Diagnostics of neurologic manifestations of a koronavirusny infection has certain difficulties. The matter is that the health workers dealing with patients with heavy course of COVID-19 are concentrated on providing maintenance of life, first of all, on ensuring functioning of the blood circulatory system and maintenance of a saturation is not lower than a dangerous threshold. In cases of fast transition from easy symptoms to the urgent placement of the patient to intensive care unit, artificial ventilation of the lungs with constant observation and assessment of activity of all main systems of an organism will be required for much of them. Taking into account a possibility of a sharp aggravation of symptoms of patients with COVID-19, a main objective of the protocol is prevention of hypoxemic ischemia. Therefore understanding of neurologic manifestations of COVID-19 lags behind more vital issues connected with survival of patients with heavy course of a disease.
Besides, priority purpose of an intensive care can prevent other specialists to take out the assessment because for carrying out inspection the patient will need to leave intensive care unit (for example, for carrying out KT or MPT). In each case when the decision on that the patient left intensive care unit is made, the risk and advantage of carrying out these researches have to be carefully weighed.
Neurologic manifestations of COVID-19 are understood as result of straight lines or the mediated impacts of SARS-CoV-2 on the central and peripheral nervous system. Damages of peripheral bodies, such as lungs, liver and heart belong to indirect influences of a virus. For example, damage of a myocardium and lungs the SARS-CoV-2 virus can cause heart failure and arrhythmia which, in turn, can increase secondary risk of neurologic complications. Besides, SARS-CoV-2 can directly injure a brain and a spinal cord by means of hematogenous distribution and reproduction of neurons to central nervous system.
Other coronaviruses, such as SARS-CoV-1 and HCoV-OC43, get through the nasal courses and extend in structures of a nervous system. Penetration of a virus into a cell happens through ACE2R, and receptors of this type are widely provided in the central nervous system in neurons, a motive zone of a cerebral cortex, a hypothalamus, a thalamus and a trunk of a brain.
In a brain can point several clinical symptoms observed at patients to distribution of ACE2. For example, direct injury of neurons to the cardiovascular and respiratory centers of a myelencephalon explains cardiovascular and respiratory complications at patients with COVID-19. Besides, loss of taste and sense of smell at patients with COVID-19 can be connected with penetration of a virus through ACE2 receptors in an olfactory system and a hypothalamus.
Recently published retrospective observations are focused on neurologic manifestations at patients with COVID-19 from the Chinese Wuhan and include 214 patients hospitalized with laboratory confirmed diagnoses. These observations show that about 60% of patients were defined as lungs, and the rest were defined as having a heavy infection concerning their respiratory status. About 36% of patients from a cohort had neurologic manifestations, serious condition of patients, was more connected with comorbid conditions, is more often — with hypertensia, than with presence of the most typical respiratory symptoms.
It is obvious that patients with the neurologic symptoms connected with the central nervous system (including the stroke connected with a trombotichesky mikroangiopatiya, cardiological frustration, a headache, loss of sense of smell and taste, etc.) were much more senior and were in more serious condition, in comparison with patients, having damages of peripheral nervous system. At these patients the D-dimera level (reminding a consumption coagulopathy — the IDCS was also most possibly increased), multiple defeat of bodies, increase in hepatic transaminases, the renal failure which is shown in increase in an urea nitrogen and level of creatinine in blood, increase in level of a creatine kinase in serum of muscular tissue was observed. It was established that the disease conducts the system of a hemostasis to a procoagulant state.
Some patients having neurologic manifestations had no typical symptoms of COVID-19 and they showed a negative take at KT of a thorax and in blood tests. Several days later these patients had a cough, a pharyngalgia in combination with a lymphopenia and development of damages of lungs as opaque glass on repeated KT of a thorax. SARS-CoV-2 infection at these patients was confirmed.
Thus, it is possible to draw a conclusion that patients with koronavirusny infections can have the various clinical manifestations connected with damage of the central or peripheral nervous system.