• Coronavirus : un peu moins de 6 patients sur 10 souffrent de problèmes neurologiques. Étude sur 841 patients hospitalisés à Albacete en Espagne

    6 de cada 10 pacientes con coronavirus desarrollaron algún problema neurológico

    Un estudio publicado en la revista Neurology, el más extenso hasta la fecha, revisa a un total de 841 pacientes hospitalizados en Albacete, España, durante el mes de marzo

    Hasta 57,4% de los pacientes afectados por coronavirus ha desarrollado algún tipo de síntoma neurológico, según queda recogido en el trabajo llevado a cabo por un grupo de investigadores, liderado por el profesor de la Universidad de Castilla-La Mancha y jefe de Neurología del Hospital Universitario de Albacete, Tomás Segura.

    El trabajo, publicado en la revista Neurology, el más extenso hasta la fecha, revisa a un total de 841 pacientes hospitalizados en Albacete, España, durante el mes de marzo, informó en nota de prensa la universidad.

    Mialgias principalmente, además de cefaleas y encefalopatías son algunos de los síntomas neurológicos que han desarrollado hasta el 57,4% de los 841 pacientes que fueron hospitalizados en Albacete por covid-19 durante el mes de marzo, tal y como revela esta publicación de gran relevancia a nivel internacional, pues es uno de los primeros artículos que se publican sobre complicaciones neurológicas y sirve de base para sucesivas investigaciones y revisiones de la comunidad científica.

    • Neurologic manifestations in hospitalized patients with COVID-19: The ALBACOVID registry | Neurology

      Objective: The coronavirus disease 2019 (COVID-19) has spread worldwide since December 2019. Neurological symptoms have been reported as part of the clinical spectrum of the disease. We aim to determine whether neurological manifestations are common in hospitalized COVID-19 patients and to describe their main characteristics.

      Methods: We systematically review all patients diagnosed with COVID-19 admitted to hospital in a Spanish population during March 2020. Demographic characteristics, systemic and neurological clinical manifestations, and complementary tests were analyzed.

      Results: Of 841 patients hospitalized with COVID-19 (mean age 66.4 years, 56.2% men) 57.4% developed some form of neurological symptom. Nonspecific symptoms such as myalgias (17.2%), headache (14.1%), and dizziness (6.1%) were present mostly in the early stages of infection. Anosmia (4.9%) and dysgeusia (6.2%) tended to occur early (60% as the first clinical manifestation) and were more frequent in less severe cases. Disorders of consciousness occurred commonly (19.6%), mostly in older patients and in severe and advanced COVID-19 stages. Myopathy (3.1%), dysautonomia (2.5%), cerebrovascular diseases (1.7%), seizures (0.7%), movement disorders (0.7%), encephalitis (n=1), Guillain-Barré syndrome (n=1), and optic neuritis (n=1) were also reported, but less frequent. Neurological complications were the main cause of death in 4.1% of all deceased study subjects.

      Conclusions: Neurological manifestations are common in hospitalized COVID-19 patients. In our series, more than half of patients presented some form of neurological symptom. Clinicians need to maintain close neurological surveillance for prompt recognition of these complications. The investigation of the mechanisms and emerging consequences of SARS-CoV-2 neurological involvement require further studies.

    • Il y a bien sûr une différence entre symptômes neurologiques et atteinte directe du système nerveux ; les symptômes par mécanisme indirect sont beaucoup plus fréquents : par exemple les insuffisances respiratoire, rénale, hépatique qui peuvent se voir dans toutes les infections graves et pas seulement dans la covid-19 se répercutent toutes sur le cerveau ; sans même aller jusque là une simple fièvre quelque soit son origine ou même une simple cystite sans fièvre peuvent entraîner une confusion mentale chez le sujet âgé.

    • emerging spectrum of COVID-19 neurology : clinical, radiological and laboratory findings | Brain | Oxford Academic

      Quand les symptômes neurologiques peuvent être regroupés en syndromes, les auteurs retiennent, de manière isolée ou associés, 5 mécanismes : les effets systémiques d’une infection grave (dans lesquels on peut compter les défaillances d’organes évoqués dans mon précédent post) le choc cytokinique et l’hyperinflammation (entre autres cérébrale) qui en résulte ; auto-immunité dite post infectieuse (dirigée contre le système nerveux central ou périphérique) ; atteinte vasculaire et/ou de la coagulation (responsable d’infarctus ou d’hémorragies cérébraux) ; une atteinte directe, mécanisme a priori exceptionnel.

      The potential mechanisms underpinning the syndromes described include either individually, or in combination, direct viral injury, a secondary hyperinflammation syndrome related to cytokines including IL-6 (Mehta et al., 2020), vasculopathy and/or coagulopathy, post-infectious inflammation including autoantibody production to neuronal antigens, and the effects of a severe systemic disorder with the neurological consequences of sepsis and hypoxia. Evidence of direct viral infection has proved elusive so far with only a few cases with SARS-CoV-2 in CSF reported, and few supportive histopathological features , though clearly further study would be helpful (Reichard et al., 2020, Von Weyhern et al., 2020). Elevation of pro-inflammatory cytokines was found to correlate with COVID-19 disease severity (Herold et al., 2020; Huang et al., 2020), and some patients responded to IL-1 or IL- 6 blockade (Cavalli et al., 2020; Price et al., 2020); in support of this possible mechanism, transient splenial lesions have been reported in a number of cases, including in children with multisystem inflammatory syndrome (MIS-C), in which elevated cytokines are thought to play a role (Starkey et al., 2017; Abdel-Mannan et al., 2020; Hayashi et al., 2020; Riollano- Cruz et al., 2020). Interestingly, some of the clinical features seen in our youngest patient (Patient 39, aged 16 with pseudotumour cerebri with cranial nerve palsies) overlapped with those seen in MIS-C, including gastrointestinal symptoms, rash and cardiac involvement (Supplementary Table 1). Exact mechanisms in each case will be largely speculative until clear clinical, radiological and histological correlates have been drawn; given the breadth of clinical presentations, it is likely that a number or spectrum of these mechanisms are involved.

    • Defining causality in #COVID-19 and neurological disorders | Journal of Neurology, Neurosurgery & Psychiatry


      Clinicians are increasingly recognising neurological presentations occur in some patients.1 A case series from Wuhan described associated neurological syndromes (eg, ‘dizziness’ and ‘impaired consciousness’), but with little detail regarding symptomatology, and cerebrospinal fluid (CSF) and neuroimaging findings.2 The extent to which these disorders were caused by the virus per se, rather than being complications of critical illness, unmasking of degenerative disease, or iatrogenic effects of repurposed medications is not clear.

      Numerous case reports have since emerged and, at the time of writing, published cases include encephalopathy,3 encephalitis,4 Guillain-Barré syndrome (GBS)5 and stroke.6 In most of these cases, the virus has been identified in respiratory samples, and in a small number in CSF. So far, the reporting of clinical features has been extremely variable, for example, several cases have claimed to report encephalitis without clear evidence of central nervous system (CNS) inflammation, which would not meet established definitions of the disease.7

      Whether severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) is associated with neurological manifestations is of critical importance as this may result in substantial morbidity and mortality.

      Defining causality
      It is crucial that neurologists and neuropsychiatrists apply a systematic strategy to determine whether there is evidence that SARS-CoV2 is causing these manifestations, whether they are a consequence of severe systemic disease alone, or simply coincidence. In 1965, Hill proposed criteria on which to build an argument for disease causation, which can be applied to COVID-19.8

      What is the strength of the association?
      So far, it appears fairly weak . >2.5 million people have been infected with SARS-CoV2 and to date (to the authors’ knowledge) there have been only 93 published cases of neurological manifestations (about 5/100 000). However, reported cases are an underestimate of the real incidence, and this underscores the need for proper epidemiological study.

    • #Anosmie, #migraines… : ces symptômes neurologiques qui persistent #post-COVID

      Medscape édition française : Quels sont les troubles neurologiques que vous observez en post-Covid ?
      Pr Dominique Salmon–Ceron : Notre consultation post-Covid, où il y a beaucoup de passage, nous a permis de repérer un certain nombre de symptômes neurologiques persistants. Les patients rapportent notamment des sensations de fourmillements, de ruissellement qui touchent le plus souvent les membres mais qui peuvent aussi se situer autour du nez, de la tête ou ailleurs.
      Nous observons aussi des dysrégulations thermiques, des problèmes de déglutition, des migraines prolongées et des anosmies.
      Ces symptômes apparaissent quelque temps après la phase aiguë de l’infection alors que les patients vont mieux. Ils évoluent parfois par poussées successives. Mais, avec le temps, les poussées ont tendance à diminuer.

      Nous avons donc la preuve que le SARS-CoV-2 s’attaque au système nerveux ?
      Pr Salmon–Ceron : Le SARS-CoV-2 est clairement un virus avec un neurotropisme, une avidité pour le cerveau. Mais, nous ne savons pas trop ce qui se passe. Est-ce une réponse immune disproportionnée, la myéline est-elle atteinte ? Les études débutent. Pour l’instant nous n’avons pas de réponse.


    • Maître Pandaï sur Twitter : "Étude de cohorte sur 60 patients, par IRM : « Nos résultats révèlent une possible perturbation de l’intégrité fonctionnelle du cerveau dans la phase de récupération du Covid-19, suggérant un potentiel de neuro-invasion de SARS-CoV-2. » https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30228-5/fulltext" / Twitter

    • Neurological associations of COVID-19 - The Lancet Neurology

      Precise case definitions must be used to distinguish non-specific complications of severe disease (eg, hypoxic encephalopathy and critical care neuropathy) from those caused directly or indirectly by the virus, including infectious, para-infectious, and post-infectious encephalitis, hypercoagulable states leading to stroke, and acute neuropathies such as Guillain-Barré syndrome. Recognition of neurological disease associated with SARS-CoV-2 in patients whose respiratory infection is mild or asymptomatic might prove challenging, especially if the primary COVID-19 illness occurred weeks earlier. The proportion of infections leading to neurological disease will probably remain small . However, these patients might be left with severe neurological sequelae. With so many people infected, the overall number of neurological patients, and their associated health burden and social and economic costs might be large.