新冠肺炎时代的周围神经病变

IF 1 4区 医学 Q3 EMERGENCY MEDICINE Signa Vitae Pub Date : 2021-09-15 DOI:10.22514/sv.2021.189
P. Zis
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引用次数: 1

摘要

术语周围神经病变是指周围神经系统(PNS)的疾病,包括单一和多个(不对称)单神经病变,以及多个神经的对称受累(多发性神经病)。进一步的分类取决于现象学、神经生理学、病理学和病因参数的混合。症状的时间演变将多发性神经病分为急性或慢性。急性PN,如格林-巴利综合征(GBS)是罕见的,但却是一个需要识别的重要实体,因为它有时很严重,但却是可以治疗的。大多数PN是慢性的,通常会持续几个月。2019冠状病毒病(新冠肺炎)是由SARS-CoV-2引起的传染性疾病。新冠肺炎的症状多种多样,但通常包括发烧、咳嗽、头痛、疲劳、呼吸困难以及嗅觉或味觉丧失。据报道,在新冠肺炎感染的急性和亚急性期,作为COVID后综合征的一部分,或由于接种了SARS-CoV-2疫苗,出现了神经并发症。据报道,在急性期,GBS的患病率为每100000例严重急性呼吸系统综合征冠状病毒2型感染中有15例。脱髓鞘GBSs变体尤其是最普遍的。尽管不一定是由严重急性呼吸系统综合征冠状病毒2型直接引起的,但长期呆在重症监护室会增加重症监护室相关神经肌病的风险。在慢性期,正在进行的前瞻性观察性研究的初步结果表明,患有新冠肺炎的患者患轻度轴突周围神经病变的风险增加,这表明存在长度依赖性。有趣的是,据报道,即使在没有电生理学证实的PN的情况下,新冠肺炎后,五分之一的患者报告先前存在的神经性症状恶化或出现新的神经性疾病症状,尤其是疼痛。这种症状往往会持续数月。需要进一步的研究来描述新冠肺炎感染期间和之后PNS参与的自然史。
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Peripheral neuropathy in the COVID-19 era
The term peripheral neuropathy refers to disorders of the peripheral nervous system (PNS) including single and multiple (asymmetric) mononeuropathies, and symmetrical involvement of many nerves (polyneuropathy). Further classification depends on a mixture of phenomenological, neurophysiological, pathological and aetiological parameters. The temporal evolution of symptoms divides polyneuropathy (PN) into acute or chronic. Acute PN e.g. Guillain-Barre syndrome (GBS) is rare but an important entity to recognise because whilst at times severe, it is treatable. Most PN are chronic and usually develop over several months. Coronavirus disease 2019 (COVID-19) is a contagious disease caused by SARS-CoV-2. Symptoms of COVID-19 are variable, but often include fever, cough, headache, fatigue, breathing difficulties, and loss of smell or taste. Neurological complications have been reported in the context of COVID-19 infection both in the acute and subacute phase, as part of the post-COVID syndrome or as a result of the vaccination against SARS-CoV-2. In the acute phase, it has been reported that GBS prevalence is 15 cases per 100,000 SARS-CoV-2 infections. Demyelinating GBSs variant in particular is the most prevalent. Although not necessarily directly caused by SARS-CoV-2, prolonged stay in ICUs is associated with increased risk of ICU related neuro-myopathy. In the chronic phase, preliminary results of ongoing prospective observational studies suggest that patients suffered from COVID-19 have increased risk of developing mild axonal peripheral neuropathy that shows evidence of length dependency. Interestingly, it has been reported that – even in the absence of electrophysiologically confirmed PN – 1 in 5 patients reported deterioration of pre-existing neuropathic symptoms or development of new neuropathic symptoms, particularly pain, after COVID-19. Such symptoms tend to persist for months. Further studies are needed to describe the natural history of the PNS involvement during and after COVID-19 infection.
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来源期刊
Signa Vitae
Signa Vitae 医学-急救医学
CiteScore
1.30
自引率
9.10%
发文量
0
审稿时长
3 months
期刊介绍: Signa Vitae is a completely open-access,peer-reviewed journal dedicate to deliver the leading edge research in anaesthesia, intensive care and emergency medicine to publics. The journal’s intention is to be practice-oriented, so we focus on the clinical practice and fundamental understanding of adult, pediatric and neonatal intensive care, as well as anesthesia and emergency medicine. Although Signa Vitae is primarily a clinical journal, we welcome submissions of basic science papers if the authors can demonstrate their clinical relevance. The Signa Vitae journal encourages scientists and academicians all around the world to share their original writings in the form of original research, review, mini-review, systematic review, short communication, case report, letter to the editor, commentary, rapid report, news and views, as well as meeting report. Full texts of all published articles, can be downloaded for free from our web site.
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