RESUMO
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; IC95%: 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
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: 3,594). 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
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Infecções por Coronavirus/complicações , Pneumonia Viral/complicações , Pandemias , Doenças do Sistema Nervoso/virologia , Doenças do Sistema Nervoso/diagnóstico por imagem , Estado Terminal , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Estudos RetrospectivosRESUMO
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: 3,594). 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.
Assuntos
Betacoronavirus , Infecções por Coronavirus/complicações , Estado Terminal , Doenças Musculares/etiologia , Doenças do Sistema Nervoso/etiologia , Pandemias , Pneumonia Viral/complicações , Doença Aguda , Adulto , Fatores Etários , Idoso , COVID-19 , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Hemorragia Cerebral/etiologia , Confusão/epidemiologia , Confusão/etiologia , Infecções por Coronavirus/epidemiologia , Cuidados Críticos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Musculares/epidemiologia , Doenças do Sistema Nervoso/epidemiologia , Neuroimagem , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , SARS-CoV-2 , Espanha/epidemiologiaRESUMO
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: 3,594). 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.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Biópsia por Agulha Fina , Neoplasias Pleurais , Imageamento por Ressonância Magnética/instrumentação , Imageamento por Ressonância Magnética/métodos , Radiografia Torácica , Atelectasia Pulmonar/complicações , Atelectasia Pulmonar , Pneumonectomia/métodos , Radiografia Torácica/métodos , Radiografia Torácica/tendências , Derrame Pleural/complicações , Derrame PleuralRESUMO
Caso clínico: Presentamos dos casos de paquimeningitis hipertrófica con alteraciones oftalmológicas asociadas. Uno de los pacientes presentó paquimeningitis hipertrófica presuntamente secundaria a neurosarcoidosis focal y paresia del sexto par. La segunda paciente presentó paquimeningitis hipertrófica crónica idiopática (tipo poco frecuente) difusa con alteraciones de la motilidad ocular y en la visión. Discusión: La paquimeningitis hipertrófica es una patología con un amplio espectro de etiologías y manifestaciones clínicas, que debe ser tenida en cuenta en el diagnóstico de alteraciones de la motilidad ocular
Case reports: We report two cases of hypertrophic pachymeningitis with ophthalmological disturbances. One patient suffered from hypertrophic pachymeningitis supposedly secondary to a focal neurosarcoidosis and had a sixth nerve paresis. The second patient suffered from a diffuse idiopathic hypertrophic chronic pachymeningitis (a rare form) and displayed disturbances in vision and ocular motility. Discussion: Hypertrophic pachymeningitis is a condition with a wide spectrum of etiologies and clinical manifestations, and needs to be considered as the cause in patients with alterations in ocular motility (Arch Soc Esp Oftalmol 2008; 83: 497-500)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Meningite/complicações , Meningite/diagnóstico , Meningite/terapia , Hipertrofia/complicações , Neurite (Inflamação)/complicações , Neurite Óptica/complicações , Neurite Óptica/diagnóstico , Neurite Óptica/terapia , Doenças do Nervo Oculomotor/complicações , Doenças do Nervo Oculomotor/diagnóstico , Sarcoidose/complicações , Paralisia/complicações , Doenças do Nervo Oculomotor/etiologia , Doenças do Nervo Oculomotor/terapia , Tomografia Computadorizada de Emissão/métodos , Tomografia Computadorizada de EmissãoRESUMO
CASE REPORTS: We report two cases of hypertrophic pachymeningitis with ophthalmological disturbances. One patient suffered from hypertrophic pachymeningitis supposedly secondary to a focal neurosarcoidosis and had a sixth nerve paresis. The second patient suffered from a diffuse idiopathic hypertrophic chronic pachymeningitis (a rare form) and displayed disturbances in vision and ocular motility. DISCUSSION: Hypertrophic pachymeningitis is a condition with a wide spectrum of etiologies and clinical manifestations, and needs to be considered as the cause in patients with alterations in ocular motility
Assuntos
Dura-Máter/patologia , Meningite/complicações , Transtornos da Motilidade Ocular/etiologia , Neurite Óptica/etiologia , Transtornos da Visão/etiologia , Doenças do Nervo Abducente/complicações , Corticosteroides/administração & dosagem , Corticosteroides/uso terapêutico , Adulto , Azatioprina/uso terapêutico , Nervos Cranianos , Feminino , Humanos , Imunossupressores/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Meningite/diagnóstico , Meningite/diagnóstico por imagem , Meningite/tratamento farmacológico , Meningite/patologia , Metilprednisolona/administração & dosagem , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Doenças do Sistema Nervoso/complicações , Paralisia/complicações , Sarcoidose/complicações , Fatores de Tempo , Tomografia Computadorizada de Emissão de Fóton Único , Tomografia Computadorizada por Raios XRESUMO
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