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Neurology ; 96(11): e1527-e1538, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: covidwho-1028513


OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is protean in its manifestations, affecting nearly every organ system. However, nervous system involvement and its effect on disease outcome are poorly characterized. The objective of this study was to determine whether neurologic syndromes are associated with increased risk of inpatient mortality. METHODS: A total of 581 hospitalized patients with confirmed SARS-CoV-2 infection, neurologic involvement, and brain imaging were compared to hospitalized non-neurologic patients with coronavirus disease 2019 (COVID-19). Four patterns of neurologic manifestations were identified: acute stroke, new or recrudescent seizures, altered mentation with normal imaging, and neuro-COVID-19 complex. Factors present on admission were analyzed as potential predictors of in-hospital mortality, including sociodemographic variables, preexisting comorbidities, vital signs, laboratory values, and pattern of neurologic manifestations. Significant predictors were incorporated into a disease severity score. Patients with neurologic manifestations were matched with patients of the same age and disease severity to assess the risk of death. RESULTS: A total of 4,711 patients with confirmed SARS-CoV-2 infection were admitted to one medical system in New York City during a 6-week period. Of these, 581 (12%) had neurologic issues of sufficient concern to warrant neuroimaging. These patients were compared to 1,743 non-neurologic patients with COVID-19 matched for age and disease severity admitted during the same period. Patients with altered mentation (n = 258, p = 0.04, odds ratio [OR] 1.39, confidence interval [CI] 1.04-1.86) or radiologically confirmed stroke (n = 55, p = 0.001, OR 3.1, CI 1.65-5.92) had a higher risk of mortality than age- and severity-matched controls. CONCLUSIONS: The incidence of altered mentation or stroke on admission predicts a modest but significantly higher risk of in-hospital mortality independent of disease severity. While other biomarker factors also predict mortality, measures to identify and treat such patients may be important in reducing overall mortality of COVID-19.

/mortalidad , Confusión/fisiopatología , Trastornos de la Conciencia/fisiopatología , Mortalidad Hospitalaria , Accidente Cerebrovascular/fisiopatología , Anciano , Anciano de 80 o más Años , Ageusia/epidemiología , Ageusia/fisiopatología , /fisiopatología , Ataxia/epidemiología , Ataxia/fisiopatología , Confusión/epidemiología , Trastornos de la Conciencia/epidemiología , Enfermedades de los Nervios Craneales/epidemiología , Enfermedades de los Nervios Craneales/fisiopatología , Delirio/epidemiología , Delirio/fisiopatología , Femenino , Cefalea/epidemiología , Cefalea/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Parestesia/epidemiología , Parestesia/fisiopatología , Disautonomías Primarias/epidemiología , Disautonomías Primarias/fisiopatología , Recurrencia , Convulsiones/epidemiología , Convulsiones/fisiopatología , Accidente Cerebrovascular/epidemiología , Vértigo/epidemiología , Vértigo/fisiopatología
Psychosomatics ; 61(6): 585-596, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-726823


BACKGROUND: The pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as one of the biggest health threats of our generation. A significant portion of patients are presenting with delirium and neuropsychiatric sequelae of the disease. Unique examination findings and responses to treatment have been identified. OBJECTIVE: In this article, we seek to provide pharmacologic and treatment recommendations specific to delirium in patients with COVID-19. METHODS: We performed a literature search reviewing the neuropsychiatric complications and treatments in prior coronavirus epidemics including Middle Eastern respiratory syndrome and severe acute respiratory syndrome coronaviruses, as well as the emerging literature regarding COVID-19. We also convened a work group of consultation-liaison psychiatrists actively managing patients with COVID-19 in our hospital. Finally, we synthesized these findings to provide preliminary pharmacologic recommendations for treating delirium in these patients. RESULTS: Delirium is frequently found in patients who test positive for COVID-19, even in the absence of respiratory symptoms. There appears to be a higher rate of agitation, myoclonus, abulia, and alogia. No data are currently available on the treatment of delirium in patients with COVID-19. Extrapolating from general delirium treatment, Middle Eastern respiratory syndrome/severe acute respiratory syndrome case reports, and our experience, preliminary recommendations for pharmacologic management have been assembled. CONCLUSIONS: COVID-19 is associated with neuropsychiatric symptoms. Low-potency neuroleptics and alpha-2 adrenergic agents may be especially useful in this setting. Further research into the pathophysiology of COVID-19 will be key in developing more targeted treatment guidelines.

Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Encefalopatías/fisiopatología , Infecciones por Coronavirus/fisiopatología , Delirio/tratamiento farmacológico , Agonistas de Dopamina/uso terapéutico , Neumonía Viral/fisiopatología , Betacoronavirus , Encefalopatías/psicología , Depresores del Sistema Nervioso Central/uso terapéutico , Infecciones por Coronavirus/psicología , Delirio/fisiopatología , Delirio/psicología , Moduladores del GABA/uso terapéutico , Humanos , Lorazepam/uso terapéutico , Melatonina/uso terapéutico , Pandemias , Neumonía Viral/psicología , Guías de Práctica Clínica como Asunto
Eur Geriatr Med ; 11(5): 857-862, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: covidwho-652264


PURPOSE: To ascertain delirium prevalence and outcomes in COVID-19. METHODS: We conducted a point-prevalence study in a cohort of COVID-19 inpatients at University College Hospital. Delirium was defined by DSM-IV criteria. The primary outcome was all-cause mortality at 4 weeks; secondary outcomes were physical and cognitive function. RESULTS: In 71 patients (mean age 61, 75% men), 31 (42%) had delirium, of which only 12 (39%) had been recognised by the clinical team. At 4 weeks, 20 (28%) had died, 26 (36%) were interviewed by telephone and 21 (30%) remained as inpatients. Physical function was substantially worse in people after delirium - 50 out of 166 points (95% CI - 83 to - 17, p = 0.01). Mean cognitive scores at follow-up were similar and delirium was not associated with mortality in this sample. CONCLUSIONS: Our findings indicate that delirium is common, yet under-recognised. Delirium is associated with functional impairments in the medium term.

Infecciones por Coronavirus , Delirio , Pandemias , Neumonía Viral , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , Cognición/fisiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Estudios Transversales , Delirio/epidemiología , Delirio/etiología , Delirio/mortalidad , Delirio/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/complicaciones , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Índice de Severidad de la Enfermedad
Neurol India ; 68(3): 560-572, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-640338


COVID-19, in most patients, presents with mild flu-like illness. Elderly patients with comorbidities, like hypertension, diabetes, or lung and cardiac disease, are more likely to have severe disease and deaths. Neurological complications are frequently reported in severely or critically ill patients with comorbidities. In COVID-19, both central and peripheral nervous systems can be affected. The SARS-CoV-2 virus causes the disease COVID-19 and has the potential to invade the brain. The SARS-CoV-2 virus enters the brain either via a hematogenous route or olfactory system. Angiotensin-converting enzyme two receptors, present on endothelial cells of cerebral vessels, are a possible viral entry point. The most severe neurological manifestations, altered sensorium (agitation, delirium, and coma), are because of hypoxic and metabolic abnormalities. Characteristic cytokine storm incites severe metabolic changes and multiple organ failure. Profound coagulopathies may manifest with ischemic or hemorrhagic stroke. Rarely, SARS-CoV-2 virus encephalitis or pictures like acute disseminated encephalomyelitis or acute necrotizing encephalopathy have been reported. Nonspecific headache is a commonly experienced neurological symptom. A new type of headache "personal protection equipment-related headache" has been described. Complete or partial anosmia and ageusia are common peripheral nervous system manifestations. Recently, many cases of Guillain-Barré syndrome in COVID-19 patients have been observed, and a postinfectious immune-mediated inflammatory process was held responsible for this. Guillain-Barré syndrome does respond to intravenous immunoglobulin. Myalgia/fatigue is also common, and elevated creatine kinase levels indicate muscle injury. Most of the reports about neurological complications are currently from China. COVID-19 pandemic is spreading to other parts of the world; the spectrum of neurological complications is likely to widen further.

Ageusia/fisiopatología , Infecciones por Coronavirus/fisiopatología , Síndrome de Liberación de Citoquinas/inmunología , Encefalitis/fisiopatología , Síndrome de Guillain-Barré/fisiopatología , Cefalea/fisiopatología , Trastornos del Olfato/fisiopatología , Neumonía Viral/fisiopatología , Accidente Cerebrovascular/fisiopatología , Ageusia/etiología , Betacoronavirus , Trastornos de la Coagulación Sanguínea/sangre , Trastornos de la Coagulación Sanguínea/etiología , Barrera Hematoencefálica , Isquemia Encefálica/sangre , Isquemia Encefálica/etiología , Isquemia Encefálica/inmunología , Isquemia Encefálica/fisiopatología , Coma/etiología , Coma/fisiopatología , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/inmunología , Delirio/etiología , Delirio/fisiopatología , Encefalitis/etiología , Encefalitis/inmunología , Encefalomielitis Aguda Diseminada/etiología , Encefalomielitis Aguda Diseminada/inmunología , Encefalomielitis Aguda Diseminada/fisiopatología , Fatiga/etiología , Fatiga/fisiopatología , Síndrome de Guillain-Barré/etiología , Cefalea/etiología , Humanos , Hemorragias Intracraneales/sangre , Hemorragias Intracraneales/etiología , Hemorragias Intracraneales/fisiopatología , Leucoencefalitis Hemorrágica Aguda/etiología , Leucoencefalitis Hemorrágica Aguda/inmunología , Leucoencefalitis Hemorrágica Aguda/fisiopatología , Mialgia/etiología , Mialgia/fisiopatología , Trastornos del Olfato/etiología , Pandemias , Equipo de Protección Personal/efectos adversos , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/inmunología , Accidente Cerebrovascular/sangre , Accidente Cerebrovascular/etiología , Accidente Cerebrovascular/inmunología
Psychosomatics ; 61(5): 544-550, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-616923

Agonistas de Receptores Adrenérgicos alfa 2/uso terapéutico , Antipsicóticos/uso terapéutico , Infecciones por Coronavirus/terapia , Delirio/tratamiento farmacológico , Hipnóticos y Sedantes/efectos adversos , Neumonía Viral/terapia , Agitación Psicomotora/tratamiento farmacológico , Fármacos Inductores del Sueño/uso terapéutico , Anciano , Analgésicos Opioides/efectos adversos , Azepinas/uso terapéutico , Betacoronavirus , Depresores del Sistema Nervioso Central/uso terapéutico , Clordiazepóxido/efectos adversos , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Infecciones por Coronavirus/psicología , Delirio/etiología , Delirio/fisiopatología , Delirio/psicología , Dexmedetomidina/efectos adversos , Femenino , Guanfacina/uso terapéutico , Haloperidol/uso terapéutico , Humanos , Hidromorfona/efectos adversos , Unidades de Cuidados Intensivos , Ketamina/efectos adversos , Melatonina/uso terapéutico , Midazolam/efectos adversos , Oxicodona/efectos adversos , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía Viral/psicología , Propofol/efectos adversos , Agitación Psicomotora/etiología , Agitación Psicomotora/fisiopatología , Agitación Psicomotora/psicología , Respiración Artificial , Trastornos del Sueño del Ritmo Circadiano/tratamiento farmacológico , Trastornos del Sueño del Ritmo Circadiano/etiología , Trastornos del Sueño del Ritmo Circadiano/fisiopatología , Traqueostomía , Triazoles/uso terapéutico , Ácido Valproico/uso terapéutico