Manifestaciones neurológicas de la infección COVID-19

  • Andres Ricaurte-Fajardo Pontificia Universidad Javeriana Bogotá https://orcid.org/0000-0002-7374-4460
  • Juan Sebastian Ricaurte Pontificia Universidad Javeriana Cali
  • Valeria Hernández-Aguirre Pontificia Universidad Javeriana Cali
  • Carlos Andrés Clavijo-Prado, Dr. Pontificia Universidad Javeriana Cali https://orcid.org/0000-0001-9486-8529
Palabras clave: COVID-19, Coronavirus, Cefalea, Manifestaciones neurológicas, SARS-CoV-2

Resumen

El COVID-19 es una entidad infecciosa con una alta capacidad de contagio que se ha propagado rápidamente a lo largo del mundo, se caracteriza por generar síntomas respiratorios, sin embargo, se ha descrito la presencia de síntomas neurológicos asociados a la enfermedad, dentro de los más importantes se encuentran la cefalea, anosmia y disgeusia, los cuáles pueden aparecer incluso antes que los síntomas respiratorios. El objetivo de esta revisión de la literatura es realizar una descripción de la información publicada en cuanto a las manifestaciones neurológicas de la infección por SARS-CoV-2. Se realizó una búsqueda de artículos en MEDLINE vía PubMed, Google Académico, EMBASE, SCIELO y Scopus con los términos en inglés “Central Nervous system”, “Neurological manifestations”, “COVID-19” y “SARS CoV-2”, sin restricción en cuanto a fecha de publicación ni idioma. Se encontró que el virus tiene una alta capacidad de invadir el sistema nervioso central, en el presente artículo describimos las diferentes complicaciones a nivel cerebral, como encefalitis viral, encefalopatía tóxica infecciosa y enfermedad cerebrovascular (ataque cerebrovascular isquémico agudo y hemorrágico), así como algunos puntos clave para la identificación oportuna de las mismas, lo que permite una mejor toma de decisiones y tener un impacto positivo en términos de morbi-mortalidad.

Abstract:

COVID-19 is a highly contagious infectious disease, it is characterized by generating respiratory symptoms, however, the presence of neurological symptoms associated with the disease has been described, among the most important are headache, anosmia and dysgeusia, which can appear even before respiratory symptoms. The objective of this literature review is to describe the published data regarding the neurological manifestations of SARS-CoV-2 infection. A search for articles was carried out in MEDLINE via PubMed, Google Scholar, EMBASE, SCIELO and Scopus with the terms in English: “Central Nervous system”, “Neurological manifestations”, “COVID-19” and “SARS CoV-2”, without restriction on publication date and language. It was found that the virus has a high capacity to invade the central nervous system, in this article we describe the different complications at the cerebral level, such as viral encephalitis, infectious toxic encephalopathy and cerebrovascular disease (ischemic stroke and intracerebral hemorrhage), as well as some key points for the timely identification of them, allowing better decision making and having a positive impact in terms of morbidity and mortality.

Key words: COVID-19, Coronavirus, headache, neurological manifestations, SARS-CoV-2.

 

Biografía del autor/a

Andres Ricaurte-Fajardo, Pontificia Universidad Javeriana Bogotá

 

 Médico, Semillero de Neurología y Neurocirugía.

Juan Sebastian Ricaurte, Pontificia Universidad Javeriana Cali

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Valeria Hernández-Aguirre, Pontificia Universidad Javeriana Cali

Estudiante de medicina, Semillero de Innovadores en Salud ISSEM.

Carlos Andrés Clavijo-Prado, Dr., Pontificia Universidad Javeriana Cali

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

Citas

Asadi-Pooya AA, Simani L. Central nervous system manifestations of COVID-19: A systematic review. J Neurol Sci. 2020; 413: 116832. DOI: 10.1016/j.jns.2020.116832

Rothan HA, Byrareddy SN. The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun.2020; 109:102433. DOI: 10.1016/j.jaut.2020.102433.

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med . 2020; 382(8):727-733. DOI: 10.1056/NEJMoa2001017.

Driggin E, Madhavan MV, Bikdeli B, Chuich T, Laracy J, Biondi-Zoccai G et al. Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic. J Am Coll Cardiol. 2020; 75(18):2352-2371. DOI: 10.1016/j.jacc.2020.03.031.

Lake MA. What we know so far: COVID-19 current clinical knowledge and research. Clin Med (Lond). 2020; 20(2):124-127. DOI: 10.7861/clinmed.2019-coron.

García Alfonso C, Martínez Reyes AE, García V, Ricaurte Fajardo A, Torres I, Coral Casas J. Actualización en diagnóstico y tratamiento del ataque cerebrovascular isquémico agudo. Univ Médica. 2019; 60(3):41-57

Carod Artal FJ. Complicaciones neurológicas por coronavirus y COVID-19. Rev Neurol. 2020; 70(9):311-322. DOI: 10.33588/rn.7009.2020179.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet . 2020; 395(10223):497-506. DOI: 10.1016/S0140-6736(20)30183-5.

Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. 2020; 323(14):1406-1407. DOI: 10.1001/jama.2020.2565.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients with 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. DOI: 10.1001/jama.2020.1585.

Chang D, Lin M, Wei L, Xie L, Zhu G, Dela Cruz CS et al. Epidemiologic and Clinical Characteristics of Novel Coronavirus Infections Involving 13 Patients Outside Wuhan, China. JAMA . 2020; 323(11):1092-1093. DOI: 10.1001/jama.2020.1623.

Shen KL, Yang YH. Diagnosis and treatment of 2019 novel coronavirus infection in children: a pressing issue. World J Pediatr. 2020; 1-3. DOI: 10.1007/s12519-020-00344-6.

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4):420-422. DOI: 10.1016/S2213-2600(20)30076-X.

Geng YJ, Wei ZY, Qian HY, Huang J, Lodato R, Castriotta RJ. Pathophysiological characteristics and therapeutic approaches for pulmonary injury and cardiovascular complications of coronavirus disease 2019. Cardiovasc Pathol. 2020; 47:107228. DOI: 10.1016/j.carpath.2020.107228.

Frizzelli A, Tuttolomondo D, Aiello M, Majori M, Bertorelli G, Chetta A. What happens to people’s lungs when they get coronavirus disease 2019?. Acta Biomed . 2020; 91(2):146-149. DOI: 10.23750/abm.v91i2.9574.

Xu X, Chen P, Wang J, Feng J, Zhou H, Li X et al. Evolution of the novel coronavirus from the ongoing Wuhan outbreak and modeling of its spike protein for risk of human transmission. Sci China Life Sci. 2020; 63(3):457-460. DOI: 10.1007/s11427-020-1637-5.

Wu Y, Xu X, Chen Z, Duan J, Hashimoto K, Yang L et al. Nervous system involvement after infection with COVID-19 and other coronaviruses. Brain Behav Immun. 2020; 87:18-22.

Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020; 277(8):2251-61. https://doi.org/10.1007/s00405-020-05965-1

Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol . 2019; 17(3):181-192. DOI: 10.1038/s41579-018-0118-9.

Lu R, Zhao X, Li J, Niu P, Yang B, Wu H et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395(10224):565-574. DOI: 10.1016/S0140-6736(20)30251-8.

Schoeman D, Fielding BC. Coronavirus envelope protein: Current knowledge. Virol J . 2019; 16(1):69. DOI: 10.1186/s12985-019-1182-0.

Corman VM, Lienau J, Witzenrath M. Coronaviruses as the cause of respiratory infections. Internist (Berl) . 2019; 60(11):1136-1145. DOI: 10.1007/s00108-019-00671-5.

Wu A, Peng Y, Huang B, Ding X, Wang X, Niu P et al. Genome Composition and Divergence of the Novel Coronavirus (2019-nCoV) Originating in China. Cell Host Microbe . 2020; 27(3):325-328. DOI: 10.1016/j.chom.2020.02.001.

Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 2020; ciaa330. DOI: 10.1093/cid/ciaa330.

Koyuncu OO, Hogue IB, Enquist LW. Virus infections in the nervous system. Cell Host Microbe. 2013; 13(4): 379-393. DOI: 10.1016/j.chom.2013.03.010

Lozano J. Fisiopatología, diagnóstico y tratamiento de las cefaleas. Offarm. 2001; 20;96-107

Olesen J. Headache Classification Committee of the International Headache Society (IHS) The International Classification of Headache Disorders, 3rd edition. Cephalalgia. 2018; 38(1):1-211. DOI: 10.1177/0333102417738202.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020 Apr 30;382(18):1708-1720. DOI: 10.1056/NEJMoa2002032

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; 10;77(6):1-9

Desforges M, Le Coupanec A, Dubeau P, Bourgouin A, Lajoie L, Dubé M et al. Human coronaviruses and other respiratory viruses: Underestimated opportunistic pathogens of the central nervous system?. Viruses. 2019; 12(1):14. DOI: 10.3390/v12010014.

Morfopoulou S, Brown JR, Davies EG, Anderson G, Virasami A, Qasim W, et al. Human coronavirus OC43 associated with fatal encephalitis. N Engl J Med. 2016; 375(5):497-8. DOI: 10.1056/NEJMc1509458.

Platt MP, Bolding KA, Wayne CR, Chaudhry S, Cutforth T, Franks KM, et al. Th17 lymphocytes drive vascular and neuronal deficits in a mouse model of postinfectious autoimmune encephalitis. Proc Natl Acad Sci U S A . 2020; 117(12):6708-6716. DOI: 10.1073/pnas.1911097117.

Greenlee JE. Encephalitis and postinfectious encephalitis. Continuum (Minneap Minn). 2012; 18(:1271-89. DOI: 10.1212/01.CON.0000423847.40147.06.

Venkatesan A, Murphy OC. Viral Encephalitis. Neurol Clin. 2018; 36(4):705-724. DOI: 10.1016/j.ncl.2018.07.001.

Dubey D, Pittock SJ, Kelly CR, McKeon A, Lopez-Chiriboga AS, Lennon VA et al. Autoimmune encephalitis epidemiology and a comparison to infectious encephalitis. Ann Neurol . 2018; 83(1):166-177. DOI: 10.1002/ana.25131.

Moriguchi T, Harii N, Goto J, Harada D, Sugawara H, Takamino J, et al. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int J Infect Dis . 2020;94:55–8. Available from: https://doi.org/10.1016/j.ijid.2020.03.062

Ellul MA, Benjamin L, Singh B, Lant S, Michael BD, Easton A, et al .Neurological associations of COVID-19. Lancet Neurol . 2020 Jul 2;S1474-4422(20)30221-0.

Varatharaj A, Thomas N, Ellul MA, Davies NWS, Pollak TA, Tenorio EL et al. Neurological and neuropsychiatric complications of COVID-19 in 153 patients: a UK-wide surveillance study. Lancet Psychiatry. 2020; 25:S2215-0366(20)30287-X. DOI: 10.1016/S2215-0366(20)30287-X.

Helms J, Kremer S, Merdji H, Clere-Jehl R, Schenck M, Kummerlen C et al. Neurologic features in severe SARS-COV-2 infection. N Engl J Med. 2020 Jun 4;382(23):2268-2270. DOI: 10.1056/NEJMc2008597.

Agarwal A, Gutch M, Kumar S, Agrawal S. State of the globe: Acute febrile encephalopathy. J Glob Infect Dis. 2016;8(4):127-128. DOI: 10.4103/0974-777X.193748.

Chaudhuri A, Kennedy PGE. Diagnosis and treatment of viral encephalitis. Postgraduate Medical Journal 2002; 78:575-583

Modi A, Atam V, Jain N, Gutch M, Verma R. The etiological diagnosis and outcome in patients of acute febrile encephalopathy: A prospective observational study at tertiary care center. Neurol India. 2012; 60(2):168-73. DOI: 10.4103/0028-3886.96394.

Kumar S, Pandey AK, Gutch M, Razi SM, Gupta A, Jain N et al. Acute viral encephalitis clinical features and outcome: Experience from a tertiary center of North India. Ann Trop Med Public Heal. 2015; 8:262-266

Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP et al. Large-Vessel Stroke as a Presenting Feature of Covid-19 in the Young. N Engl J Med . 2020; 382(20):e60. DOI: 10.1056/NEJMc2009787.

Li Y, Wang M, Zhou Y, Chang J, Xian Y, Mao L et al. Acute Cerebrovascular Disease Following COVID-19: A Single Center, Retrospective, Observational Study. 2020. Disponible en: https://papers.ssrn.com/sol3/papers.cfm?abstract_id=3550025

Valderrama EV, Humbert K, Lord A, Frontera J, Yaghi S. Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Ischemic Stroke. Stroke. 2020; STROKEAHA120030153. DOI: 10.1161/STROKEAHA.120.030153.

Amaya P, Bayona H, Folleco E, Martínez C, Coral J, Roa LF et al. Recomendaciones de diagnóstico y tratamiento del ataque cerebrovascular isquémico agudo durante la contingencia por covid-19 Recommendations for diagnosis and treatment of the acute ischemic stroke during COVID-19 contingency. Acta. Neurol. Colomb. 2020; 36(2):1-10.

Dafer RM, Osteraas ND, Biller J. Acute Stroke Care in the Coronavirus Disease 2019 Pandemic. J Stroke Cerebrovasc Dis . 2020; 104881. DOI: 10.1016/j.jstrokecerebrovasdis.2020.104881.

Melandri G, Vagnarelli F, Calabrese D, Semprini F, Nanni S, Branzi A. Review of tenecteplase (TNKase) in the treatment of acute myocardial infarction. Vasc Health Risk Manag. 2009; 5(1):249-56. DOI: 10.2147/vhrm.s3848.

Guillermin A, Yan DJ, Perrier A, Marti C. Safety and efficacy of tenecteplase versus alteplase in acute coronary syndrome: A systematic review and meta-Analysis of randomized trials. Arch Med Sci . 2016; 12(6):1181-1187. DOI: 10.5114/aoms.2016.58929.

Suzuki K, Kimura K, Takeuchi M, Morimoto M, Kanazawa R, Kamiya Y et al. The randomized study of endovascular therapy with versus without intravenous tissue plasminogen activator in acute stroke with ICA and M1 occlusion (SKIP study). Int J Stroke. 2019; 14(7):752-755. DOI: 10.1177/1747493019840932. Epub 2019 Mar 29.

Sharifi-Razavi A, Karimi N, Rouhani N. COVID-19 and intracerebral haemorrhage: causative or coincidental?. New Microbes New Infect. 2020; 35:100669.

Sahin AR. 2019 Novel Coronavirus (COVID-19) Outbreak: A Review of the Current Literature. EJMO 2020; 4(1):1-7. DOI: 10.14744/ejmo.2020.12220

Saavedra JM. Brain angiotensin II: New developments, unanswered questions and therapeutic opportunities. Cell Mol Neurobiol . 2005; 25(3-4):485-512. DOI: 10.1007/s10571-005-4011-5.

Klempin F, Mosienko V, Matthes S, Villela DC, Todiras M, Penninger JM et al. Depletion of angiotensin-converting enzyme 2 reduces brain serotonin and impairs the running-induced neurogenic response. Cell Mol Life Sci. 2018; 75(19):3625-3634. DOI: 10.1007/s00018-018-2815-y.

Dogra S, Jain R, Cao M, Bilaloglu S, Zagzag D, Hochman S et al. Hemorrhagic stroke and anticoagulation in COVID-19. J Stroke Cerebrovasc Dis. 2020; 29(8):1-6.

Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B. COVID-19 associated Acute Hemorrhagic Necrotizing Encephalopathy: CT and MRI Features. Radiology . 2020 Mar 31; 201187. DOI: 10.1148/radiol.2020201187.

Zhao H, Shen D, Zhou H, Liu J, Chen S. Guillain-Barré syndrome associated with SARS-CoV-2 infection: causality or coincidence?. Lancet Neurol . 2020; 19(5):383-384. DOI: 10.1016/S1474-4422(20)30109-5.

Padroni M, Mastrangelo V, Asioli GM, Pavolucci L, Abu-Rumeileh S, Piscaglia MG et al. Guillain-Barré syndrome following COVID-19: new infection, old complication?. J Neurol . 2020; 1-3. DOI: 10.1007/s00415-020-09849-6.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020; 395(10229):1033-1034. DOI: 10.1016/S0140-6736(20)30628-0.

Willison HJ, Jacobs BC, van Doorn PA. Guillain-Barré syndrome. Lancet. 2016; 388(10045):717-27. DOI: 10.1016/S0140-6736(16)00339-1.

Kim JE, Heo JH, Kim HO, Song SH, Park SS, Park TH et al. Neurological complications during treatment of middle east respiratory syndrome. J Clin Neurol . 2017; 13(3):227-233. DOI: 10.3988/jcn.2017.13.3.227.

Publicado
2020-08-12
Cómo citar
Ricaurte-Fajardo, A., Ricaurte, J., Hernández-Aguirre, V., & Clavijo-Prado, C. (2020). Manifestaciones neurológicas de la infección COVID-19. Salutem Scientia Spiritus, 6(1), 132-140. Recuperado a partir de https://revistas.javerianacali.edu.co/index.php/salutemscientiaspiritus/article/view/2329