Manifestaciones neurológicas COVID-19.

  • Carlos Andres Clavijo-Prado Pontificia Universidad Javeriana Cali, Instituto Neurológico del Pacifico http://orcid.org/0000-0001-9486-8529
  • Alvaro Leonardo Abadía-Rincón Pontificia Universidad Javeriana Cali
  • Juliana Aroca-Torres Pontificia Universidad Javeriana Cali
  • Ana Maria Vargas-Ramirez Estudiante de medicina, Pontificia Universidad Javeriana Cali, Colombia
Palabras clave: COVID-19, SARS-CoV-2, síntomas neurológicos, crisis sintomática, epilepsia, ACV, cefalea

Resumen

Desde diciembre de 2019 se ha presentado una vertiginosa propagación de lo que hoy conocemos como Enfermedad por Coronavirus ó COVID-19, denominado así por la organización mundial de la salud (OMS) en marzo del presente año. Actualmente es una emergencia a nivel mundial que ha dejado millones de infectados y miles de muertos. Fue inicialmente reportada en la vecindad de los mercados de animales salvajes en la ciudad de Wuhan (China), descrito como un síndrome respiratorio agudo generado por un microorganismo identificado como Coronavirus 2 (SARS-CoV-2). El murciélago es identificado como reservorio principal de los Coronavirus, sin embargo se cree que el principal reservorio de este virus es el pangolín (mamífero de la especie de los folidotos, originario de países asiáticos). Los síntomas reportados inicialmente fueron principalmente respiratorios, sin embargo, cada vez han sido más evidentes signos y síntomas neurológicos asociados a la infección por este germen, tales como dolor de cabeza, náuseas, vómito, encefalopatía, encefalitis, enfermedad cerebrovascular, anosmia, ageusia, crisis epilépticas , alteración de pares craneales, entre otros síntomas de sistema nervioso central y periférico. A pesar de que la incidencia de estos síntomas no ha sido la mayor, si ha contribuido a incrementar la morbi-mortalidad en individuos más susceptibles, por esto es importante el reconocimiento de los mismos de tal forma que nos permita tomar decisiones oportunas que impacten en el proceso de morbi-mortalidad de los pacientes con COVID-19. Se realizó una búsqueda en MEDLINE, Embase y Lilacs seleccionando guías principalmente con AGREE igual o mayor a 85, adicionalmente se incluyeron algunos estudios observacionales que permitieran una mejor descripción de algunos trastornos reportados como casos. Finalmente se describen las complicaciones neurológicas más frecuentes y se plantean de forma crítica estudios adicionales que permitan esclarecer dudas de nuestro conocimiento actual.

Abstract:

Since December 2019, there has been a vertiginous spread of what we now know as Coronavirus Disease or (COVID-19), named after the World Health Organization (WHO) in March of this year. It is currently a worldwide emergency that has left millions infected and thousands of deaths around the world. It was initially reported in the vicinity of wild animal markets in Wuhan City, China, described as an acute respiratory syndrome generated by a microorganism identified as Coronavirus 2 (SARS-CoV-2). The bat is identified as the main reservoir for Coronaviruses, however it is believed that the main reservoir for this virus is the pangolin (mammal of the folidot species originating in Asian countries). The initial symptoms were mainly respiratory, however, neurological signs and symptoms associated with infection by this germ have been increasingly evident, such as headache, nausea, vomiting, encephalopathy, encephalitis, cerebrovascular disease, anosmia, ageusia, epileptic seizures, alteration of cranial pairs, among others of the nervous and peripheral system. Despite the fact that the incidence of these symptoms has not been the highest, if it has contributed to increasing morbidity and mortality in more susceptible individuals, it is therefore important to recognize them in a way that allows us to make timely decisions that impact on the morbi-mortality process of patients with COVID-19. A search was carried out in MEDLINE, Embase and Lilacs selecting guides mainly with AGREEMENT equal to or greater than 85, additionally some observational studies are included that allow a better description of some disorders reported as cases. Finally, the most frequent neurological complications are described and additional studies are critically proposed that specifically clarify doubts of our current knowledge.

Key words: COVID-19, SARS-CoV-2, neurological symptoms, symptomatic crisis, epilepsy, stroke, headache.

Biografía del autor/a

Carlos Andres Clavijo-Prado, Pontificia Universidad Javeriana Cali, Instituto Neurológico del Pacifico

Médico, Especialista en Neurología, Profesor Departamento de Clínicas Médicas.

Alvaro Leonardo Abadía-Rincón, Pontificia Universidad Javeriana Cali

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Juliana Aroca-Torres, Pontificia Universidad Javeriana Cali

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Ana Maria Vargas-Ramirez, Estudiante de medicina, Pontificia Universidad Javeriana Cali, Colombia

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Citas

Jin Y, Yang H, Ji W, Wu W, Chen S, Zhang W. Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses . 2020). DOI: 10.3390/v12040372.

Li Y, Bai W, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. Journal of medical virology. 2020; 92(7):707-709. DOI: 10.1002/jmv.25824.

Organización Mundial de la Salud. Comentarios del Director General en la sesión informativa para los medios sobre 2019-nCoV el 11 de febrero de 2020.

Jin H, Hong C, Chen S et al. Consensus for prevention and management of coronavirus disease 2019 (COVID-19) for neurologists. Stroke & Vascular Neurology. 2020. DOI: 10.1136/ svn-2020-00038.

Michalicová A, Bhide K, Bhide M, Kováč A. How viruses infiltrate the central nervous system. Acta Virol. 2017. DOI: 10.4149/av_2017_401.

Wright EJ, Brew BJ, Wesselingh SL. Pathogenesis and Diagnosis of Viral Infections of the Nervous System. Neurol Clin 2008; 26(3):617-63. DOI:10.1016/j.ncl.2008.03.006.

Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol. 2020. DOI:10.1002/jmv.25748.

Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020. DOI:10.1016/J.BBI.2020.03.031.

Klein RS, Garber C, Howard N. Infectious immunity in the central nervous system and brain function. Nat Immunol. 2017. DOI:10.1038/ni.3656.

Warren-Gash C, Blackburn R, Whitaker H, McMenamin J, Hayward AC. Laboratory-confirmed respiratory infections as triggers for acute myocardial infarction and stroke: A self controlled case series analysis of national linked datasets from Scotland. Eur Respir J. 2018. DOI:10.1183/13993003.01794-2017

Palacios Cruz M, Santos E, Velázquez Cervantes M, León Juárez M. COVID-19, a worldwide public health emergency. Revista Clínica Española. 2020. DOI:10.1016/j.rce.2020.03.001

Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020; 7(1):11. DOI: 10.1186/s40779-020-00240-0.

Van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. 2020; 382(16):1564-1567. DOI: 10.1056/NEJMc2004973.

Ptacek S, García Moncó J, Azorín D, Ezpeleta D, Erro M, Díez Romero C et al. En: Ezpeleta D, García A (editores). Manual COVID-19 para el neurólogo general. Ediciones SEN; 2020.

Abdul Mannan Baig, Areeba Khaleeq, Usman Ali, and Hira Syeda. Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host−Virus Interaction, and Proposed Neurotropic Mechanisms. ACS Chemical Neuroscience 2020; 11 (7): 995-998.

Steardo L, Zorec R, Verkhratsky A. Neuroinfection may potentially contribute to pathophysiology and clinical manifestations of COVID-19. Acta Physiol. 2020. DOI:10.1111/apha.13473

Brann D, Tsukahara T, Weinreb C, Logan DW, Datta SR. Non-neural expression of SARS-CoV-2 entry genes in the olfactory epithelium suggests mechanisms underlying anosmia in COVID-19 patients. BioRxiv. 2020. DOI:10.1101/2020.03.25.009084.

South AM, Diz D, Chappell MC. COVID-19, ACE2 and the cardiovascular consequences. Am J Physiol Heart Circ Physiol. 2020; 318(5):H1084-H1090. DOI: 10.1152/ajpheart.00217.2020.

Suzuki M, Saito K, Min WP, et al. Identification of viruses in patients with post viral olfactory dysfunction. Laryngoscope. 2007; 117(2):272-277. DOI:10.1097/01.mlg.0000249922.37381.1e

Netland J, Meyerholz DK, Moore S, Cassell M, Perlman S. Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2. J Virol. 2008; 82(15):7264-7275.

Sankowski R, Mader S, Valdés-Ferrer S. Systemic inflammation and the brain: Novel roles of genetic, molecular, and environmental cues as drivers of neurodegeneration. Front Cell Neurosci. 2015. DOI:10.3389/fncel.2015.00028

McNeil JB, Hughes CG, Girard T, et al. Plasma biomarkers of inflammation, coagulation, and brain injury as predictors of delirium duration in older hospitalized patients. PLoS One. 2019. DOI:10.1371/journal.pone.0226412.

Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost. 2020; 4:844-847. DOI: 10.1111/jth.14768.

Chan JF, Zhang AJ, Yuan S, et al. Simulación de las manifestaciones clínicas y patológicas de la enfermedad por coronavirus 2019 (COVID-19) en modelo golden de hámster sirio: implicaciones para la patogénesis y la transmisibilidad de la enfermedad. Clin Infect Dis. 2020. DOI: 10.1093/cid/ciaa325.

Gu J, Gong E, Zhang B, et al. Multiple organ infection and the pathogenesis of SARS. J Exp Med. 2005. DOI:10.1084/jem.20050828.

Kadoguchi T, Kinugawa S, Takada S, et al. Angiotensin II can directly induce mitochondrial dysfunction, decrease oxidative fibre number and induce atrophy in mouse hindlimb skeletal muscle. Exp Physiol. 2015. DOI:10.1113/expphysiol.2014.084095.

Ogata M, Satou T, Kadota J, Saito N, Yoshida T, Okumura H, Ueki T, Nagafuji K, Kako S, Uoshima N, Tsudo M, Itamura H, Fukuda T. Human herpesvirus 6 (HHV-6) reactivation and HHV-6 encephalitis after allogeneic hematopoietic cell transplantation: a multicenter, prospective study. Clinical Infectious Diseases. 2013; 57(5):671-681. DOI: 10.1093/cid/cit358.

Helms J, Kremer S, Merdji H, Schenck M, Kummerlen C , Collange O , Boulay C, Kremer S, Ohana M, Anheim M, Meziani F. Neurologic Features in Severe SARS-CoV-2 Infection . N Engl J Med. 2020; 382(23):2268-2270. DOI: 10.1056/NEJMc2008597.

Lau KK, Yu WC, Chu CM, Lau ST, Sheng B, Yuen KY. Possible central nervous system infection by SARS coronavirus. Emerg Infect DIS. 2004; 10:342-4. DOI: 10.3201/eid1002.030638.

Arabi YM, Harthi A, Hussein J, et al. Severe neurologic syndrome associated with Middle East respiratory syndrome coronavirus (MERS-CoV) Infection. 2015; 43(4):495-501. DOI: 10.1007/s15010-015-0720-y.

Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77(6):683-690. DOI:10.1001/jamaneurol.2020.1127.

Gutiérrez-Ortiz C, Méndez A, Rodrigo-Rey S, San Pedro-Murillo E, Bermejo-Guerrero L, Gordo-Mañas R, Aragón-Gómez F, Benito-León J. Miller Fisher Syndrome and polyneuritis cranialis in COVID-19. Neurology. 2020. DOI: 10.1212/WNL.0000000000009619.

Dana Leifer, COVID-19 presenting with ophthalmoparesis from cranial nerve palsy. Neurology 2020. DOI: 10.1212/WNL.0000000000009700

Lu L e. New onset acute symptomatic seizure and risk factors in coronavirus disease 2019: A retrospective multicenter study. Epilepsia. 2020; 61(6):e49-e53. DOI: 10.1111/epi.16524.

COVID-19 drug interactions. University of Liverpool. Actualizado el 9 de abril de 2020. Disponible en: http://www.covid19-druginteractions.org/

Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M, Talbot J, Human Coronaviruses and Other Respiratory Viruses: Underestimated Opportunistic Pathogens of the Central Nervous System Viruses. 2019; 12(1). DOI: 10.3390/v12010014.

Rivera LMS, Ávila DF, Molano WB, Arroyave DJ, Ramírez AJB, Maldonado AD, Loaiza JHI, Jáuregui E, Muñoz MCL, Restrepo JP, Charry JSS. Recomendaciones sobre el manejo de pacientes adultos con enfermedades reumáticas en el contexto de la infección por SARS-CoV-2 / COVID-19. Asociación Colombiana de Reumatología. Revista Colombiana de Reumatología. 2020. DOI: 10.1016/j.rcreu.2020.05.007.

Publicado
2020-08-12
Cómo citar
Clavijo-Prado, C., Abadía-Rincón, A., Aroca-Torres, J., & Vargas-Ramirez, A. (2020). Manifestaciones neurológicas COVID-19. Salutem Scientia Spiritus, 6(1), 124-131. Recuperado a partir de https://revistas.javerianacali.edu.co/index.php/salutemscientiaspiritus/article/view/2322