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      Daño neurológico en infecciones por SARS-CoV-2 Translated title: Neurological damage in SARS-CoV-2 infections

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          Abstract

          RESUMEN La actual pandemia producida por el coronavirus 2 del síndrome respiratorio agudo severo (SARS-CoV-2), ha impactado gravemente la economía y el sistema de salud en más de 190 países de todo el mundo en un evento sin precedentes, que desde su inicio ha dado lugar a innumerables informes de casos centrados en las manifestaciones sistémicas y respiratorias potencialmente mortales de la enfermedad. Sin embargo, aún no se conoce por completo el alcance de las posibles manifestaciones neurológicas causadas por este nuevo virus. Comprender la interacción del SARS-CoV-2 con el sistema nervioso es esencial para evaluar las probables consecuencias patológicas a corto y largo plazo. Esta revisión busca reunir y discutir la evidencia sobre la ocurrencia de manifestaciones neurológicas y/o compromiso del sistema nervioso en pacientes infectados con SARS-CoV-2.

          Translated abstract

          ABSTRACT The current Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic has severely impacted the economy and health care system in more than 180 countries around the world in an unprecedented event, which since its inception has resulted in countless case reports focusing on the potentially fatal systemic and respiratory manifestations of the disease. However, the full extent of possible neurological manifestations caused by this new virus is not yet known. Understanding the interaction of SARS-CoV-2 with the nervous system is essential to assessing likely short- and long-term pathologic consequences. This review seeks to gather and discuss evidence on the occurrence of neurological manifestations and/or nervous system involvement in SARS-CoV-2 infected patients.

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          Most cited references101

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          Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China

          The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan, China, is serious and has the potential to become an epidemic worldwide. Several studies have described typical clinical manifestations including fever, cough, diarrhea, and fatigue. However, to our knowledge, it has not been reported that patients with COVID-19 had any neurologic manifestations.
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            Neurologic Features in Severe SARS-CoV-2 Infection

            To the Editor: We report the neurologic features in an observational series of 58 of 64 consecutive patients admitted to the hospital because of acute respiratory distress syndrome (ARDS) due to Covid-19. The patients received similar evaluations by intensivists in two intensive care units (ICUs) in Strasbourg, France, between March 3 and April 3, 2020. Six patients were excluded because of paralytic neuromuscular blockade when neurologic data were collected or because they had died without a neurologic examination having been performed. In all 58 patients, reverse-transcriptase–polymerase-chain-reaction (RT-PCR) assays of nasopharyngeal samples were positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The median age of the patients was 63 years, and the median Simplified Acute Physiology Score II at the time of neurologic examination was 52 (interquartile range, 37 to 65, on a scale ranging from 0 to 163, with higher scores indicating greater severity of illness). Seven patients had had previous neurologic disorders, including transient ischemic attack, partial epilepsy, and mild cognitive impairment. The neurologic findings were recorded in 8 of the 58 patients (14%) on admission to the ICU (before treatment) and in 39 patients (67%) when sedation and a neuromuscular blocker were withheld. Agitation was present in 40 patients (69%) when neuromuscular blockade was discontinued (Table 1). A total of 26 of 40 patients were noted to have confusion according to the Confusion Assessment Method for the ICU; those patients could be evaluated when they were responsive (i.e., they had a score of −1 to 1 on the Richmond Agitation and Sedation Scale, on a scale of −5 [unresponsive] to +4 [combative]). Diffuse corticospinal tract signs with enhanced tendon reflexes, ankle clonus, and bilateral extensor plantar reflexes were present in 39 patients (67%). Of the patients who had been discharged at the time of this writing, 15 of 45 (33%) had had a dysexecutive syndrome consisting of inattention, disorientation, or poorly organized movements in response to command. Magnetic resonance imaging (MRI) of the brain was performed in 13 patients (Figs. S1 through S3 in the Supplementary Appendix, available with the full text of this letter at NEJM.org). Although these patients did not have focal signs that suggested stroke, they underwent MRI because of unexplained encephalopathic features. Enhancement in leptomeningeal spaces was noted in 8 patients, and bilateral frontotemporal hypoperfusion was noted in all 11 patients who underwent perfusion imaging. Two asymptomatic patients each had a small acute ischemic stroke with focal hyperintensity on diffusion-weighted imaging and an overlapping decreased apparent diffusion coefficient, and 1 patient had a subacute ischemic stroke with superimposed increased diffusion-weighted imaging and apparent diffusion coefficient signals. In the 8 patients who underwent electroencephalography, only nonspecific changes were detected; 1 of the 8 patients had diffuse bifrontal slowing consistent with encephalopathy. Examination of cerebrospinal fluid (CSF) samples obtained from 7 patients showed no cells; in 2 patients, oligoclonal bands were present with an identical electrophoretic pattern in serum, and protein and IgG levels were elevated in 1 patient. RT-PCR assays of the CSF samples were negative for SARS-CoV-2 in all 7 patients. In this consecutive series of patients, ARDS due to SARS-CoV-2 infection was associated with encephalopathy, prominent agitation and confusion, and corticospinal tract signs. Two of 13 patients who underwent brain MRI had single acute ischemic strokes. Data are lacking to determine which of these features were due to critical illness–related encephalopathy, cytokines, or the effect or withdrawal of medication, and which features were specific to SARS-CoV-2 infection.
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              Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host–Virus Interaction, and Proposed Neurotropic Mechanisms

              The recent outbreak of coronavirus infectious disease 2019 (COVID-19) has gripped the world with apprehension and has evoked a scare of epic proportion regarding its potential to spread and infect humans worldwide. As we are in the midst of an ongoing pandemic of COVID-19, scientists are struggling to understand how it resembles and differs from the severe acute respiratory syndrome coronavirus (SARS-CoV) at the genomic and transcriptomic level. In a short time following the outbreak, it has been shown that, similar to SARS-CoV, COVID-19 virus exploits the angiotensin-converting enzyme 2 (ACE2) receptor to gain entry inside the cells. This finding raises the curiosity of investigating the expression of ACE2 in neurological tissue and determining the possible contribution of neurological tissue damage to the morbidity and mortality caused by COIVD-19. Here, we investigate the density of the expression levels of ACE2 in the CNS, the host–virus interaction and relate it to the pathogenesis and complications seen in the recent cases resulting from the COVID-19 outbreak. Also, we debate the need for a model for staging COVID-19 based on neurological tissue involvement.
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                Author and article information

                Journal
                rfmh
                Revista de la Facultad de Medicina Humana
                Rev. Fac. Med. Hum.
                Universidad Ricardo Palma (URP) (Lima, , Peru )
                1814-5469
                2308-0531
                April 2021
                : 21
                : 2
                : 387-398
                Affiliations
                [2] Lambayeque orgnameLaboratorio de Inmunología - Virología. Dirección de Investigación. Hospital Regional Lambayeque Perú
                [1] Lambayeque Lambayeque orgnameUniversidad Nacional Pedro Gallo Peru
                Article
                S2308-05312021000200387 S2308-0531(21)02100200387
                10.25176/rfmh.v21i1.3062
                b20b2954-8c1c-4dde-8330-53b7ec7f3d4a

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 16 June 2020
                : 22 February 2021
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 103, Pages: 12
                Product

                SciELO Peru

                Categories
                Artículo de revisión

                Infecciones por Coronavirus,Neurologic Manifestations. (Source: MeSH - NLM),Brain,Central Nervous System,SARS-CoV-2,Coronavirus infection,Manifestaciones Neurológicas. (Fuente: DeCs - BIREME),Cerebro,Sistema nervioso central

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