The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings.

Autor:	Paterson RW; University College London, Queen Square Institute of Neurology, London, UK.; Darent Valley Hospital, Dartford, Kent, UK.; UK Dementia Research Institute, London, UK., Brown RL; University College London, Queen Square Institute of Neurology, London, UK.; UCL Institute of Immunity and Transplantation, London, UK., Benjamin L; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK.; University of Liverpool, Brain Infections Group, Liverpool, Merseyside, UK., Nortley R; University College London, Queen Square Institute of Neurology, London, UK.; Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK., Wiethoff S; University College London, Queen Square Institute of Neurology, London, UK.; Center for Neurology and Hertie Institute for Clinical Brain Research, Eberhard-Karls-University, Tübingen, Germany., Bharucha T; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.; Department of Biochemistry, University of Oxford, Oxford, UK.; Lao-Oxford-Mahosot Hospital-Wellcome Trust-Research Unit, Mahosot Hospital, Vientiane, Laos., Jayaseelan DL; University College London, Queen Square Institute of Neurology, London, UK.; Watford General Hospital, Watford, Hertfordshire, UK., Kumar G; Darent Valley Hospital, Dartford, Kent, UK., Raftopoulos RE; King's College Hospital, Denmark Hill, London, UK., Zambreanu L; University College London, Queen Square Institute of Neurology, London, UK.; Watford General Hospital, Watford, Hertfordshire, UK., Vivekanandam V; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Khoo A; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Geraldes R; Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK.; University of Oxford, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK., Chinthapalli K; University College London, Queen Square Institute of Neurology, London, UK.; Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK., Boyd E; Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK., Tuzlali H; Wexham Park Hospital, Frimley Health NHS Foundation Trust, Berkshire, UK., Price G; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Christofi G; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Morrow J; University College London, Queen Square Institute of Neurology, London, UK.; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., McNamara P; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., McLoughlin B; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Lim ST; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Mehta PR; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Levee V; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Keddie S; University College London, Queen Square Institute of Neurology, London, UK., Yong W; Northwick Park Hospital, Harrow, London, UK., Trip SA; University College London, Queen Square Institute of Neurology, London, UK.; Northwick Park Hospital, Harrow, London, UK., Foulkes AJM; University College London, Queen Square Institute of Neurology, London, UK.; Watford General Hospital, Watford, Hertfordshire, UK., Hotton G; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Miller TD; Lister Hospital, Stevenage, Hertfordshire, UK., Everitt AD; Imperial College Healthcare NHS Trust, London, UK., Carswell C; Imperial College Healthcare NHS Trust, London, UK.; Chelsea and Westminster Hospital, London, UK., Davies NWS; Chelsea and Westminster Hospital, London, UK., Yoong M; Barts and The London NHS Trust, London, UK., Attwell D; UCL, Department of Neuroscience, Physiology and Pharmacology, London, UK., Sreedharan J; King's College Hospital, Denmark Hill, London, UK., Silber E; King's College Hospital, Denmark Hill, London, UK., Schott JM; University College London, Queen Square Institute of Neurology, London, UK., Chandratheva A; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK., Perry RJ; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK., Simister R; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK., Checkley A; Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK., Longley N; Hospital for Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK., Farmer SF; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Carletti F; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Houlihan C; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.; UCL Division of Infection and Immunity, London, UK., Thom M; University College London, Queen Square Institute of Neurology, London, UK., Lunn MP; University College London, Queen Square Institute of Neurology, London, UK., Spillane J; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.; Guy's and St Thomas' NHS Foundation Trust, London, UK., Howard R; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.; Guy's and St Thomas' NHS Foundation Trust, London, UK., Vincent A; University College London, Queen Square Institute of Neurology, London, UK.; University of Oxford, Nuffield Department of Clinical Neurosciences, John Radcliffe Hospital, Oxford, UK., Werring DJ; Stroke Research Centre, UCL Queen Square Institute of Neurology, London, UK., Hoskote C; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Jäger HR; University College London, Queen Square Institute of Neurology, London, UK.; Lysholm Department of Neuroradiology, National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Manji H; University College London, Queen Square Institute of Neurology, London, UK.; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK., Zandi MS; University College London, Queen Square Institute of Neurology, London, UK.; National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, Queen Square, London, UK.
Jazyk:	angličtina
Zdroj:	Brain : a journal of neurology [Brain] 2020 Oct 01; Vol. 143 (10), pp. 3104-3120.
DOI:	10.1093/brain/awaa240
Abstrakt:	Preliminary clinical data indicate that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with neurological and neuropsychiatric illness. Responding to this, a weekly virtual coronavirus disease 19 (COVID-19) neurology multi-disciplinary meeting was established at the National Hospital, Queen Square, in early March 2020 in order to discuss and begin to understand neurological presentations in patients with suspected COVID-19-related neurological disorders. Detailed clinical and paraclinical data were collected from cases where the diagnosis of COVID-19 was confirmed through RNA PCR, or where the diagnosis was probable/possible according to World Health Organization criteria. Of 43 patients, 29 were SARS-CoV-2 PCR positive and definite, eight probable and six possible. Five major categories emerged: (i) encephalopathies (n = 10) with delirium/psychosis and no distinct MRI or CSF abnormalities, and with 9/10 making a full or partial recovery with supportive care only; (ii) inflammatory CNS syndromes (n = 12) including encephalitis (n = 2, para- or post-infectious), acute disseminated encephalomyelitis (n = 9), with haemorrhage in five, necrosis in one, and myelitis in two, and isolated myelitis (n = 1). Of these, 10 were treated with corticosteroids, and three of these patients also received intravenous immunoglobulin; one made a full recovery, 10 of 12 made a partial recovery, and one patient died; (iii) ischaemic strokes (n = 8) associated with a pro-thrombotic state (four with pulmonary thromboembolism), one of whom died; (iv) peripheral neurological disorders (n = 8), seven with Guillain-Barré syndrome, one with brachial plexopathy, six of eight making a partial and ongoing recovery; and (v) five patients with miscellaneous central disorders who did not fit these categories. SARS-CoV-2 infection is associated with a wide spectrum of neurological syndromes affecting the whole neuraxis, including the cerebral vasculature and, in some cases, responding to immunotherapies. The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease. Early recognition, investigation and management of COVID-19-related neurological disease is challenging. Further clinical, neuroradiological, biomarker and neuropathological studies are essential to determine the underlying pathobiological mechanisms that will guide treatment. Longitudinal follow-up studies will be necessary to ascertain the long-term neurological and neuropsychological consequences of this pandemic. (© The Author(s) (2020). Published by Oxford University Press on behalf of the Guarantors of Brain.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu