Neurological complications in critical patients with COVID-19

Abstract

Introduction We analysed the neurological complications of patients with severe SARS-CoV-2 infection who required intensive care unit (ICU) admission. Patients and methods We conducted a retrospective, observational, descriptive study of consecutive patients admitted to the ICU due to severe respiratory symptoms secondary to SARS-CoV-2 infection between 1 April and 1 June 2020. Results We included 30 patients with neurological symptoms; 21 were men (72.40%), and mean age (standard deviation [SD]) was 57.41 years (11.61). The mean duration of ICU stay was 18.83 days (14.33). The neurological conditions recorded were acute confusional syndrome in 28 patients (93.33%), neuromuscular disease in 15 (50%), headache in 5 (16.66%), cerebrovascular disease in 4 (13.33%), and encephalopathies/encephalitis in 4 (13.33%). CSF analysis results were normal in 6 patients (20%). Brain MRI or head CT showed alterations in 20 patients (66.6%). EEG was performed in all patients (100%), with 8 (26.66%) showing abnormal findings. In 5 of the 15 patients with clinical myopathy, diagnosis was confirmed with electroneuromyography. We found a correlation between older age and duration of ICU stay ( P = .002; 95% CI, 4.032-6.022; OR:). Conclusions Severe COVID-19 mainly affects men, as observed in other series. Half of our patients presented acute myopathy, and almost all patients left the ICU with acute confusional syndrome, which fully resolved; no correlation was found with EEG or neuroimaging findings. Older age is associated with longer ICU stay.

Alterações neuromusculares em pacientes com COVID-19

“…Após a análise de todos os estudos incluídos na revisão integrativa, verificou-se ocorrência de quatro estudos experimentais, sendo um ensaio clínico randomizado (nível de evidência 2) [12], dois estudos observacionais (nível de evidência 4) [13,14], três estudos de casos e uma carta ao editor (nível de evidência 5) [15][16][17][18].…”

“…Os estudos incluídos foram produzidos no ano de 2020, nos continentes, Europeu [13,16,17], Americano [12,14] e Asiático [15,18]. Fisioterapia Brasil 2021;2293):469-485…”

“…Os participantes dos estudos tinham idades que variaram entre 42 e 90 anos. Em relação as patologias associadas a COVID-19, os estudos apresentaram as seguintes complicações: disfunção neuromuscular [13,18], miastenia gravis [14], mialgia e disfunção muscular [12], síndrome de Guillain-Barré [16], miopatia [17] e fraqueza muscular geral [15].…”

“…Em relação ao local do corpo que os pacientes referiam maior índice álgico, estavam referidos ao sistema musculoesquelético, mais especificamente Fisioterapia Brasil 2021;2293):469-485 os músculos do membro superior, membro inferior e região lombar da coluna vertebral [12,13,16,17]. Os exames mais realizados foram Tomografia Computadorizada [12,13], Radiografia [12,14] e Eletroneuromiografia [13,17].…”

COVID-19 and fatigue: Where do we go from here? Response to Ortelli et al.

“…In the blog we aim to scrutinise and contextualise findings with regards to the global literature.The patients included by Ortelli et al had each suffered profound neurological complications of SARS-CoV-2 infection such as stroke, encephalopathy, critical illness neuropathy / myopathy or Guillain-Barre syndrome. These neurological complications are relatively rare, but more likely to occur in the most severe cases of COVID-19 [1]. As alluded to by the authors, the 12 included patients were thus at the 'severe' end of the COVID-19 disease-spectrum, with likely extended hospital stays and more intensive treatments than the average COVID-19 patient.…”