380
13. Song E, Zhang C, Israelow B, Lu-Culligan A, Prado AV, Skriabine S, et al. Neuroinvasion of SARS-CoV-2 in human and mouse brain. J Exp Med [Internet]. 2021 [cited 2022 Feb 10]; 218(3) :e20202135. Available from: https://pubmed.ncbi.nlm.nih.gov/33433624. doi: 10.1084/jem.20202135
14. Bauer L, Laksono BM, Vrij FMS de, Kushner SA, Harschnitz O, Riel D van. The neuroinvasiveness, neurotropism, and neurovirulence of SARS-CoV-2. Trends Neurosci. 2022; 45(5):358–68. doi: 10.1016/j.tins.2022.02.006
15. Harapan BN, Yoo HJ. Neurological symptoms, manifestations, and complications associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease 19 (COVID-19). J Neurol. 2021; 268(9):3059–71. doi: 10.1007/s00415-021-10406-y
16. Uddin MB, Liang Y, Shao S, Palani S, McKelvey M, Weaver SC, Sun K. Type I IFN Signaling Protects Mice from Lethal SARS-CoV-2 Neuroinvasion. Immunohorizons. 2022 Oct 11;6(10):716-721. doi: 10.4049/immunohorizons.2200065.
17. Zubair AS, McAlpine LS, Gardin T, Farhadian S, Kuruvilla DE, Spudich S. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: A review. JAMA Neurol. 2020; 77(8):1018-27. doi: 10.1001/jamaneurol.2020.2065
18. Jafari Khaljiri H, Jamalkhah M, Amini Harandi A, Pakdaman H, Moradi M, Mowla A. Comprehensive Review on Neuro-COVID-19 Pathophysiology and Clinical Consequences. Neurotox Res. 2021; 39(5):1613-29. doi: 10.1007/s12640-021-00389-z
19. Perrin P, Collongues N, Baloglu S, Bedo D, Bassand X, Lavaux T, et al. Cytokine release syndrome-associated encephalopathy in patients with COVID-19. Eur J Neurol. 2021;28(1):248–58. doi: 10.1111/ene.14491
20. Garg RK. Spectrum of neurological manifestations in Covid-19: A review. Neurol India. 2020; 68(3):560-72. doi: 10.4103/0028-3886.289000
21. Berger JR. COVID-19 and the nervous system. J Neurovirol. 2020; 26(2):143-8. doi: 10.1007/s13365-020-00840-5
22. Ahmed MU, Hanif M, Ali MJ, Haider MA, Kherani D, Memon GM, Karim AH, Sattar A. Neurological Manifestations of COVID-19 (SARS-CoV-2): A Review. Front Neurol. 2020; 11:518. doi: 10.3389/fneur.2020.00518
23. Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77(6):683–90. doi: 10.1001/jamaneurol.2020.1127
24. Chen Ch, Haupert SR, Zimmermann L, Shi X, Fritsche LG, Mukherjee B. Global Prevalence of Post-Coronavirus Disease 2019 (COVID-19) Condition or Long COVID: A Meta-Analysis and Systematic Review. J Infect Dis. 2022; 226(9):1593-1607. doi: 10.1093/infdis/jiac136
25. Fernández-de-Las-Peñas C, Gómez-Mayordomo V, Cuadrado ML, Palacios-Ceña D, Florencio LL, Guerrero AL, et al. The presence of headache at onset in SARS-CoV-2 infection is associated with long-term post-COVID headache and fatigue: A case-control study. Cephalalgia. 2021; 41(13):1332-41. doi: 10.1177/03331024211020404
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