Encéphalopathie aiguë et Covid-19: hypothèses physiopathologiques

Abstract

Encéphalopathie aiguë et Covid-19 : hypothèses physiopathologiques L'encéphalopathie aiguë est l'une des principales complications neurologiques des patients hospitalisés pour un Covid-19. Si les complications électrolytiques, les différents traitements et l'hypoxémie ont un effet sur l'homéostasie cérébrale entraînant une perturbation de la cognition, les conséquences cérébrales directes ou indirectes du SARS-CoV-2 ne sont pas complètement élucidées. L'implication du virus entraînant une atteinte endothéliale des vaisseaux cérébraux pourrait participer à cette encéphalopathie, via une fragilisation de la barrière hématoencéphalique et un passage facilité des cytokines pro-inflammatoires. L'atteinte virale directe ou la réaction autoimmune secondaire ont également été invoquées. Face aux multiples mécanismes physiopathologiques possibles pouvant expliquer cette encéphalopathie, le débat est ouvert. COVID-19-related acute encephalopathy : physiopathological hypothesisAcute encephalopathy is one of the most frequent neurological complication in patients hospitalized for COVID-19. Electrolyte imbalance, drugs, and hypoxemia can all affect brain homeostasis, leading to acute cognitive dysfunction and direct implications of the SARS-CoV-2 are not completely understood. Neurological complications of SARS-CoV-2 infection are poorly understood : an inflammatory insult to the endothelium affecting the blood-brain barrier may explain the clinical presentation, but other hypotheses including direct viral damage or an immune-mediated reaction are also suggested. Among these various potential mechanisms, often combined, the controversy remains.

Factors contributing to cognitive dysfunction in patients suffering from COVID-19

“…In clinical, patients with COVID-19 could experience decreased appetite, impaired kidney function, and pulmonary hypoxia, all of which can lead to electrolyte imbalance. Electrolyte imbalance can also affect brain homeostasis, leading to acute cognitive dysfunction [29]. COVID-19 severity was associated with the degree of cognitive decline [25].…”

COVID-19 Encephalopathy: Delayed Onset in Unvaccinated Patients

“…Infections causing cytokine storms and sepsis, which promote cytokines such as IL-6, 8, 10, and TNF alpha, have also been associated with hysterical states, most likely from the intense inflammatory reaction of the body [ 5 ]. Lastly, the metabolic derangements caused by COVID-19, such as hyponatremia, acute kidney injury, and elevated liver function tests, may individually affect mentation and delirium, resulting in metabolic encephalopathy [ 6 ].…”