Complicaciones neurológicas en pacientes críticos por SARS-CoV-2

Abstract

Introducción Nos proponemos analizar las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV-2 que han requerido ingreso en unidad de cuidados intensivos (UCI). Pacientes y métodos Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresados en UCI por infección respiratoria grave por SARS-CoV-2 desde el 1 de abril hasta el 1 de junio de 2020. Resultados Registramos 30 pacientes con síntomas neurológicos, 21 hombres (72,40%), edad media: 57,41 años ± 11,61 desviación estándar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindrómico: 28 pacientes (93,33%) con síndrome confusional agudo, 15 (50%) con patología neuromuscular, 5 (16,66%) con cefalea, 4 (13,33%) con patología cerebrovascular y 4 (13,33%) con encefalopatías/encefalitis. Punción lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostró alteraciones en 20 casos (66,6%). Se realizó EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatía clínica se ha podido confirmar con ENMG. Hemos encontrado relación entre la mayor edad y los días de ingreso en UCI (p = 0,002; IC 95%: 4,032-6,022; OR: 3,594). Conclusiones La infección grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presenta una miopatía aguda, y casi la totalidad de los pacientes salen de la UCI con síndromes confusionales agudos que evolucionan a una resolución completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad se asocia con un mayor número de días de estancia en UCI.

Antibiotics Prescribing in Intensive Care Settings during the COVID-19 Era: A Systematic Review

“…The remaining studies were from Brazil, Oman, Congo, Turkey, UK, Colombia, Kosovo, and Indonesia. Detailed data on the characteristics of the conclusive studies are given in Table S1 [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 ].…”

Uma revisão integrativa das sequelas da COVID-19

“…Dos 27 estudos incluídos nesta revisão, 40,74% (n=11) são estudos observacionais (7,(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) , 33,33% (n=9) são revisões sistemáticas (9,11,12,14,28,29,30,31,32) , 22,22% (n=6) são revisões de literatura (10,13,15,33,34,35) e 3,70% (n=1) série de casos (36) . Quanto ao ano de publicação, 81,48% (n=22) (9)(10)(11)(12)(13)(14)(18)(19)(20)(21)(22)(23)(24)28,29,(30)(31)(32)(33)(34)(35)(36) dos estudos são de 2020 e 18,52% (n=5) (7,…”

SARS-CoV-2 infection: possible underdiagnosis of cerebral venous sinus thrombosis

“…Despite the high prevalence of thrombotic complications in patients with COVID-19, few cases of CVT have been reported to date 1 , 3 . Large Spanish series 4 , 5 identified no cases of CVT during the first wave of COVID-19. In our case, although our patient attended the emergency department with progressively reduced consciousness and very elevated D-dimer levels 9 , it was not until respiratory stability was achieved that we were able to establish a diagnosis and start treatment.…”

“…The most frequent thrombotic complications include pulmonary thromboembolism, myocardial infarction, and ischaemic and haemorrhagic stroke, which manifest 1–2 weeks after diagnosis 2 . Cerebral venous sinus thrombosis (CVT) has been described in small case series 1 , 3 , but it has not been observed in larger registries of hospitalised patients with COVID-19 4 , 5 . The clinical manifestations of CVT are variable (from headache, focal symptoms, and epileptic seizures to altered level of consciousness 6 ), which may lead to underdiagnosis or diagnostic delay in patients with SARS-CoV-2 infection, as COVID-19 may also present with neurological manifestations 4 , 5 , 7 .…”

“…Cerebral venous sinus thrombosis (CVT) has been described in small case series 1 , 3 , but it has not been observed in larger registries of hospitalised patients with COVID-19 4 , 5 . The clinical manifestations of CVT are variable (from headache, focal symptoms, and epileptic seizures to altered level of consciousness 6 ), which may lead to underdiagnosis or diagnostic delay in patients with SARS-CoV-2 infection, as COVID-19 may also present with neurological manifestations 4 , 5 , 7 . We describe the case of a patient with CVT secondary to SARS-CoV-2 infection.…”