501
|
Yaeger KA, Fifi JT, Lara-Reyna J, Rossitto C, Ladner T, Yim B, Hardigan T, Maragkos GA, Shigematsu T, Majidi S, Mocco J. Initial Stroke Thrombectomy Experience in New York City during the COVID-19 Pandemic. AJNR Am J Neuroradiol 2020; 41:1357-1360. [PMID: 32616582 PMCID: PMC7658874 DOI: 10.3174/ajnr.a6652] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 05/18/2020] [Indexed: 12/15/2022]
Abstract
New York City has become the global epicenter of the coronavirus 2019 (COVID-19) pandemic. Despite a massive shift in health care resources, cerebrovascular disease continues to be a substantial burden. We review the first 10 patients undergoing thrombectomy following a series of governmental and institutional policy changes diverting resources to the care of critically ill patients with COVID-19. Ten patients with emergent large-vessel occlusion underwent thrombectomy between March 23 and April 1, 2020. Five patients tested positive for the COVID-19 virus. Successful reperfusion was achieved in 9 of 10 patients, at a median time of 37 minutes from vascular access. The postprocedural NIHSS score improved by an average of 7.7 points. Of the 5 patients positive for COVID-19, none have experienced a critical respiratory illness. We report the early incidence of COVID-19 positivity in patients with emergent large-vessel occlusion and demonstrate that thrombectomy continues to be an efficacious option, as well as safe for health care providers.
Collapse
Affiliation(s)
- K A Yaeger
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York.
| | - J T Fifi
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - J Lara-Reyna
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - C Rossitto
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - T Ladner
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - B Yim
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - T Hardigan
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - G A Maragkos
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - T Shigematsu
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - S Majidi
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| | - J Mocco
- From the Department of Neurosurgery, Mount Sinai Health System, New York, New York
| |
Collapse
|
502
|
Orozco-Hernández JP, Marin-Medina DS, Sánchez-Duque JA. [Neurological manifestations of SARS-CoV-2 infection]. Semergen 2020; 46 Suppl 1:106-108. [PMID: 32439269 PMCID: PMC7211628 DOI: 10.1016/j.semerg.2020.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 04/26/2020] [Accepted: 05/03/2020] [Indexed: 12/22/2022]
Affiliation(s)
- J P Orozco-Hernández
- Grupo de Investigación Epidemiología, Salud y Violencia, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Grupo de Investigación Applied Neuroscience, Instituto de Epilepsia y Parkinson del Eje Cafetero-Neurocentro S.A., Pereira, Risaralda, Colombia.
| | - D S Marin-Medina
- Grupo de Investigación Epidemiología, Salud y Violencia, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia; Grupo de Investigación Applied Neuroscience, Instituto de Epilepsia y Parkinson del Eje Cafetero-Neurocentro S.A., Pereira, Risaralda, Colombia; Grupo de Investigación NeuroUnal, Departamento de Neurología, Universidad Nacional de Colombia, Bogotá D.C., Colombia
| | - J A Sánchez-Duque
- Grupo de Investigación Salud, Familia y Sociedad, Departamento de Medicina Social y Salud Familiar, Facultad de Ciencias de la Salud, Universidad del Cauca, Popayán, Cauca, Colombia; Grupo de Investigación Salud Pública e Infección, Facultad de Ciencias de la Salud, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia
| |
Collapse
|
503
|
Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. J Stroke Cerebrovasc Dis 2020; 29:104953. [PMID: 32689621 PMCID: PMC7221408 DOI: 10.1016/j.jstrokecerebrovasdis.2020.104953] [Citation(s) in RCA: 170] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey. PATIENTS AND METHODS A Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses. RESULTS Of the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01). CONCLUSIONS The observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies.
Collapse
Affiliation(s)
- J E Siegler
- Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, United States.
| | - M E Heslin
- Cooper Medical School of Rowan University, Camden, NJ 08103, United States.
| | - L Thau
- Cooper Medical School of Rowan University, Camden, NJ 08103, United States.
| | - A Smith
- Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, United States.
| | - T G Jovin
- Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, United States.
| |
Collapse
|
504
|
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; 77:1018-1027. [PMID: 32469387 PMCID: PMC7484225 DOI: 10.1001/jamaneurol.2020.2065] [Citation(s) in RCA: 615] [Impact Index Per Article: 153.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in December 2019, causing human coronavirus disease 2019 (COVID-19), which has now spread into a worldwide pandemic. The pulmonary manifestations of COVID-19 have been well described in the literature. Two similar human coronaviruses that cause Middle East respiratory syndrome (MERS-CoV) and severe acute respiratory syndrome (SARS-CoV-1) are known to cause disease in the central and peripheral nervous systems. Emerging evidence suggests COVID-19 has neurologic consequences as well. Observations This review serves to summarize available information regarding coronaviruses in the nervous system, identify the potential tissue targets and routes of entry of SARS-CoV-2 into the central nervous system, and describe the range of clinical neurological complications that have been reported thus far in COVID-19 and their potential pathogenesis. Viral neuroinvasion may be achieved by several routes, including transsynaptic transfer across infected neurons, entry via the olfactory nerve, infection of vascular endothelium, or leukocyte migration across the blood-brain barrier. The most common neurologic complaints in COVID-19 are anosmia, ageusia, and headache, but other diseases, such as stroke, impairment of consciousness, seizure, and encephalopathy, have also been reported. Conclusions and Relevance Recognition and understanding of the range of neurological disorders associated with COVID-19 may lead to improved clinical outcomes and better treatment algorithms. Further neuropathological studies will be crucial to understanding the pathogenesis of the disease in the central nervous system, and longitudinal neurologic and cognitive assessment of individuals after recovery from COVID-19 will be crucial to understand the natural history of COVID-19 in the central nervous system and monitor for any long-term neurologic sequelae.
Collapse
Affiliation(s)
- Adeel S Zubair
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Lindsay S McAlpine
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Tova Gardin
- Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Shelli Farhadian
- Division of Infectious Disease, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Division of Neurological Infections and Global Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Deena E Kuruvilla
- Division of Headache and Facial Pain, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| | - Serena Spudich
- Division of Neurological Infections and Global Neurology, Department of Neurology, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
505
|
Siegler JE, Heslin ME, Thau L, Smith A, Jovin TG. Falling stroke rates during COVID-19 pandemic at a comprehensive stroke center. J Stroke Cerebrovasc Dis 2020. [PMID: 32689621 DOI: 10.1016/j.jstrokecerebrovasdis.2020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023] Open
Abstract
INTRODUCTION Although there is evidence to suggest a high rate of cerebrovascular complications in patients with SARS-CoV-2 infection, anecdotal reports indicate a falling rate of new ischemic stroke diagnoses. We conducted an exploratory single-center analysis to estimate the change in number of new stroke diagnoses in our region, and evaluate the proximate reasons for this change during the COVID-19 pandemic at a tertiary care center in New Jersey. PATIENTS AND METHODS A Comprehensive Stroke Center prospective cohort was retrospectively analyzed for the number of stroke admissions, demographic features, and short-term outcomes 5 months prior to 3/1/2020 (pre-COVID-19), and in the 6 weeks that followed (COVID-19 period). The primary outcome was the number of new acute stroke diagnoses before and during the COVID-19 period, as well as the potential reasons for a decline in the number of new diagnoses. RESULTS Of the 328 included patients, 53 (16%) presented in the COVID-19 period. There was a mean fall of 38% in new stroke diagnoses (mean 1.13/day [SD 1.07] from 1.82/day [SD 1.38], p<0.01), which was related to a 59% decline in the number of daily transfers from referral centers (p<0.01), 25% fewer telestroke consultations (p=0.08), and 55% fewer patients presenting directly to our institution by private vehicle (p<0.01) and 29% fewer patients through emergency services (p=0.09). There was no significant change in the monthly number of strokes due to large vessel occlusion (LVO), however the proportion of new LVOs nearly doubled in the COVID-19 period (38% vs. 21%, p=0.01). CONCLUSIONS The observations at our tertiary care center corroborate anecdotal reports that the number of new stroke diagnoses is falling, which seems related to a smaller proportion of patients seeking healthcare services for milder symptoms. These preliminary data warrant validation in larger, multi-center studies.
Collapse
Affiliation(s)
- J E Siegler
- Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, United States.
| | - M E Heslin
- Cooper Medical School of Rowan University, Camden, NJ 08103, United States.
| | - L Thau
- Cooper Medical School of Rowan University, Camden, NJ 08103, United States.
| | - A Smith
- Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, United States.
| | - T G Jovin
- Cooper Neurological Institute, Cooper University Hospital, 3 Cooper Plaza, Suite 320, Camden, NJ 08103, United States.
| |
Collapse
|
506
|
Ehrenfeld M, Tincani A, Andreoli L, Cattalini M, Greenbaum A, Kanduc D, Alijotas-Reig J, Zinserling V, Semenova N, Amital H, Shoenfeld Y. Covid-19 and autoimmunity. Autoimmun Rev 2020; 19:102597. [PMID: 32535093 PMCID: PMC7289100 DOI: 10.1016/j.autrev.2020.102597] [Citation(s) in RCA: 330] [Impact Index Per Article: 82.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023]
Affiliation(s)
- Michael Ehrenfeld
- The Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Israel.
| | - Angela Tincani
- I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Sechenov University, Russia; U.O. Reumatologia e Immunologia Clinica, ASST-Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Laura Andreoli
- U.O. Reumatologia e Immunologia Clinica, ASST-Spedali Civili di Brescia, Università degli Studi di Brescia, Italy
| | - Marco Cattalini
- Pediatrics Clinic, ASST Spedali Civili di Brescia, Brescia, Italy; Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Assaf Greenbaum
- The Hebrew University, Hadassah Medical School, Jerusalem, Israel
| | - Darja Kanduc
- Department of Biosciences, Biotechnologies, and Biopharmaceutics, University of Bari, Italy
| | - Jaume Alijotas-Reig
- Hospital Universitari Vall d'Hebron & Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vsevolod Zinserling
- V.A. Almazov Research Center and S.P. Botkin infectious Hospital, Saint-Petersburg, Russia
| | - Natalia Semenova
- V.A. Almazov Research Center and S.P. Botkin infectious Hospital, Saint-Petersburg, Russia
| | - Howard Amital
- The Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yehuda Shoenfeld
- The Zabludowicz Center for autoimmune diseases, Sheba Medical Center, Israel; The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; I.M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation, Sechenov University, Russia
| |
Collapse
|
507
|
Affiliation(s)
- Patrick D Lyden
- Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA
| |
Collapse
|
508
|
SARS-CoV-2 and the Nervous System: From Clinical Features to Molecular Mechanisms. Int J Mol Sci 2020. [PMID: 32751841 DOI: 10.3390/ijms21155475.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Increasing evidence suggests that Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) can also invade the central nervous system (CNS). However, findings available on its neurological manifestations and their pathogenic mechanisms have not yet been systematically addressed. A literature search on neurological complications reported in patients with COVID-19 until June 2020 produced a total of 23 studies. Overall, these papers report that patients may exhibit a wide range of neurological manifestations, including encephalopathy, encephalitis, seizures, cerebrovascular events, acute polyneuropathy, headache, hypogeusia, and hyposmia, as well as some non-specific symptoms. Whether these features can be an indirect and unspecific consequence of the pulmonary disease or a generalized inflammatory state on the CNS remains to be determined; also, they may rather reflect direct SARS-CoV-2-related neuronal damage. Hematogenous versus transsynaptic propagation, the role of the angiotensin II converting enzyme receptor-2, the spread across the blood-brain barrier, the impact of the hyperimmune response (the so-called "cytokine storm"), and the possibility of virus persistence within some CNS resident cells are still debated. The different levels and severity of neurotropism and neurovirulence in patients with COVID-19 might be explained by a combination of viral and host factors and by their interaction.
Collapse
|
509
|
Pennisi M, Lanza G, Falzone L, Fisicaro F, Ferri R, Bella R. SARS-CoV-2 and the Nervous System: From Clinical Features to Molecular Mechanisms. Int J Mol Sci 2020; 21:E5475. [PMID: 32751841 PMCID: PMC7432482 DOI: 10.3390/ijms21155475] [Citation(s) in RCA: 101] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 02/07/2023] Open
Abstract
Increasing evidence suggests that Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) can also invade the central nervous system (CNS). However, findings available on its neurological manifestations and their pathogenic mechanisms have not yet been systematically addressed. A literature search on neurological complications reported in patients with COVID-19 until June 2020 produced a total of 23 studies. Overall, these papers report that patients may exhibit a wide range of neurological manifestations, including encephalopathy, encephalitis, seizures, cerebrovascular events, acute polyneuropathy, headache, hypogeusia, and hyposmia, as well as some non-specific symptoms. Whether these features can be an indirect and unspecific consequence of the pulmonary disease or a generalized inflammatory state on the CNS remains to be determined; also, they may rather reflect direct SARS-CoV-2-related neuronal damage. Hematogenous versus transsynaptic propagation, the role of the angiotensin II converting enzyme receptor-2, the spread across the blood-brain barrier, the impact of the hyperimmune response (the so-called "cytokine storm"), and the possibility of virus persistence within some CNS resident cells are still debated. The different levels and severity of neurotropism and neurovirulence in patients with COVID-19 might be explained by a combination of viral and host factors and by their interaction.
Collapse
Affiliation(s)
- Manuela Pennisi
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 97–95123 Catania, Italy; (M.P.); (F.F.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia, 78–95123 Catania, Italy
- Oasi Research Institute–IRCCS, Via Conte Ruggero, 73–94018 Troina, Italy;
| | - Luca Falzone
- Epidemiology Unit, IRCCS Istituto Nazionale Tumori “Fondazione G. Pascale”, Via Mariano Semmola, 53 –80131 Naples, Italy;
| | - Francesco Fisicaro
- Department of Biomedical and Biotechnological Sciences, University of Catania, Via Santa Sofia, 97–95123 Catania, Italy; (M.P.); (F.F.)
| | - Raffaele Ferri
- Oasi Research Institute–IRCCS, Via Conte Ruggero, 73–94018 Troina, Italy;
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technologies, University of Catania, Via Santa Sofia, 87–95123 Catania, Italy;
| |
Collapse
|
510
|
Khan S, Gomes J. Neuropathogenesis of SARS-CoV-2 infection. eLife 2020; 9:59136. [PMID: 32729463 PMCID: PMC7392602 DOI: 10.7554/elife.59136] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 07/23/2020] [Indexed: 12/12/2022] Open
Abstract
The COVID-19 pandemic caused by the SARS-CoV-2 has recently emerged as a serious jolt to human life and economy. Initial knowledge established pulmonary complications as the chief symptom, however, the neurological aspect of the disease is also becoming increasingly evident. Emerging reports of encephalopathies and similar ailments with the detection of the virus in the CSF has elicited an urgent need for investigating the possibility of neuroinvasiveness of the virus, which cannot be ruled out given the expression of low levels of ACE2 receptors in the brain. Sensory impairments of the olfactory and gustatory systems have also been reported in a large proportion of the cases, indicating the involvement of the peripheral nervous system. Hence, the possibility of neurological damage caused by the virus demands immediate attention and investigation of the mechanisms involved, so as to customize the treatment of patients presenting with neurological complications.
Collapse
Affiliation(s)
- Shumayila Khan
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi, India
| | - James Gomes
- Kusuma School of Biological Sciences, Indian Institute of Technology Delhi, New Delhi, India
| |
Collapse
|
511
|
Venketasubramanian N. Stroke Care Services in Singapore During COVID-19 Pandemic-A National Perspective. Front Neurol 2020; 11:780. [PMID: 32849231 PMCID: PMC7399214 DOI: 10.3389/fneur.2020.00780] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/25/2020] [Indexed: 12/25/2022] Open
Abstract
Stroke is a significant cause of admission to Singapore's acute care hospitals. Because of the current COVID-19 pandemic, there have been major changes in the stroke care system. On calling for the public ambulance, those suspected to have COVID-19 infection are taken to the National Center for Infectious Diseases. Otherwise, on arrival at the emergency room, all cases with fever or respiratory symptoms [COVID-19 suspect patients (CSPs)] are evaluated separately by staff wearing full personal protective equipment (PPE). Triage is not delayed. CSPs needing hyperacute therapies are sent to a specially prepared scanner; if not, imaging is deferred to the latter part of the day. CSPs are managed in isolation rooms, and sent to the acute stroke unit (ASU) if two consecutive COVID-19 swabs are negative. Investigation and rehabilitation are done within the room. ASU rounds are attended by essential members, communication by electronic means. Multidisciplinary team rounds have largely ceased, and discussions are via electronic platforms. Patient transfer and staff movement are minimized. All hospital staff wear face-masks, infection control is strictly enforced. Visitors are not allowed; staff make daily calls to update families. Mild stroke patients may be sent home with rehabilitation advice. Out-patient rehabilitation centers are closed. Patients return for out-patient visits only if needed; medications are sent to their home, and nurses make essential home visits. Stroke support and rehabilitation activities have started on-line. Continuing medical education activities are mainly by webinars. Stroke research has been severely hampered. Overall, evidence-based stroke care is delivered in a re-organized manner, with a clear eye on infection control.
Collapse
|
512
|
Jenab Y, Rezaei N, Hedayat B, Naderian M, Shirani S, Hosseini K. Occurrence of acute coronary syndrome, pulmonary thromboembolism, and cerebrovascular event in COVID-19. Clin Case Rep 2020; 8:2414-2417. [PMID: 32837723 PMCID: PMC7404759 DOI: 10.1002/ccr3.3112] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/10/2020] [Accepted: 06/21/2020] [Indexed: 01/06/2023] Open
Abstract
COVID‐19 causes significant hypoxia along with an exacerbated inflammatory milieu, which may be a trigger for atherosclerotic plaque rupture and/or thromboembolic events. Herein, we presented a case of COVID‐19 presented with acute coronary syndrome followed by pulmonary thromboembolism and cerebrovascular accident.
Collapse
Affiliation(s)
- Yaser Jenab
- Cardiology DepartmentTehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Nima Rezaei
- Immunology, Asthma and Allergy Research InstituteTehran University of Medical SciencesTehranIran
| | - Behnam Hedayat
- Cardiology DepartmentTehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Mohammadreza Naderian
- Cardiology DepartmentTehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Shapour Shirani
- Radiology DepartmentTehran Heart CenterTehran University of Medical SciencesTehranIran
| | - Kaveh Hosseini
- Cardiology DepartmentTehran Heart CenterTehran University of Medical SciencesTehranIran
| |
Collapse
|
513
|
Román GC, Spencer PS, Reis J, Buguet A, Faris MEA, Katrak SM, Láinez M, Medina MT, Meshram C, Mizusawa H, Öztürk S, Wasay M. The neurology of COVID-19 revisited: A proposal from the Environmental Neurology Specialty Group of the World Federation of Neurology to implement international neurological registries. J Neurol Sci 2020; 414:116884. [PMID: 32464367 PMCID: PMC7204734 DOI: 10.1016/j.jns.2020.116884] [Citation(s) in RCA: 145] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 01/08/2023]
Abstract
A comprehensive review of the neurological disorders reported during the current COVID-19 pandemic demonstrates that infection with SARS-CoV-2 affects the central nervous system (CNS), the peripheral nervous system (PNS) and the muscle. CNS manifestations include: headache and decreased responsiveness considered initial indicators of potential neurological involvement; anosmia, hyposmia, hypogeusia, and dysgeusia are frequent early symptoms of coronavirus infection. Respiratory failure, the lethal manifestation of COVID-19, responsible for 264,679 deaths worldwide, is probably neurogenic in origin and may result from the viral invasion of cranial nerve I, progressing into rhinencephalon and brainstem respiratory centers. Cerebrovascular disease, in particular large-vessel ischemic strokes, and less frequently cerebral venous thrombosis, intracerebral hemorrhage and subarachnoid hemorrhage, usually occur as part of a thrombotic state induced by viral attachment to ACE2 receptors in endothelium causing widespread endotheliitis, coagulopathy, arterial and venous thromboses. Acute hemorrhagic necrotizing encephalopathy is associated to the cytokine storm. A frontal hypoperfusion syndrome has been identified. There are isolated reports of seizures, encephalopathy, meningitis, encephalitis, and myelitis. The neurological diseases affecting the PNS and muscle in COVID-19 are less frequent and include Guillain-Barré syndrome; Miller Fisher syndrome; polyneuritis cranialis; and rare instances of viral myopathy with rhabdomyolysis. The main conclusion of this review is the pressing need to define the neurology of COVID-19, its frequency, manifestations, neuropathology and pathogenesis. On behalf of the World Federation of Neurology we invite national and regional neurological associations to create local databases to report cases with neurological manifestations observed during the on-going pandemic. International neuroepidemiological collaboration may help define the natural history of this worldwide problem.
Collapse
Affiliation(s)
- Gustavo C Román
- Environmental Neurology Specialty Group of the World Federation of Neurology (ENSG-WFN), London, UK; Department of Neurology, Neurological Institute, Houston Methodist Hospital, 6560 Fannin Street, Suite 802, Houston, TX 77030, USA.
| | - Peter S Spencer
- Department of Neurology, School of Medicine, Oregon Institute of Occupational Health Sciences, Oregon Health & Science University, Portland, OR 97239, USA
| | - Jacques Reis
- Université de Strasbourg, 67000 Strasbourg, France and Association RISE, 67205 Oberhausbergen, France
| | - Alain Buguet
- General (r) French Army Health Services, Malaria Research Unit, UMR 5246 CNRS, Claude-Bernard Lyon-1 University, 69622 Villeurbanne, France
| | - Mostafa El Alaoui Faris
- World Congress of Neurology, Marrakesh WCN2011, Moroccan Foundation Against Neurological Disease, Neurology, Mohammed V University of Rabat, Rabat, Morocco
| | - Sarosh M Katrak
- Neurology Department, Jaslok Hospital & Research Center, Professor Emeritus GMC and Sir JJ Group of Hospitals, Mumbai, India
| | - Miguel Láinez
- Spanish Neurological Society, Department of Neurology, University Clinic Hospital, Catholic University of Valencia, 46010, Valencia, Spain
| | - Marco Tulio Medina
- Latin America, WFN, Pan American Federation of Neurological Societies (PAFNS), Neurology and Epileptology, Faculty of Medical Sciences, National Autonomous University of Honduras, Tegucigalpa, Honduras
| | | | - Hidehiro Mizusawa
- World Congress of Neurology, Kyoto WCN2017, National Center of Neurology and Psychiatry (NCNP), Japan, Department of Neurology and Neurological Science, Graduate School of Medical and Dental Sciences, Tokyo, Japan
| | - Serefnur Öztürk
- Turkish Neurological Society, Department of Neurology, Selcuk University Faculty of Medicine, Konya, Turkey
| | - Mohammad Wasay
- Pakistan International Neuroscience Society, Neurology, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
514
|
Larson AS, Savastano L, Kadirvel R, Kallmes DF, Hassan AE, Brinjikji W. Coronavirus Disease 2019 and the Cerebrovascular-Cardiovascular Systems: What Do We Know So Far? J Am Heart Assoc 2020; 9:e016793. [PMID: 32393136 PMCID: PMC7670533 DOI: 10.1161/jaha.120.016793] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The severe acute respiratory syndrome coronavirus 2 pandemic of 2019 to 2020 has resulted in multiple hospitalizations, deaths, and economic hardships worldwide. Although respiratory involvement in patients with coronavirus disease 2019 (COVID-19) is well known, the potential cardiovascular and cerebrovascular manifestations are less understood. We performed a PubMed and Google Scholar search and reviewed relevant literature on COVID-19 and cardiovascular system involvement. Severe acute respiratory syndrome coronavirus 2 possesses high affinity for angiotensin-converting enzyme 2 receptor, which is highly concentrated in the lungs and cardiovascular tissue, thereby provoking concern for cardiovascular involvement in COVID-19 cases. Preexisting cardiovascular and cerebrovascular disease has been shown in previous reports to be a risk factor for severe infection. On the basis of our review of published studies, COVID-19 patients may be more likely to experience acute cardiac injury, arrhythmia, coagulation defects, and acute stroke and are likely to have poorer outcomes as a result. As the COVID-19 pandemic continues, more data about potential cardiovascular and cerebrovascular manifestations of the disease are required.
Collapse
Affiliation(s)
| | | | | | | | - Ameer E. Hassan
- Department of NeurosurgeryMayo ClinicRochesterMN
- Departments of Neurology and RadiologyUniversity of Texas Rio Grande ValleyHarlingenTX
| | | |
Collapse
|
515
|
TunÇ A, ÜnlÜbaŞ Y, Alemdar M, AkyÜz E. Coexistence of COVID-19 and acute ischemic stroke report of four cases. J Clin Neurosci 2020; 77:227-229. [PMID: 32409210 PMCID: PMC7200342 DOI: 10.1016/j.jocn.2020.05.018] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/04/2020] [Indexed: 12/31/2022]
Abstract
Coronaviruses are revealed to target the human respiratory system mainly. However, they also have neuro-invasive abilities and might spread from the respiratory system to the central nervous system. Herein, we report four patients with COVID-19 simultaneously diagnosed with acute ischemic stroke. There were four stroke cases with simultaneously diagnosis of Covid-19 till the April 14, 2020 in the city of Sakarya, Turkey. They were aged between 45 and 77 years. All four cases were likely to have contracted the virus in Sakarya. The patients had all commonly reported symptoms of Covid-19. Three patients have elevated D-dimer levels, and two of them had high C-reactive protein (CRP) levels. They were managed symptomatically for both the infection and the stroke. Our findings suggest that ischemic cerebrovascular diseases may simultaneously develop in the course of Covid-19 independently of the critical disease process. Increased inflammation predicted by CRP and D-dimer levels may play a role in the formation of ischemia. In particular, elder patients with prothrombotic risk factors should also be considered for the signs of cerebrovascular events in addition to infectious symptoms.
Collapse
Affiliation(s)
- Abdulkadir TunÇ
- Clinic of Neurology, Sakarya University, Sakarya Training and Research Hospital, Sakarya, Turkey.
| | - Yonca ÜnlÜbaŞ
- Clinic of Neurology, Sakarya University, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Murat Alemdar
- Clinic of Neurology, Sakarya University, Sakarya Training and Research Hospital, Sakarya, Turkey
| | - Enes AkyÜz
- Department Pediatrics, Wisconsin-Madison University, School of Medicine and Public Health, United States
| |
Collapse
|
516
|
Whittaker A, Anson M, Harky A. Neurological Manifestations of COVID-19: A systematic review and current update. Acta Neurol Scand 2020; 142:14-22. [PMID: 32412088 PMCID: PMC7273036 DOI: 10.1111/ane.13266] [Citation(s) in RCA: 247] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 01/08/2023]
Abstract
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), was first identified in December of 2019 in the city of Wuhan, China. Since the outbreak, various reports detail its symptoms and outcomes, primarily focusing on respiratory complications. However, reports are emerging of the virus’ effects systemically, including that of the nervous system. A review of all current published literature was conducted, and we report that headache and anosmia were common neurological manifestations of SARS‐CoV‐2. Less common symptoms include seizure, stroke and isolated cases of Guillain‐Barre syndrome. Further research is now warranted to precisely determine the relationship between those patients developing neurological sequelae, their clinical state and any subsequent morbidity and mortality.
Collapse
Affiliation(s)
| | - Matthew Anson
- Department of Medicine St George’s University of London London UK
- Faculty of Life Sciences and Medicine King’s College London London UK
| | - Amer Harky
- Department of Cardiothoracic Surgery Liverpool Heart and Chest Liverpool UK
- School of Medicine University of Liverpool Liverpool UK
| |
Collapse
|
517
|
Ng Kee Kwong KC, Mehta PR, Shukla G, Mehta AR. COVID-19, SARS and MERS: A neurological perspective. J Clin Neurosci 2020; 77:13-16. [PMID: 32417124 PMCID: PMC7198407 DOI: 10.1016/j.jocn.2020.04.124] [Citation(s) in RCA: 87] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 04/30/2020] [Indexed: 12/25/2022]
Abstract
Central to COVID-19 pathophysiology is an acute respiratory infection primarily manifesting as pneumonia. Two months into the COVID-19 outbreak, however, a retrospective study in China involving more than 200 participants revealed a neurological component to COVID-19 in a subset of patients. The observed symptoms, the cause of which remains unclear, included impaired consciousness, skeletal muscle injury and acute cerebrovascular disease, and appeared more frequently in severe disease. Since then, findings from several studies have hinted at various possible neurological outcomes in COVID-19 patients. Here, we review the historical association between neurological complications and highly pathological coronaviruses including SARS-CoV, MERS-CoV and SARS-CoV-2. We draw from evidence derived from past coronavirus outbreaks, noting the similarities and differences between SARS and MERS, and the current COVID-19 pandemic. We end by briefly discussing possible mechanisms by which the coronavirus impacts on the human nervous system, as well as neurology-specific considerations that arise from the repercussions of COVID-19.
Collapse
Affiliation(s)
| | - Puja R Mehta
- The National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK
| | - Garima Shukla
- Division of Neurology, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Arpan R Mehta
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK; UK Dementia Research Institute at University of Edinburgh, Edinburgh, UK; Anne Rowling Regenerative Neurology Clinic, University of Edinburgh, Edinburgh, UK; Euan MacDonald Centre, University of Edinburgh, Edinburgh, UK; Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
| |
Collapse
|
518
|
Flexman AM, Abcejo AS, Avitsian R, De Sloovere V, Highton D, Juul N, Li S, Meng L, Paisansathan C, Rath GP, Rozet I. Neuroanesthesia Practice During the COVID-19 Pandemic: Recommendations From Society for Neuroscience in Anesthesiology and Critical Care (SNACC). J Neurosurg Anesthesiol 2020; 32:202-209. [PMID: 32301764 PMCID: PMC7236852 DOI: 10.1097/ana.0000000000000691] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 04/13/2020] [Indexed: 12/12/2022]
Abstract
The pandemic of coronavirus disease 2019 (COVID-19) has several implications relevant to neuroanesthesiologists, including neurological manifestations of the disease, impact of anesthesia provision for specific neurosurgical procedures and electroconvulsive therapy, and health care provider wellness. The Society for Neuroscience in Anesthesiology and Critical Care appointed a task force to provide timely, consensus-based expert guidance for neuroanesthesiologists during the COVID-19 pandemic. The aim of this document is to provide a focused overview of COVID-19 disease relevant to neuroanesthesia practice. This consensus statement provides information on the neurological manifestations of COVID-19, advice for neuroanesthesia clinical practice during emergent neurosurgery, interventional radiology (excluding endovascular treatment of acute ischemic stroke), transnasal neurosurgery, awake craniotomy and electroconvulsive therapy, as well as information about health care provider wellness. Institutions and health care providers are encouraged to adapt these recommendations to best suit local needs, considering existing practice standards and resource availability to ensure safety of patients and providers.
Collapse
Affiliation(s)
- Alana M. Flexman
- Department of Anesthesiology and Perioperative Care, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Arnoley S. Abcejo
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, NY
| | - Rafi Avitsian
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH
| | - Veerle De Sloovere
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - David Highton
- Princess Alexandra Hospital, University of Queensland, Woolloongabba, Australia
| | - Niels Juul
- Department of Anesthesia, Aarhus University Hospital, Aarhus, Denmark
| | - Shu Li
- Department of Anesthesiology, Beijing Tian Tan Hospital, Capital Medical University, Beijing, P.R. China
| | - Lingzhong Meng
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT
| | | | - Girija P. Rath
- Department of Neuroanesthesiology and Critical Care, Neurosciences Centre, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Irene Rozet
- Department of Anesthesiology and Pain Management, University of Washington, Seattle, WA
| |
Collapse
|
519
|
Parihar J, Tripathi M, Dhamija RK. Seizures and Epilepsy in Times of Corona Virus Disease 2019 Pandemic. J Epilepsy Res 2020; 10:3-7. [PMID: 32983949 PMCID: PMC7494888 DOI: 10.14581/jer.20002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/22/2020] [Accepted: 06/05/2020] [Indexed: 01/08/2023] Open
Abstract
The end of the year 2019 was marked by novel coronavirus (severe acute respiratory syndrome coronavirus-2, SARS-CoV-2) outbreak in China that rapidly spread to the rest of the world. While the involvement of the lower respiratory system causing pneumonia is identified as the primary target of the virus, extra-pulmonary manifestations, especially of the central nervous system, are also being increasingly reported. Previous research on Middle East respiratory syndrome coronavirus and SARS-CoV have shown neurological involvement in human coronavirus infections. While several cases of seizures have been reported in patients with coronavirus disease 2019 (COVID-19) patients, there is no specific data to suggest an association of COVID-19 with epilepsy. Epilepsy patients on immunosuppressive medications may have a higher risk of contracting the viral infection. There can be an indirect relation of COVID-19 to epilepsy as the viral infection is associated with fever in most COVID-19 cases, which can lower seizure threshold. Additionally, inadequate sleep and stress due to ongoing pandemic of coronavirus can be another trigger for seizure precipitation in epilepsy patients. Drug compliance, availability of antiepileptic drugs, and drug interactions with COVID-19 experimental drugs are major concerns in epilepsy patients. Adopting telemedicine services and the use of epilepsy helplines may be important in assisting epilepsy patients and ensuring that treatment continues uninterrupted.
Collapse
Affiliation(s)
- Jasmine Parihar
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| | - Manjari Tripathi
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder K Dhamija
- Department of Neurology, Lady Hardinge Medical College & Associated Hospitals, New Delhi, India
| |
Collapse
|
520
|
Douglas KAA, Douglas VP, Moschos MM. Ocular Manifestations of COVID-19 (SARS-CoV-2): A Critical Review of Current Literature. In Vivo 2020; 34:1619-1628. [PMID: 32503820 DOI: 10.21873/invivo.11952] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 12/15/2022]
Abstract
The novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in China in the city of Wuhan in December of 2019 and since then more than 5,000,000 people have been infected, with approximately 338,000 deaths worldwide. The virus causes the coronavirus disease 2019 (COVID-19), which is characterized by fever, myalgia and cough, with severe acute respiratory syndrome being the most fearsome complication. Nevertheless, the vast majority of cases present mild symptoms or none. Central nervous system and cardiovascular manifestations have been reported. The range of ocular manifestations, either as a result of the infection or as a result of the treatment, has not yet been discussed. In this study, a systematic review of current literature relevant to COVID-19 was performed with focus on modes of transmission, ocular manifestations related to infection and medications, as well as the control of infection in ophthalmic practice.
Collapse
Affiliation(s)
- Konstantinos A A Douglas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, U.S.A.,First Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Vivian Paraskevi Douglas
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA, U.S.A
| | - Marilita M Moschos
- First Department of Ophthalmology, Gennimatas General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| |
Collapse
|
521
|
Ghannam M, Alshaer Q, Al-Chalabi M, Zakarna L, Robertson J, Manousakis G. Neurological involvement of coronavirus disease 2019: a systematic review. J Neurol 2020; 267:3135-3153. [PMID: 32561990 PMCID: PMC7304377 DOI: 10.1007/s00415-020-09990-2] [Citation(s) in RCA: 75] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/08/2020] [Accepted: 06/10/2020] [Indexed: 01/08/2023]
Abstract
Background In December 2019, unexplained cases of pneumonia emerged in Wuhan, China, which were found to be secondary to the novel coronavirus SARS-CoV-2. On March 11, 2020, the WHO declared the Coronavirus Disease 2019 (COVID-2019) outbreak, a pandemic. Objective To clarify the neurological complications of SARS-CoV-2 infection including the potential mechanisms and therapeutic options. Methods We conducted a systematic literature search from December 01, 2019 to May 14, 2020 using multiple combinations of keywords from PubMed and Ovid Medline databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We included articles with cases of COVID-19 where neurological involvement was evident. Results We were able to identify 82 cases of COVID-19 with neurological complications. The mean age was 62.3 years. 37.8% of the patients were women (n = 31). 48.8% of the patients (n = 40) had cerebrovascular insults, 28% (n = 23) had neuromuscular disorders, and 23% of the patients (n = 19) had encephalitis or encephalopathy. Conclusions Neurological manifestations of COVID-19 are not rare, especially large vessel stroke, Guillain–Barre syndrome, and meningoencephalitis. Moving forward, further studies are needed to clarify the prevalence of the neurological complications of SARS-CoV-2 infection, investigate their biological backgrounds, and test treatment options. Physicians should be cautious not to overlook other neurological diagnoses that can mimic COVID-19 during the pandemic. Electronic supplementary material The online version of this article (10.1007/s00415-020-09990-2) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Malik Ghannam
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| | - Qasem Alshaer
- Department of Neurology, Emory University, Atlanta, GA USA
| | | | - Lara Zakarna
- Department of Neuroscience, An-Najah National University, Nablus, Palestine
| | - Jetter Robertson
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| | - Georgios Manousakis
- Department of Neurology, University of Minnesota, 516 Delaware St. SE, Minneapolis, MN USA
| |
Collapse
|
522
|
Xiong W, Mu J, Guo J, Lu L, Liu D, Luo J, Li N, Liu J, Yang D, Gao H, Zhang Y, Lin M, Shen S, Zhang H, Chen L, Wang G, Luo F, Li W, Chen S, He L, Sander JW, Zhou D. New onset neurologic events in people with COVID-19 in 3 regions in China. Neurology 2020; 95:e1479-e1487. [PMID: 32554771 DOI: 10.1212/wnl.0000000000010034] [Citation(s) in RCA: 99] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/02/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To investigate new-onset neurologic impairments associated with coronavirus disease 2019 (COVID-19). METHODS A retrospective multicenter cohort study was conducted between January 18 and March 20, 2020, including people with confirmed COVID-19 from 56 hospitals officially designated in 3 Chinese regions; data were extracted from medical records. New-onset neurologic events as assessed by neurology consultants based on manifestations, clinical examination, and investigations were noted, in which critical events included disorders of consciousness, stroke, CNS infection, seizures, and status epilepticus. RESULTS We enrolled 917 people with average age 48.7 years and 55% were male. The frequency of new-onset critical neurologic events was 3.5% (32/917) overall and 9.4% (30/319) among those with severe or critical COVID-19. These were impaired consciousness (n = 25) or stroke (n = 10). The risk of critical neurologic events was highly associated with age above 60 years and previous history of neurologic conditions. Noncritical events were seen in fewer than 1% (7/917), including muscle cramp, unexplained headache, occipital neuralgia, tic, and tremor. Brain CT in 28 people led to new findings in 9. Findings from lumbar puncture in 3 with suspected CNS infection, unexplained headache, or severe occipital neuralgia were unremarkable. CONCLUSIONS People with COVID-19 aged over 60 and with neurologic comorbidities were at higher risk of developing critical neurologic impairment, mainly impaired consciousness and cerebrovascular accidents. Brain CT should be considered when new-onset brain injury is suspected, especially in people under sedation or showing an unexplained decline in consciousness. Evidence of direct acute insult of severe acute respiratory syndrome coronavirus 2 to the CNS is lacking.
Collapse
Affiliation(s)
- Weixi Xiong
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Jie Mu
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Jian Guo
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Lu Lu
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Dan Liu
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Jianfei Luo
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Nian Li
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Jing Liu
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Dan Yang
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Hui Gao
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Yingying Zhang
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Mintao Lin
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Sisi Shen
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Hesheng Zhang
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Lei Chen
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Gang Wang
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Fengming Luo
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Weimin Li
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Shengli Chen
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Li He
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Josemir W Sander
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands
| | - Dong Zhou
- From the Departments of Neurology (W.X., J.M., J.G., L.L., H.G., Y.Z., M.L., S.S., H.Z., L.C., L.H., D.Z.), Pulmonary & Critical Care Medicine (D.L., G.W., W.L.), and Medical Affairs (N.L.), West China Hospital of Sichuan University, Chengdu; Department of Gastrointestinal Surgery (J. Luo), Renmin Hospital of Wuhan University; Department of Neurology (J. Liu, D.Y., S.C.), Chongqing Three Gorges Central Hospital, Chongqing; NIHR University College London Hospitals Biomedical Research Centre (J.W.S.), UCL Queen Square Institute of Neurology, Queen Square, London, UK; Chalfont Centre for Epilepsy (J.W.S.), Chalfont St Peter, UK; and Stichting Epilepsie Instellingen Nederland (SEIN) (J.W.S.), Heemstede, Netherlands.
| |
Collapse
|
523
|
Wang H, Tang X, Fan H, Luo Y, Song Y, Xu Y, Chen Y. Potential mechanisms of hemorrhagic stroke in elderly COVID-19 patients. Aging (Albany NY) 2020; 12:10022-10034. [PMID: 32527987 PMCID: PMC7346040 DOI: 10.18632/aging.103335] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 05/14/2020] [Indexed: 04/11/2023]
Abstract
The novel severe acute respiratory syndrome coronavirus 2 is the causative agent of coronavirus disease 2019, a new human infectious disease. While fever, cough, and respiratory distress are typical first symptoms, a fraction of those affected present instead with neurological symptoms suggestive of central nervous system compromise. This review summarizes the potential contribution of coronavirus disease 2019 to hemorrhagic stroke in the elderly and proposes possible mechanisms. Reports show that the most affected patients have underlying chronic diseases such as hypertension and diabetes, which are two key risk factors for hemorrhagic stroke. Angiotensin-converting enzyme 2 is the main host cell surface receptor interacting with the severe acute respiratory syndrome coronavirus 2 spike glycoprotein to allow viral entry and infection. We speculate that ensuing downregulation of angiotensin-converting enzyme 2 expression may compound the risk conferred by pre-existing comorbidities and critically influence the pathogenesis of hemorrhagic stroke by elevating blood pressure and impairing cerebrovascular endothelial function. Additionally, both age- and/or disease-related immune dysfunction and enhanced catecholamine release secondary to anxiety and stress may also aggravate central nervous system symptoms of severe acute respiratory syndrome coronavirus 2 infection. Thus, assessment of systemic inflammatory biomarkers and tight control of hemodynamic parameters upon admission are crucial to minimize mortality and morbidity in coronavirus disease 2019 patients with central nervous system symptoms suggestive of incipient stroke.
Collapse
Affiliation(s)
- Haili Wang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Xiaojia Tang
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Hongyang Fan
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yuhan Luo
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Yuxia Song
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
- Department of Neurology, Clinical Medical College of Yangzhou, Dalian Medical University, Yangzhou 225000, Jiangsu, China
| | - Yao Xu
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| | - Yingzhu Chen
- Department of Neurology, Clinical Medical College, Yangzhou University, Yangzhou 225000, Jiangsu, China
| |
Collapse
|
524
|
MadaniNeishaboori A, Moshrefiaraghi D, Mohamed Ali K, Toloui A, Yousefifard M, Hosseini M. Central Nervous System Complications in COVID-19 Patients; a Systematic Review and Meta-Analysis based on Current Evidence. ARCHIVES OF ACADEMIC EMERGENCY MEDICINE 2020; 8:e62. [PMID: 33134959 PMCID: PMC7587989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Several studies have confirmed neurological involvements, such as acute cerebrovascular disease and impaired consciousness in COVID-19. In the present study, our aim is to investigate the current evidence regarding central nervous system (CNS) complications in patients with confirmed COVID-19. METHODS An extensive search was conducted in electronic databases including Medline (using PubMed), Embase, Scopus, and Web of Science, in addition to the manual search in Google and Google scholar search engines, for articles published from 2019 until April 21st, 2020. Inclusion criteria was articles that were reviewed and reported the incidence of neurological outcomes in patients with confirmed COVID-19 disease. RESULTS The initial search yielded 638 records, from which 7 articles were included. Overall, the incidence of CNS complications was calculated to be 6.27% (95% CI: 3.32 to 9.98). The incidence of the most common CNS complications, encephalopathy and acute cerebrovascular disease, were 9.14% (95%CI: 2.20 to 19.81) and 2.59% (95% CI: 1.31 to 4.25), respectively. CONCLUSION CNS complications do exist in COVID-19 patients, encephalopathy being the most concerning one. The heterogeneity in the existing literature causes an uncertainty in reporting the definite prevalence rate for each complication. Thus, further studies are needed for scientists to reach a more accurate estimate of the prevalence of these complications in COVID-19 patients. However, healthcare providers should consider the possibility of CNS involvements in patients with SARS-CoV-2 infection.
Collapse
Affiliation(s)
| | | | | | - Amirmohammad Toloui
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Yousefifard
- Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
525
|
Cervantes-Arslanian A, Lau KHV, Anand P, Shulman JG, Ford T, Takahashi C, Daneshmand A, Nguyen TN, Suchdev K, Abdennadher M, Saxena A, Macone A, Perloff MD, Zhu S, Greer DM. Rapid Dissemination of Protocols for Managing Neurology Inpatients with COVID-19. Ann Neurol 2020; 88:211-214. [PMID: 32395831 PMCID: PMC7272820 DOI: 10.1002/ana.25774] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/07/2020] [Accepted: 05/07/2020] [Indexed: 01/06/2023]
Affiliation(s)
| | - K H Vincent Lau
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Pria Anand
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Julie G Shulman
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Thomas Ford
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | | | - Ali Daneshmand
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Thanh N Nguyen
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Kushak Suchdev
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | | | - Aneeta Saxena
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Amanda Macone
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Michael D Perloff
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - Shuhan Zhu
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| | - David M Greer
- Department of Neurology, Boston Medical Center, Boston, Massachusetts
| |
Collapse
|
526
|
Pop R, Quenardelle V, Hasiu A, Mihoc D, Sellal F, Dugay MH, Lebedinsky PA, Schluck E, LA Porta A, Courtois S, Gheoca R, Wolff V, Beaujeux R. Impact of the COVID-19 outbreak on acute stroke pathways - insights from the Alsace region in France. Eur J Neurol 2020; 27:1783-1787. [PMID: 32399995 PMCID: PMC7273043 DOI: 10.1111/ene.14316] [Citation(s) in RCA: 76] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
Abstract
Background and purpose To date, no study has attempted to quantify the impact of the COVID‐19 outbreak on the incidence and treatment of acute stroke. Methods This was a retrospective review of acute stroke pathway parameters in all three stroke units in the Alsace region during the first month of the outbreak (1–31 March 2020), using the similar period from 2019 as a comparator. A secondary detailed analysis of all stroke alerts and stroke unit admissions was performed in the centre with the largest case volume. Results Compared to the same period in 2019, in March 2020 there were 39.6% fewer stroke alerts and 33.3% fewer acute revascularization treatments [40.9% less intravenous thrombolysis (IVT) and 27.6% less mechanical thrombectomy (MT)]. No marked variation was observed in the number of stroke unit admissions (−0.6%). The proportion of patients with acute revascularization treatments (IVT or MT) out of the total number of stroke unit admissions was significantly lower in March 2020 (21.3%) compared to 2019 (31.8%), P = 0.034. There were no significant differences in time delays or severity of clinical symptoms for patients treated by IVT or MT, nor in the distribution of final diagnosis amongst stroke alerts and stroke unit admissions. Conclusion These results suggest that the overall incidence of stroke remained the same, but fewer patients presented within the therapeutic time window. Increased public awareness and corrective measures are needed to mitigate the deleterious effects of the COVID‐19 outbreak on acute stroke care.
Collapse
Affiliation(s)
- R Pop
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.,Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France
| | - V Quenardelle
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - A Hasiu
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - D Mihoc
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France
| | - F Sellal
- Neurology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - M H Dugay
- Neurology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - P A Lebedinsky
- Interventional Neuroradiology Department, Hôpitaux Civils de Colmar, Colmar, France
| | - E Schluck
- Neurology Department, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - A LA Porta
- Neurology Department, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - S Courtois
- Neurology Department, Mulhouse and South Alsace Region Hospital Group, Mulhouse, France
| | - R Gheoca
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - V Wolff
- Stroke Unit, Strasbourg University Hospitals, Strasbourg, France
| | - R Beaujeux
- Interventional Neuroradiology Department, Strasbourg University Hospitals, Strasbourg, France.,Institut de Chirurgie Minime Invasive Guidée par l'Image, Strasbourg, France
| |
Collapse
|
527
|
Finsterer J, Stollberger C. Update on the neurology of COVID-19. J Med Virol 2020; 92:2316-2318. [PMID: 32401352 PMCID: PMC7272942 DOI: 10.1002/jmv.26000] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 05/09/2020] [Indexed: 12/31/2022]
Affiliation(s)
- Josef Finsterer
- Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria
| | | |
Collapse
|
528
|
Venketasubramanian N, Hennerici MG. Stroke in COVID-19 and SARS-CoV-1. Cerebrovasc Dis 2020; 49:235-236. [PMID: 32454503 PMCID: PMC7316642 DOI: 10.1159/000508370] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/04/2020] [Indexed: 01/06/2023] Open
|
529
|
Singh AK, Bhushan B, Maurya A, Mishra G, Singh SK, Awasthi R. Novel coronavirus disease 2019 (COVID-19) and neurodegenerative disorders. Dermatol Ther 2020; 33:e13591. [PMID: 32412679 PMCID: PMC7261984 DOI: 10.1111/dth.13591] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/10/2020] [Accepted: 05/11/2020] [Indexed: 12/28/2022]
Abstract
During the last few months, the whole humanity is experiencing largest and most severe sudden influx of COVID‐19 outbreak caused by the novel coronavirus (CoV) originated from Wuhan, China. According to the WHO reports, total 3 862 676 positive cases and 265 961 deaths have been recorded worldwide due to COVID‐19 infection as of May 9, 2020. CoVs are a large family of viruses (enveloped, single‐stranded RNA viruses), which includes severe acute respiratory syndrome coronavirus (SARS‐CoV) and Middle East respiratory syndrome‐related coronavirus (MERS‐CoV). New SARS CoV2 is the members of Betacoronavirus genus. These viruses cause infections in bats, camels and humans, and a few other associated species. Despite many neurologic complications associated with SARS‐CoV‐2 infection, it is still unclear whether these symptoms results from direct neural injury or due to some other reason. Currently, it appears that most of the neurological symptoms of COVID‐19 are nonspecific and secondary to the systemic illness. A single case of acute hemorrhagic necrotizing encephalopathy has been reported. SARS‐CoV‐2 associated Guillain‐Barré syndrome is an atypical case. Till today, no convincing evidence is available to confirm that the SARS‐CoV‐2 virus directly affects nerves system in humans. However, postinfection surveillance will be necessary to identify the possible post‐COVID‐19 neurologic syndromes.
Collapse
Affiliation(s)
- Anurag Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Bharat Bhushan
- Department of Dentistry, Government Medical College, Haldwani, Nainital, Uttarakhand, India
| | - Anand Maurya
- Institute of Medical Sciences, Faculty of Ayurveda, Department of Medicinal Chemistry, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Gaurav Mishra
- Institute of Medical Sciences, Faculty of Ayurveda, Department of Medicinal Chemistry, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Santosh Kumar Singh
- Centre of Experimental Medicine and Surgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Rajendra Awasthi
- Amity Institute of Pharmacy, Amity University Uttar Pradesh, Noida, Uttar Pradesh, India
| |
Collapse
|
530
|
Gklinos P. Neurological manifestations of COVID-19: a review of what we know so far. J Neurol 2020; 267:2485-2489. [PMID: 32458197 PMCID: PMC7250266 DOI: 10.1007/s00415-020-09939-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/17/2020] [Accepted: 05/19/2020] [Indexed: 12/21/2022]
Abstract
Coronavirus disease 2019 (COVID‐19) has become a pandemic disease globally. While it mostly presents with respiratory symptoms, it has already been found that it could manifest with a series of neurological symptoms as well, either at presentation or during the course of the disease. Symptoms vary from non-specific such as headache or dizziness to more specific such as convulsions and cerebrovascular disease (CVD). This study aims to give an overview of the neurological manifestations of COVID-19 and discuss the potential pathogenetic mechanisms of central nervous system (CNS) involvement. Clinicians and especially internists, neurologists, and infectious disease specialists should be aware of these symptoms and able to recognize them early. Prompt diagnosis and immediate management of the neurological manifestations of the novel coronavirus will not only improve the prognosis of COVID-19 patients but will also prevent the dissemination of the disease due to misdiagnosed cases.
Collapse
Affiliation(s)
- Panagiotis Gklinos
- Neurology Department, KAT General Hospital of Attica, 2 Nikis Str., Kifisia, Attica, 14561, Athens, Greece.
| |
Collapse
|
531
|
Radmanesh A, Derman A, Lui YW, Raz E, Loh JP, Hagiwara M, Borja MJ, Zan E, Fatterpekar GM. COVID-19-associated Diffuse Leukoencephalopathy and Microhemorrhages. Radiology 2020; 297:E223-E227. [PMID: 32437314 PMCID: PMC7507998 DOI: 10.1148/radiol.2020202040] [Citation(s) in RCA: 198] [Impact Index Per Article: 49.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Diffuse leukoencephalopathy and juxtacortical and/or callosal microhemorrhages were brain imaging features in critically ill patients with coronavirus disease 2019. Coronavirus disease 2019 (COVID-19) has been reported in association with a variety of brain imaging findings such as ischemic infarct, hemorrhage, and acute hemorrhagic necrotizing encephalopathy. Herein, the authors report brain imaging features in 11 critically ill patients with COVID-19 with persistently diminished mental status who underwent MRI between April 5 and April 25, 2020. These imaging features include (a) confluent T2 hyperintensity and mild restricted diffusion in bilateral supratentorial deep and subcortical white matter (in 10 of 11 patients) and (b) multiple punctate microhemorrhages in juxtacortical and callosal white matter (in seven of 11 patients). The authors also discuss potential pathogeneses. © RSNA, 2020 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Alireza Radmanesh
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Anna Derman
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Yvonne W Lui
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Eytan Raz
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - John P Loh
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Mari Hagiwara
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Maria J Borja
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Elcin Zan
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| | - Girish M Fatterpekar
- From the Department of Radiology, New York University Grossman School of Medicine, 660 First Ave, 2nd Floor, New York, NY 10016
| |
Collapse
|
532
|
Stroke in patients with SARS-CoV-2 infection: case series. J Neurol 2020; 267:2185-2192. [PMID: 32436105 PMCID: PMC7238403 DOI: 10.1007/s00415-020-09885-2] [Citation(s) in RCA: 173] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/01/2020] [Accepted: 05/04/2020] [Indexed: 01/21/2023]
Abstract
Background Italy is one of the most affected countries by the coronavirus disease 2019 (COVID-19). The responsible pathogen is named severe acute respiratory syndrome coronavirus (SARS-CoV-2). The clinical spectrum ranges from asymptomatic infection to severe pneumonia, leading to intensive care unit admission. Evidence of cerebrovascular complications associated with SARS-CoV-2 is limited. We herein report six patients who developed acute stroke during COVID-19 infection. Methods A retrospective case series of patients diagnosed with COVID-19 using reverse-transcriptase polymerase chain reaction (RT-PCR) on nasopharyngeal swabs, who developed clinical and neuroimaging evidence of acute stroke during SARS-CoV-2 infection. Results Six patients were identified (5 men); median age was 69 years (range 57–82). Stroke subtypes were ischemic (4, 67%) and hemorrhagic (2, 33%). All patients but one had pre-existing vascular risk factors. One patient developed encephalopathy prior to stroke, characterized by focal seizures and behavioral abnormalities. COVID-19-related pneumonia was severe (i.e., requiring critical care support) in 5/6 cases (83%). Liver enzyme alteration and lactate dehydrogenase (LDH) elevation were registered in all cases. Four patients (67%) manifested acute kidney failure prior to stroke. Four patients (67%) had abnormal coagulation tests. The outcome was poor in the majority of the patients: five died (83%) and the remaining one (17%) remained severely neurologically affected (mRS: 4). Conclusions Both ischemic and hemorrhagic stroke can complicate the course of COVI-19 infection. In our series, stroke developed mostly in patients with severe pneumonia and multiorgan failure, liver enzymes and LDH were markedly increased in all cases, and the outcome was poor.
Collapse
|
533
|
Kim BJ, Kim ES, Shin MJ, Kim HB, Lee HY, Hong KS, Park HK, Lee J, Sohn SI, Hwang YH, Ko SB, Park JM, Rha JH, Kwon SU, Kim JS, Heo JH, Lee BC, Yoon BW, Bae HJ. Management of Acute Stroke Patients Amid the Coronavirus Disease 2019 Pandemic: Scientific Statement of the Korean Stroke Society. J Stroke 2020; 22:203-205. [PMID: 32392907 PMCID: PMC7341004 DOI: 10.5853/jos.2020.01291] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 04/20/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Beom Joon Kim
- Department of Neurology and Gyunggi Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Eu Suk Kim
- Department of Internal Medicine and Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myoung Jin Shin
- Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hong Bin Kim
- Department of Internal Medicine and Infection Control Office, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hee Young Lee
- Center for Public Health, Seoul National University Bundang Hospital and Gyeonggi Infectious Disease Control Center, Seongnam, Korea
| | - Keun-Sik Hong
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hong-Kyun Park
- Department of Neurology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Jun Lee
- Department of Neurology, Yeungnam University Hospital, Daegu, Korea
| | - Sung-Il Sohn
- Department of Neurology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Yang-Ha Hwang
- Department of Neurology, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sang-Bae Ko
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Jong-Moo Park
- Department of Neurology, Eulji General Hospital, Eulji University School of Medicine, Seoul, Korea
| | - Joung-Ho Rha
- Department of Neurology, Inha University Hospital, Incheon, Korea
| | - Sun U Kwon
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jong S Kim
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Hoe Heo
- Department of Neurology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Chul Lee
- Department of Neurology, Hallym Neurological Institute, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Byung-Woo Yoon
- Department of Neurology, Seoul National University Hospital, Seoul, Korea
| | - Hee-Joon Bae
- Department of Neurology and Gyunggi Regional Cardiocerebrovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| |
Collapse
|
534
|
COVID-19, Angiotensin Receptor Blockers, and the Brain. Cell Mol Neurobiol 2020; 40:667-674. [PMID: 32385549 PMCID: PMC7207082 DOI: 10.1007/s10571-020-00861-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 05/02/2020] [Indexed: 12/11/2022]
|
535
|
Zhou Y, Li W, Wang D, Mao L, Jin H, Li Y, Hong C, Chen S, Chang J, He Q, Wang M, Hu B. Clinical time course of COVID-19, its neurological manifestation and some thoughts on its management. Stroke Vasc Neurol 2020; 5:177-179. [PMID: 32366614 PMCID: PMC7211099 DOI: 10.1136/svn-2020-000398] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 04/27/2020] [Accepted: 04/29/2020] [Indexed: 12/13/2022] Open
Abstract
Coronavirus disease-2019 (COVID-19) has become a global pandemic. COVID-19 runs its course in two phases, the initial incubation phase and later clinical symptomatic phase. Patients in the initial incubation phase often have insidious clinical symptoms, but they are still highly contagious. At the later clinical symptomatic phase, the immune system is fully activated and the disease may enter the severe infection stage in this phase. Although many patients are known for their respiratory symptoms, they had neurological symptoms in their first 1-2 days of clinical symptomatic phase, and ischaemic stroke occurred 2 weeks after the onset of the clinical symptomatic phase. The key is to prevent a patient from progressing to this severe infection from mild infection. We are sharing our experience on prevention and management of COVID-19.
Collapse
Affiliation(s)
- Yifan Zhou
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Wei Li
- Department of Neurology, Army Medical Center of PLA, Chongqing 400042, China
| | - David Wang
- Neurovascular Division, Barrow Neurological Institute, Saint Joseph Hospital Medical Center, Phoenix, Arizona 85013, USA
| | - Ling Mao
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Huijuan Jin
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Yanan Li
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Candong Hong
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Shengcai Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Jiang Chang
- Department of Epidemiology and Biostatistics, Key Laboratory for Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Sciences and Technology, Wuhan 430030, China
| | - Quanwei He
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Mengdie Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| | - Bo Hu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
| |
Collapse
|
536
|
Scoppettuolo P, Borrelli S, Naeije G. Neurological involvement in SARS-CoV-2 infection: A clinical systematic review. Brain Behav Immun Health 2020; 5:100094. [PMID: 33521692 PMCID: PMC7832728 DOI: 10.1016/j.bbih.2020.100094] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 06/03/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Reports of neurological involvement during Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection course are increasingly described. The aim of this review is to provide a clinical approach of SARS-CoV-2 neurological complications based on the direct or indirect (systemic/immune-mediated) role of the SARS-CoV-2 in their genesis. METHODS A review of the current literature has been carried out up to May 20th 2020 according to the PRISMA guidelines. All case series and reports of adult neurological manifestations associated to SARS-CoV-2 published in English were considered. Review and fundamental research studies on Coronaviruses neuroinvasive potential were analyzed to support pathogenic hypothesis and possible underlying mechanisms. Clinical patterns were subdivided into three groups according to putative underlying mechanisms: direct invasion of central or peripheral nervous system, systemic disorders leading to acute CNS injuries and post-infectious neurological syndromes (PINS). RESULTS Sixteen case series and 26 case reports for a total of 903 patients were identified presenting with neurological involvement during SARS-CoV-2 infection. Hypo/anosmia and dys/ageusia were found in 826 patients and mainly attributed to direct viral invasion. Cerebrovascular complications occurred in 51 patients and related to viral infection associated systemic inflammation. PINS were described in only 26 patients. A wide heterogeneity of these reports emerged concerning the extension of the clinical examination and ancillary exams performed. CONCLUSIONS Neurological complications of SARS-CoV-2 are mainly related to olfactory and gustatory sensory perception disorders through possible direct nervous system invasion while cerebrovascular disease and PINS are rare and due to distinct and indirect pathophysiological mechanisms.
Collapse
Affiliation(s)
| | - Serena Borrelli
- Department of Neurology, CHU-Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - Gilles Naeije
- Department of Neurology, CHU-Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| |
Collapse
|
537
|
Renjen P, Chaudhari D, Mishra A, Bukhari I. COVID-19 and stroke – Updated review. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_89_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
538
|
Adukia SA, Ruhatiya RS, Maheshwarappa HM, Manjunath RB, Jain GN. Extrapulmonary Features of COVID-19: A Concise Review. Indian J Crit Care Med 2020; 24:575-580. [PMID: 32963443 PMCID: PMC7482336 DOI: 10.5005/jp-journals-10071-23476] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Typical manifestations of coronavirus disease (COVID-19) involve the upper and lower respiratory tract. But as the pandemic surges, we are encountering numerous case reports and series of extrapulmonary presentations of COVID-19 in the outpatient department. Abundant retrospective data have also cited various extrapulmonary complications in the hospitalized COVID-19 patients. This knowledge needs to be condensed and disseminated in order to improve COVID-19 surveillance and to reduce the accidental exposure of healthcare workers. Our review suggests that gastrointestinal tract, cardiovascular system, nervous system, renal system, and manifestations due to hematological abnormalities are common masqueraders to watch out for.
Collapse
Affiliation(s)
- Sachin A Adukia
- Department of Neurology, NH Health City, Bengaluru, Karnataka, India
| | - Radhika S Ruhatiya
- Department of Critical Care Medicine, Mazumdar Shaw Medical Centre, Narayana Hrudayalaya, Bengaluru, Karnataka, India
| | - Harish M Maheshwarappa
- Department of Critical Care Medicine, Mazumdar Shaw Medical Centre, Narayana Hrudayalaya, Bengaluru, Karnataka, India
| | - Ramya B Manjunath
- Department of Anesthesia, NH Health City, Bengaluru, Karnataka, India
| | | |
Collapse
|
539
|
Putilina M, Vechorko V, Grishin D, Sidelnikova L. Acute cerebrovascular accidents associated with SARS-CoV-2 coronavirus infection (COVID-19). Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:109-117. [DOI: 10.17116/jnevro2020120121109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
540
|
Gromova O, Torshin I, Semenov V, Putilina M, Chuchalin A. Direct and indirect neurological manifestations of COVID-19. Zh Nevrol Psikhiatr Im S S Korsakova 2020; 120:11-21. [DOI: 10.17116/jnevro202012011111] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|