COVID-19 AND NEUROLOGICAL MANIFESTATIONS

Uvod: Krajem 2019. god. otkrivena je nova bolest nazvana COVID-19 (od engl. Corona Virus Disease-2019). Bolest je uzrokovana novim koronavirusom SARS-CoV-2 (od engl. Severe acute respiratory syndrome coronavirus 2), a s obzirom na brzo širenje od strane Svjetske zdravstvene organizacije (SZO) ubrzo je proglašena pandemija. Na početku pandemije ustanovljeno je da se COVID-19 osim dišnim simptomima može očitovati simptomima drugih organskih sustava. Između ostalog COVID-19 može se očitovati neurološkom simptomatologijom, a neurološki simptomi mogu se javiti i kao komplikacija COVID-19 te nakon preboljenja same bolesti. Cilj: nastojali smo prikupiti najnovije spoznaje o COVID-19 i neurološkim očitovanjima i komplikacijama. Također, željeli smo istaknuti i moguće razlike pri postavljanju dijagnoze i liječenja. Metode: Pretražili smo bibliografsku bazu podataka MEDLINE s ključnim riječima neurološki simptomi, komplikacije, COVID-19 sve do 2020. godine. Rezultati: Do sada su prema izvješću SZO ustanovljena 23 neurološka simptoma i 14 neuroloških dijagnoza. Prema podatcima SZO do sada je 1/3 hospitaliziranih bolesnika imala neurološke simptome. Kod bolesnika starijih od 66 godina najčešća je dijagnoza bila encefalopatija, a očitovala se agitacijom, smetenošću, delirijem te poremećajima stanja svijesti. Također, encefalopatija je bila pokazatelj lošijeg ishoda bolesti. Incidencija ishemijskih i hemoragijskih moždanih udara bila je veća kod COVID-19 pozitivnih bolesnika u odnosu na opću populaciju što se objašnjava proupalnim odgovorom i povećanom sklonosti koagulaciji tijekom bolesti. Prethodni čimbenici rizika za moždani udar kao što su pušenje, šećerna bolest i arterijska hipertenzija pridonose mehanizmu nastanka moždanog udara i lošijem ishodu. Manje učestali bili su neuromišićni poremećaji kao što su kljenut facijalnog živca i Gillian Barréov sindrom. Druge infektivne bolesti kao što je meningoencefalitis javljale su se rjeđe. Poremećaji mirisa i okusa obično bi se povukli unutar dva mjeseca. Dijagnostika i liječenje neuroloških očitovanja COVID-19 ne razlikuje se od uobičajenih postupaka. Nema specifičnog lijeka za liječenje neuroloških poremećaja tijekom COVID-19. Važno je napomenuti da bolesnici koji već imaju određenu neurodegenerativnu bolest i veći stupanj onesposobljenosti mogu imati lošiji ishod COVID-19. Također, kod dijela kroničnih neuroloških bolesti moguće je da se tijekom COVID-19 liječenje mora promijeniti. Zaključak: Tijekom pandemije neurolozi su se susreli i s različitim načinima reorganizacije bolničkog sustava liječenja neuroloških bolesnika, praćenja kroničnih neuroloških bolesnika, liječenja kroničnih bolesnika zbog pandemije te hitnih neuroloških stanja kod COVID-19 pozitivnih bolesnika. Zato je neurološka struka morala reorganizirati i osigurati neurološku dijagnostiku i liječenje za ostale bolesnike.Introduction: At the end of 2019, a new disease called COVID-19 was discovered. The disease was caused by the new coronavirus SARS-CoV-2. Due to its rapid spread, a global pandemic was soon declared by the World Health Organization (WHO). At the beginning of the pandemic, it was established that COVID-19 usually presented with respiratory symptoms but that it could also be presented with symptoms of other organs. COVID-19 can be manifested by neurological symptoms. Neurological symptoms can also occur as a complication due to COVID-19 and persist long after the disease has been overcome. Aim: We aimed to analyze scientifi c papers on neurological manifestations and complications in COVID-19 positive patients. We also wanted to highlight the possible differences in neurological diagnosis and treatment strategies. Methods: We searched MEDLINE database using the following key features: "neurological manifestations", "neurological symptoms" and "COVID-19" back to the year 2020. Results: According to a WHO report, 23 neurological symptoms and 14 neurological diagnoses have been described so far. One-third of hospitalized patients had neurological symptoms. Encephalopathy was the most common neurological condition in patients older than 66 years. Those patients presented with different symptoms including agitation, delirium, and consciousness disorders. According to some studies, encephalopathy was also a predictor of poor outcome. The number of cases of strokes (ischemic and hemorrhagic) was higher in COVID-19 positive patients than usual. This fact is explained by the tendency to a hypercoagulable state and proinfl ammatory process while having COVID-19. Also, a great number of patients have already had some risk factors (smoking, hypertension, diabetes mellitus), which contributed to the pathogenesis of stroke and also poorer outcomes. Less often neurological manifestations include neuromuscular disorders such as Guillain-Barré syndrome and facial palsy. Guillain-Barré syndrome mostly presented with sensorimotor manifestations. Other infective diseases such as meningoencephalitis occurred in rare cases. Hyposmia, anosmia, and dysgeusia occurred in most cases but resolved mostly within two months of infection. The diagnosis and treatment of neurological manifestations caused by COVID-19 do not differ from the usual diagnostic methods and treatment strategies. There is no specifi c drug to be used during COVID-19 infection and certain neurological diagnoses. Important information is that patients who already have certain neurodegenerative diseases and a higher degree of neurological disability may have worse outcome while having COVID-19. Also, in several neurological patients with a preexisting neurological diagnosis, the strategy and treatment of the underlying neurological disease had to change depending on whether or not the person had COVID-19. Conclusion: In conclusion, during the pandemic, neurologists met with different ways to reorganize the hospital system for treatment of neurological patients, monitoring of chronic neurological patients, treatment of chronic patients due to the pandemic, and emergency neurological conditions in COVID-19 positive patients. Also, the neurologists had to organize normal functioning of neurological diagnostic methods and treatment for other patients