Hypertensive man, with a history of stroke and high body mass index, presented dysarthria and left hemiparesis.
Brain CT showed occlusion and infarction of the left posterior cerebral artery. He had a history of atrial fibrillation, hypertension, and ischemic heart disease. D-dimer values were 7750 µg/L and the INR was 3.6 at the time of stroke symptoms.Ī man who arrived 10 days after the onset of COVID-19 symptoms with dysarthria and right hemiparesis. Brain tomography confirmed acute large left cerebellar and right parietal-occipital infarcts. On day 22, he developed acute bilateral incoordination and right homonymous hemianopia, due to extensive acute posterior cerebral artery territory.Ī woman anticoagulated due to valvular atrial fibrillation, arrived 24 days after the onset of COVID-19 symptoms due to sudden confusion, incoordination, and drowsiness. The magnetic resonance imaging confirmed intradural left vertebral artery occlusion and acute left posterior inferior cerebellar artery territory infarction with petechial hemorrhage. 15 days after onset of symptoms the patient developed left upper monoparesis. In this context, the objective of this manuscript is to describe key aspects of neurological complications due to COVID-19 with post-COVID syndrome, focused on the nervous system, and the elements that must be taken into account during evaluation and neurorehabilitation of those with neurological complications.Ī man with respiratory failure due to COVID-19 is admitted to intensive care unit. Such cases also require rapid lines of communication between primary care physicians and neurologists via direct email or telephone communications through neurology registrars at least once to properly document and study these cases. On the other hand, pandemic statistics highlight the need for careful and continuous follow-up of all patients with COVID-19, even those considered asymptomatic, with regular screening for probable long-term persistent neurological sequelae. Rehabilitation encompasses many sequelae, and the rehabilitation team in a specialized center can treat many sequelae simultaneously, however, in regions where resources are limited and there are no specialized neurorehabilitation centers and multidisciplinary teams, it is a challenge to prioritize the rehabilitation of one organ over another. However, since COVID-19 is a multisystemic disease that considerably affects organs such as lungs and heart, the rehabilitation process is not equivalent in comparison to other groups of patients who develop neurological complications due to other causes, which is why the neurorehabilitation approach is more complex. The neurological complications that more frequently cause severe sequelae will require neurorehabilitation to try to recover the lost functional capacity.
#Lost to time synonym series
However, case series and observational studies show data on a large number of patients who develop cerebrovascular accidents (CVD), Guillain-Barré syndrome (GBS), de novo status epilepticus, and encephalopathy. The most frequently reported neurological manifestations are anosmia, ageusia, and headache. In this sense, it is pertinent to pay attention to new research aimed at evaluating prognostic markers, such as markers of inflammation in peripheral blood, such as the neutrophil–lymphocyte ratio, C-reactive protein, D-dimer, or serum ferritin, which seek to predict morbidity and mortality. Currently, Post-COVID Syndrome can include symptoms related to residual inflammation, organ damage, impact on pre-existing health conditions or non-specific effects due to hospitalization or prolonged ventilation (post-intensive care syndrome). It has been suggested that in cured patients, SARS-CoV-2 remains latent in the central nervous system for a long time, being able to reactivate and trigger neurological complications. A study with murine models showed that the dissemination path of SARS-CoV-2 into central nervous system is through the olfactory bulb, spreading to other adjacent areas and generating severe perivascular inflammation and meningitis. In post-mortem studies, viral particles have been found in the cerebrospinal fluid and cytoplasm of neocortex and hypothalamus neurons, as well as neuronal degeneration and necrosis, edema, glial cell hyperplasia, and cellular infiltrates. This receptor is also expressed in neurons and glial cells, which could explain the reported neurological manifestations, such as olfactory neuropathy (anosmia), peripheral neuropathy and brain disorders.
The COVID-19 infectious agent, SARS-CoV-2, has a high affinity for human angiotensin-converting enzyme 2 (ACE2) receptor.
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