Showing papers in "Neurologia in 2020"
TL;DR: The impact of SARS-CoV-2 infection on the onset and progression of neurodegenerative and neuropsychiatric diseases of neuroinflammatory origin should be regarded as the potential cause of a delayed pandemic that may have a major public health impact in the medium to long term.
Abstract: Resumen Introduccion La infeccion por el coronavirus SARS-CoV-2 originada en diciembre de 2019 en la region china de Wuhan ha adquirido proporciones pandemicas. A dia de hoy ha ocasionado mas de 1,7 millones de contagios y mas de 100.000 muertes en todo el mundo. La investigacion cientifica actual se centra en el mejor conocimiento de la infeccion aguda y de sus estrategias terapeuticas. Dada la magnitud de la epidemia, planteamos una revision especulativa sobre las posibles consecuencias en patologia neurologica a medio/largo plazo, con especial atencion a enfermedades neurodegenerativas y neuropsiquiatricas con base neuroinflamatoria, teniendo en cuenta la evidencia directa de afectacion neurologica a causa de la infeccion aguda. Desarrollo Revisamos de forma sistematica lo conocido sobre los mecanismos patogenicos de la infeccion por SARS-CoV-2, la repercusion de la tormenta de citoquinas sobre el sistema nervioso central y su persistencia en el tiempo y las consecuencias que la neuroinflamacion puede tener sobre el sistema nervioso central. Conclusiones El SARS-CoV-2 es un virus neuroinvasivo capaz de provocar una tormenta de citoquinas que podria convertirse en persistente en poblacion seleccionada. Aunque nuestra hipotesis tiene alto componente especulativo, la repercusion que esta situacion puede tener en la puesta en marcha y progresion de enfermedades neurodegenerativas y neuropsiquiatricas con base neuroinflamatoria debe ser considerada como posible germen de una pandemia demorada que podria tener un gran impacto en salud publica a medio o largo plazo. Se hace necesario un estrecho seguimiento de la salud cognitiva y neuropsiquiatrica de los pacientes supervivientes a infeccion COVID-19.
135 citations
TL;DR: Although neurological symptoms are not frequent in coronavirus epidemics, the high number of patients with SARS-CoV-2 infection may explain the presence of the virus in the CNS and increase the likelihood of early- or delayed-onset neurological symptoms.
Abstract: Introduction There is growing evidence that SARS-CoV-2 can gain access to the central nervous system (CNS). We revise the literature on coronavirus infection of the CNS associated with neurological diseases. Development Neurological symptoms were rarely reported in the SARS-CoV and MERS-CoV epidemics, although isolated cases were described. There are also reports of cases of neurological symptoms associated with CoV-OC43 and CoV-229E infection. The presence of neurological lesions, especially demyelinating lesions in the mouse hepatitis virus model, may explain the mechanisms by which coronaviruses enter the CNS, particularly those related with the immune response. This may explain the presence of coronavirus in patients with multiple sclerosis. We review the specific characteristics of SARS-CoV-2 and address the question of whether the high number of cases may be associated with greater CNS involvement. Conclusion Although neurological symptoms are not frequent in coronavirus epidemics, the high number of patients with SARS-CoV-2 infection may explain the presence of the virus in the CNS and increase the likelihood of early- or delayed-onset neurological symptoms. Follow-up of patients affected by the SARS-CoV-2 epidemic should include careful assessment of the CNS.
90 citations
TL;DR: The authors of as discussed by the authors show that SARS-CoV-2 puede penetrar en el sistema nervioso central (SNC) asociado with enfermedades neurologicas.
Abstract: Resumen Introduccion Diversas evidencias sugieren que el SARS-CoV-2 puede penetrar en el sistema nervioso central (SNC). Los autores revisan los datos de la literatura sobre los hallazgos de coronavirus en el SNC asociado a enfermedades neurologicas. Desarrollo En las distintas epidemias con SARS-CoV y MERS-CoV la presencia de cuadros neurologicos es baja, pero se describen cuadros aislados de pacientes. Tambien existen casos asociados a OC43-CoV y 229E-CoV. La existencia de lesiones neurologicas, especialmente desmielinizantes en el modelo MHV-CoV pueden explicar mecanismos de penetracion de los CoV en el SNC y especialmente aquellos relacionados con la respuesta inmune, que puede justificar la existencia de CoV en pacientes con esclerosis multiple. Los autores revisan aspectos diferenciales de SARS-CoV-2 y se plantean si debido al alto numero de infectados, el virus puede afectar de forma mayor al SNC. Conclusion Aunque la presencia de sintomas neurologicos en las epidemias de CoV es baja, la mayor frecuencia de infectados por SARS-CoV-2 podria justificar el paso del virus y la posibilidad de clinica neurologica precoz o tardia con mayor incidencia. El seguimiento de los pacientes de la epidemia debe atender con cuidado a la evaluacion del SNC.
75 citations
TL;DR: History of stroke increases the risk of death due to COVID-19 by 3 times, and Stroke currently seems not to be one of the main complications of CO VID-19.
Abstract: Introduction Contradictory data have been reported on the incidence of stroke in patients with COVID-19 and the risk of SARS-CoV-2 infection among patients with history of stroke. Methods This study systematically reviews case series reporting stroke as a complication of COVID-19, and analyses the prognosis of patients with COVID-19 and history of stroke. The pathophysiological mechanisms of stroke in patients with COVID-19 are also reviewed. Conclusions History of stroke increases the risk of death due to COVID-19 by 3 times. Stroke currently seems not to be one of the main complications of COVID-19.
51 citations
TL;DR: The measures taken, including the preparation of a functional reorganisation plan, strategies for hospitalisation and emergency management, the use of telephone consultations to maintain neurological care, provision of care at a unit outside the hospital for priority patients, decisions about complementary testing and periodic in-hospital treatments are reported.
Abstract: Resumen Introduccion La pandemia de Covid-19 ha supuesto la necesidad de tomar decisiones para mantener la asistencia neurologica, sin precedentes. En este articulo se analiza esa toma de decisiones operativas. Desarrollo Los autores refieren las formulas empleadas como son la realizacion de un plan de reorganizacion funcional, estrategias para la hospitalizacion y urgencias, la realizacion de consultas telefonicas para el mantenimiento de la atencion neurologica, la asistencia en un area externa al hospital para pacientes preferentes, las decisiones sobre exploraciones complementarias y tratamientos intrahospitalarios periodicos o implantar un telefono para la priorizacion de crisis epilepticas. Conclusion A pesar de la situacion de aislamiento, los servicios de neurologia deben mantener la atencion de sus pacientes a traves de distintas formulas operativas, que como cualquier elemento de gestion, deberan evaluarse.
46 citations
TL;DR: This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record.
Abstract: This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
38 citations
33 citations
TL;DR: A document of recommendations that can support the organisation of healthcare services for acute stroke care and the optimisation of their resources, guaranteeing the protection of healthcare professionals.
Abstract: Introduction The COVID-19 pandemic has resulted in complete saturation of healthcare capacities, making it necessary to reorganise healthcare systems. In this context, we must guarantee the provision of acute stroke care and optimise code stroke protocols to reduce the risk of SARS-CoV-2 infection and rationalise the use of hospital resources. The Madrid Stroke multidisciplinary group presents a series of recommendations to achieve these goals. Methods We conducted a non-systematic literature search using the keywords “stroke” and “COVID-19” or “coronavirus” or “SARS-CoV-2.” Our literature review also included other relevant studies known to the authors. Based on this literature review, a series of consensus recommendations were established by the Madrid Stroke multidisciplinary group and its neurology committee. Results These recommendations address 5 main objectives: (1) coordination of action protocols to ensure access to hospital care for stroke patients; (2) recognition of potentially COVID-19-positive stroke patients; (3) organisation of patient management to prevent SARS-CoV-2 infection among healthcare professionals; (4) avoidance of unnecessary neuroimaging studies and other procedures that may increase the risk of infection; and (5) safe, early discharge and follow-up to ensure bed availability. This management protocol has been called CORONA (Coordinate, Recognise, Organise, Neuroimaging, At home). Conclusions The recommendations presented here may assist in the organisation of acute stroke care and the optimisation of healthcare resources, while ensuring the safety of healthcare professionals.
28 citations
TL;DR: The COVID-19 pandemic has had a great impact on healthcare systems in Spain, where headache is the main reason for outpatient neurology consultation, and is one of the countries with the most reported cases of the disease.
Abstract: Introduction The COVID-19 pandemic has had a great impact on healthcare systems Spain, where headache is the main reason for outpatient neurology consultation, is one of the countries with the most reported cases of the disease Objectives This study aimed to analyse the impact of the COVID-19 pandemic on headache units in Spain and to evaluate how neurologists see the future of these units Methods We conducted a cross-sectional online survey of headache units during the sixth week of the state of alarm declared in Spain in response to the pandemic Results The response rate was 74%, with the participation of centres with different characteristics and from all Autonomous Communities of Spain Limitations in face-to-face activity were reported by 958% of centres, with preferential face-to-face consultation being maintained in 604%, and urgent procedures in 458% In 917% of centres, the cancelled face-to-face activity was replaced by telephone consultation 958% of respondents stated that they would use personal protection equipment in the future, and 86% intended to increase the use of telemedicine The majority foresaw an increase in waiting lists (938% for initial consultations, 896% for follow-up, and 894% for procedures) and a worse clinical situation for patients, but only 15% believed that their healthcare structures would be negatively affected in the future Conclusions As a consequence of the pandemic, headache care and research activity has reduced considerably This demonstrates the need for an increase in the availability of telemedicine in our centres in the near future
28 citations
TL;DR: El ictus no parece una of las complicaciones principales de COVID-19, y sobre el riesgo of los enfermos con antecedentes de ICTus de padecer la pandemia se han revisado los mecanismos por los que se pueden producir ictu en esta enfermedad.
Abstract: Resumen Introduccion Existe informacion contradictoria acerca de la incidencia de ictus en enfermos de COVID-19 y sobre el riesgo de los enfermos con antecedentes de ictus de padecer la pandemia. Metodos Revision sistematica de la bibliografia sobre las series de casos de COVID-19 que han tenido un ictus como complicacion y sobre el pronostico de los enfermos con antecedentes de ictus que sufren COVID-19. Tambien se han revisado los mecanismos por los que se pueden producir ictus en esta enfermedad. Conclusiones Tener antecedentes de ictus aumenta 3 veces el riesgo de fallecer por COVID-19. En este momento el ictus no parece una de las complicaciones principales de COVID-19.
28 citations
TL;DR: In this paper, a systematic review was conducted of studies published on scientific databases: PubMed, Cochrane, Science Direct, MEDLINE, and WHO COVID-19 database, which identified 45 studies, which were analysed and completed using the Covidence platform.
Abstract: Introduction Numerous cases have been reported of patients with symptoms of Guillain-Barre syndrome associated with COVID-19, but much information is still lacking on this association and its implications The objective of this review is to analyse the available evidence on this topic in the adult population Material and methods A systematic review was conducted of studies published on scientific databases: PubMed, Cochrane, Science Direct, MEDLINE, and WHO COVID-19 database Results We identified 45 studies, which were analysed and completed using the Covidence platform;the final analysis included 24 articles, with a total of 30 patients Conclusions We found a strong association between both conditions;furthermore, the studies analysed highlight differences in the presentation of the disease, with greater severity of symptoms in Guillain-Barre syndrome associated with COVID-19 Resumen Introduccion Se han reportado distintos casos de pacientes con cuadro de sindrome de Guillain-Barre asociado a COVID-19, pero falta mucha informacion aun sobre esta asociacion y sus implicancias, el objetivo de esta revision es analizar la evidencia disponible en esta tematica en la poblacion adulta Material y Metodos Se realizo una revision sistematica de estudios publicados en buscadores cientificos: PubMed, Cochrane, Science direct, Medline, OMS COVID-19 Resultados Se identificaron 45 estudios, los cuales se analizaron y completaron utilizando la plataforma Covidence, incluyendo para el analisis final 24 articulos y sumando un total de 30 pacientes Conclusiones Se demuestra una asociacion fuerte entre ambas patologias, ademas los estudios analizados recalcan diferencias en la presentacion de la enfermedad con mayor gravedad en los cuadros de Sindrome de Guillain-Barre asociados a COVID-19
TL;DR: Experimental models provide a deeper understanding of the different pathogenic mechanisms involved in multiple sclerosis.
Abstract: Introduction Experimental animal models constitute a useful tool to deepen our knowledge of central nervous system disorders. In the case of multiple sclerosis, however, there is no such specific model able to provide an overview of the disease; multiple models covering the different pathophysiological features of the disease are therefore necessary. Development We reviewed the different in vitro and in vivo experimental models used in multiple sclerosis research. Concerning in vitro models, we analysed cell cultures and slice models. As for in vivo models, we examined such models of autoimmunity and inflammation as experimental allergic encephalitis in different animals and virus-induced demyelinating diseases. Furthermore, we analysed models of demyelination and remyelination, including chemical lesions caused by cuprizone, lysolecithin, and ethidium bromide; zebrafish; and transgenic models. Conclusions Experimental models provide a deeper understanding of the different pathogenic mechanisms involved in multiple sclerosis. Choosing one model or another depends on the specific aims of the study.
TL;DR: In this article, una revision sistematica de estudios publicados en buscadores cientificos: PubMed, Cochrane, Science Direct, Medline, OMS COVID-19, Medline and OMS was presented.
Abstract: Resumen Introduccion Se han reportado distintos casos de pacientes con cuadro de sindrome de Guillain-Barre asociado a COVID-19, pero falta mucha informacion aun sobre esta asociacion y sus implicancias, el objetivo de esta revision es analizar la evidencia disponible en esta tematica en la poblacion adulta. Material y Metodos Se realizo una revision sistematica de estudios publicados en buscadores cientificos: PubMed, Cochrane, Science Direct, Medline, OMS COVID-19. Resultados Se identificaron 47 estudios, los cuales se analizaron y completaron utilizando la plataforma Covidence, incluyendo para el analisis final 24 articulos y sumando un total de 30 pacientes. Conclusiones Se demuestra una asociacion fuerte entre ambas patologias, ademas, los estudios analizados recalcan diferencias en la presentacion de la enfermedad con mayor gravedad en los cuadros de sindrome de Guillain-Barre asociados a COVID-19.
TL;DR: In this article, the authors describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at a hospital and classify them according to the likelihood of a causal relationship between the hypercoagulability and systemic inflammation secondary to the infection.
Abstract: Introduction Ischaemic stroke has been reported in patients with COVID-19, particularly in more severe cases. However, it is unclear to what extent this is linked to systemic inflammation and hypercoagulability secondary to the infection. Materials and methods We describe the cases of 4 patients with ischaemic stroke and COVID-19 who were attended at our hospital. Patients are classified according to the likelihood of a causal relationship between the hypercoagulable state and ischaemic stroke. We also conducted a review of studies addressing the possible mechanisms involved in the aetiopathogenesis of ischaemic stroke in these patients. Results The association between COVID-19 and stroke was probably causal in 2 patients, who presented cortical infarcts and had no relevant arterial or cardioembolic disease, but did show signs of hypercoagulability and systemic inflammation in laboratory analyses. The other 2 patients were of advanced age and presented cardioembolic ischaemic stroke; the association in these patients was probably incidental. Conclusions Systemic inflammation and the potential direct action of the virus may cause endothelial dysfunction, resulting in a hypercoagulable state that could be considered a potential cause of ischaemic stroke. However, stroke involves multiple pathophysiological mechanisms; studies with larger samples are therefore needed to confirm our hypothesis. The management protocol for patients with stroke and COVID-19 should include a complete aetiological study, with the appropriate safety precautions always being observed.
TL;DR: In this paper, the authors investigated the evolucion clinica de trastornos del olfato and el gusto in the enfermedad leve por coronavirus-2019 in pacientes espanoles.
Abstract: Resumen Introduccion La enfermedad por coronavirus-2019 (COVID-19) se ha expandido con gran rapidez en todo el mundo. Las alteraciones del olfato o gusto han emergido como un sintoma muy frecuente a medida que la enfermedad se propago en Europa. Uno de los paises con mayor numero de contagios en este continente ha sido Espana. Objetivo Investigar la evolucion clinica de los trastornos del olfato y el gusto en la enfermedad leve por COVID-19 en pacientes espanoles. Metodos Se realizo un estudio transversal a traves de encuesta on-line, en pacientes que presentaron afeccion subita del olfato o el gusto, durante los 2 meses de confinamiento total por COVID-19 en Espana. Resultados El 91,18% de los sujetos con afectacion del olfato o el gusto, que tuvieron acceso a la realizacion de PCR, fueron positivos para COVID-19. El 6,5% presento anosmia y ageusia de forma aislada. El 93,5% manifesto otros sintomas leves asociados: cefalea (51,6%), tos (51,6%), mialgias (45,2%), astenia (38,7%), congestion nasal o rinorrea (35,5%), fiebre (41,9%), febricula (29,0%), odinofagia (25,8%) y diarrea (6,5%). La duracion media de la anosmia fue de 8,33 dias, posteriormente los pacientes manifestaron hiposmia, con resolucion completa en 17,79 dias de media. En el 22,6% de los pacientes el deficit olfatorio persistio. Todos los sujetos recuperaron el sentido del gusto. Conclusiones Los trastornos olfativos y gustativos son sintomas prevalentes en la infeccion leve por COVID-19. Gran parte de los pacientes no presentan congestion nasal o rinorrea asociada y un grupo reducido de pacientes los presentan de forma aislada.
TL;DR: There is no consistent evidence to support the effectiveness of omega-3 supplementation in improving cognitive function in AD patients in the short and medium term.
Abstract: Introduction Alzheimer disease (AD) is a neurodegenerative disease characterised by progressive dementia associated with global cognitive dysfunction. Methods We conducted a systematic review and meta-analysis of clinical trials evaluating omega-3 supplementation in patients with AD. Objective To determine if there is scientific evidence of the effectiveness of omega-3 supplementation in improving cognitive function in patients with AD. Search strategy We included only randomised controlled trials (RCTs) from the following databases: Medline, Cochrane Central, Cinahl, and LILACS. An electronic search was also conducted using Google Scholar. Study selection Six articles met the eligibility criteria. The risk of bias was assessed following the Cochrane method. Conclusion There is no consistent evidence to support the effectiveness of omega-3 supplementation in improving cognitive function in AD patients in the short and medium term.
TL;DR: Steinert's disease or myotonic dystrophy type 1 is a multisystemic disease that requires specialised multidisciplinary follow-up that implies that it has to be addressed by different specialities with experience in the disease.
Abstract: Background and objectives Steinert's disease or myotonic dystrophy type 1 (MD1), (OMIM 160900 ), is the most prevalent myopathy in adults. It is a multisystemic disorder with dysfunction of virtually all organs and tissues and a great phenotypical variability, which implies that it has to be addressed by different specialities with experience in the disease. The knowledge of the disease and its management has changed dramatically in recent years. This guide tries to establish recommendations for the diagnosis, prognosis, follow-up and treatment of the complications of MD1. Material and methods Consensus guide developed through a multidisciplinary approach with a systematic literature review. Neurologists, pulmonologists, cardiologists, endocrinologists, neuropaediatricians and geneticists have participated in the guide. Recommendations The genetic diagnosis should quantify the number of CTG repetitions. MD1 patients need cardiac and respiratory lifetime follow-up. Before any surgery under general anaesthesia, a respiratory evaluation must be done. Dysphagia must be screened periodically. Genetic counselling must be offered to patients and relatives. Conclusion MD1 is a multisystemic disease that requires specialised multidisciplinary follow-up.
TL;DR: An update of the Spanish Society of Neurology's recommendations for prevention of both primary and secondary stroke in patients with dyslipidaemia is presented and target value is established according to the vascular risk group of each patient.
Abstract: Resumen Objetivo Actualizar las recomendaciones de la Sociedad Espanola de Neurologia para la prevencion del ictus, tanto primaria como secundaria, en pacientes con dislipidemia. Desarrollo Se ha realizado una revision sistematica en Pubmed evaluando los principales aspectos relacionados con el manejo de las dislipidemias en la prevencion primaria y secundaria del ictus, elaborandose una serie de recomendaciones relacionadas con los mismos. Conclusiones En prevencion primaria se recomienda determinar el riesgo vascular del paciente con el fin de definir los objetivos de LDLc. En prevencion secundaria tras un ictus de origen aterotrombotico se recomienda un objetivo de LDLc
TL;DR: It is vital to ensure acute stroke care and optimize the care processes of the stroke code to reduce the risk of contagion and rationalize the use of hospital resources.
Abstract: Resumen Introduccion La pandemia por COVID-19 ha obligado a una reorganizacion de los sistemas sanitarios y ha comportado una saturacion excepcional de sus recursos. En este contexto es vital asegurar la atencion al ictus agudo y optimizar los procesos asistenciales del codigo ictus para reducir el riesgo de contagios y racionalizar el uso de recursos hospitalarios. Para ello, desde el Grupo Multidisciplinar Ictus Madrid proponemos una serie de recomendaciones. Metodos Revision bibliografica no sistematica de las publicaciones disponibles con los terminos «stroke» y «COVID-19» o «coronavirus» o «SARS-CoV-2», asi como otras conocidas por los autores. En base a esta se redacta un documento de recomendaciones que es sometido a consenso por el Grupo Multidisciplinar Ictus Madrid y su Comite de Neurologia. Resultados Las recomendaciones se estructuran en cinco lineas fundamentales: 1) coordinar la actuacion para garantizar el acceso a la asistencia hospitalaria de los pacientes con ictus; 2) reconocer a los pacientes con ictus potencialmente infectados por COVID-19, 3) organizacion adecuada para garantizar la proteccion de los profesionales sanitarios frente al riesgo de contagio por COVID-19, 4) en la realizacion de neuroimagen y otros procedimientos que conlleven contactos de riesgo de infeccion COVID-19 hay que procurar reducirlos y asegurar la proteccion, y 5) alta y seguimiento seguros procurando optimizar la ocupacion hospitalaria. Resumimos el procedimiento de forma esquematica con el acronimo CORONA (COordinar, Reconocer, Organizar, Neuroimagen, Alta). Conclusiones Estas recomendaciones pueden servir de apoyo para la organizacion del sistema sanitario en la atencion al ictus agudo y la optimizacion de sus recursos, garantizando la proteccion de sus profesionales.
TL;DR: Half of 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, and older age is associated with longer ICU stay.
Abstract: 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 = 0.002; 95% CI, 4.032–6.022; OR). 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.
TL;DR: Olfactory and gustatory disorders are prevalent symptoms in mild COVID-19, and most patients do not present associated nasal congestion or rhinorrhoea and a small group of patients present these alterations in isolation.
Abstract: Introduction Coronavirus disease 2019 (COVID-19) has spread rapidly throughout the world. Smell and/or taste disorders have emerged as a very frequent symptom as the disease has spread in Europe. Spain is one of the European countries with the highest number of infections. Objective This study aimed to investigate the clinical progression of smell and taste disorders in Spanish patients with mild COVID-19. Methods An online survey was used to conduct a cross-sectional study of patients who presented sudden smell and/or taste disorders during the 2 months of total lockdown due to COVID-19 in Spain. Results In our sample, 91.18% of respondents with impaired smell and/or taste and who were able to undergo PCR testing were positive for SARS-CoV-2 infection. Anosmia and ageusia presented in isolation in 6.5% of participants. The remaining 93.5% presented other mild symptoms: headache (51.6%), cough (51.6%), myalgia (45.2%), asthaenia (38.7%), nasal congestion or rhinorrhoea (35.5%), fever (41.9%), low-grade fever (29.0%), odynophagia (25.8%), or diarrhoea (6.5%). The mean duration of anosmia was 8.33 days, with patients subsequently manifesting hyposmia; complete resolution occurred after a mean of 17.79 days. In 22.6% of respondents, olfactory deficits persisted. All participants recovered their sense of taste. Conclusions Olfactory and gustatory disorders are prevalent symptoms in mild COVID-19. Most patients do not present associated nasal congestion or rhinorrhoea and a small group of patients present these alterations in isolation.
TL;DR: Las complicaciones neurológicas de los pacientes con infección grave por SARS-CoV2, que han requerido ingreso en Unidad de Cuidados Intensivos (UCI), are analizar.
Abstract: Resumen Introduccion Nos proponemos analizar las complicaciones neurologicas de los pacientes con infeccion grave por SARS-CoV-2 que han requerido ingreso en unidad de cuidados intensivos (UCI). Pacientes y metodos Estudio descriptivo retrospectivo, observacional, de pacientes consecutivos ingresados en UCI por infeccion respiratoria grave por SARS-CoV-2 desde el 1 de abril hasta el 1 de junio de 2020. Resultados Registramos 30 pacientes con sintomas neurologicos, 21 hombres (72,40%), edad media: 57,41 anos ± 11,61 desviacion estandar (DE). Estancia media en UCI: 18,83 ± 14,33 DE. A nivel sindromico: 28 pacientes (93,33%) con sindrome confusional agudo, 15 (50%) con patologia neuromuscular, 5 (16,66%) con cefalea, 4 (13,33%) con patologia cerebrovascular y 4 (13,33%) con encefalopatias/encefalitis. Puncion lumbar normal en 6 pacientes (20%). La RMN craneal o TAC craneal mostro alteraciones en 20 casos (66,6%). Se realizo EEG en todos los pacientes (100%), alterado en 8 pacientes (26,66%). En 5 de los 15 pacientes con miopatia clinica se ha podido confirmar con ENMG. Hemos encontrado relacion entre la mayor edad y los dias de ingreso en UCI (p = 0,002; IC 95%: 4,032-6,022; OR: 3,594). Conclusiones La infeccion grave por COVID-19 afecta mayoritariamente a hombres, similar a lo descrito en otras series. La mitad de nuestros pacientes presenta una miopatia aguda, y casi la totalidad de los pacientes salen de la UCI con sindromes confusionales agudos que evolucionan a una resolucion completa, sin correlacionarse con los resultados del EEG o de pruebas de neuroimagen. La mayor edad se asocia con un mayor numero de dias de estancia en UCI.
TL;DR: A traves of un modelo de informadores clave se busca el consenso de como va a ser la especialidad in un plazo de 5 anos, siendo los encuestados jefes de servicio de neurologia con conocimiento amplio de la situacion al haber actuado durante the pandemia as mentioned in this paper.
Abstract: Resumen Introduccion La pandemia de COVID-19 va a conllevar cambios en la asistencia neurologica, que no se pueden prever facilmente a largo plazo. Material y metodos A traves de un modelo de informadores clave se busca el consenso de como va a ser la especialidad en un plazo de 5 anos, siendo los encuestados jefes de servicio de neurologia con conocimiento amplio de la situacion al haber actuado durante la pandemia. Resultados Aunque se obtiene un grado de acuerdo bajo entre los encuestados, si se describen acuerdos por consenso a nivel mayor (85%) y menor (70%). Los principales acuerdos se refieren al incremento de precauciones, al uso de la telemedicina, al mantenimiento de las consultas telefonicas, a la reduccion de asistencia a las consultas evitando que hayan salas de espera con un numero alto de personas, al desarrollo de tecnicas docentes no presenciales y a la adaptacion en el desarrollo de ensayos clinicos en relacion con la visita de los monitores. Sin embargo, no se acuerda que haya cambios en la indicacion de exploraciones complementarias, ni en la propia exploracion neurologica. Conclusion El metodo de informadores clave ha permitido conocer que cambios se pueden prever tras la pandemia.