Dilek YILMAZ OKUYAN, Meltem KARACAN GÖLEN

COVID-19 Polimeraz Zincir Reaksiyonu-pozitif ve Viral Pnömonili Hastalarda Nörolojik Semptomların Değerlendirilmesi

Giriş: Covid-19 hastalarında sıklıkla, ateş ve kuru öksürük, boğaz ağrısı, dispne gibi respiratuar sistemi etkileyen klinik bulgulara rastlanır. COVID-19 hastalığına bağlı enfeksiyonların her zaman solunum yollarına sınırlı kalmadığı ve nörolojik tutulumun da olabileceği gösterilmiştir. Çeşitli mekanizmalarla virüsün santral sinir sistemine yayılım sonucunda oluşabilecek nörolojik tablolar icerisinde; baş ağrısı, baş dönmesi, nöbet, ensefalit, inme ve nöromuskuler bozukluklar, periferik sinir sistemi tutulumları yer almaktadır. Yöntem: Bu çalışmada COVID-19 pnömonisi olan 179 hastanın eşlik eden nörolojik bulgu, muayene özellikleri ve laboratuar parametreleri retrospektif olarak değerlendirildi. Bulgular: Çalışmada hastaların 101’inde (%56,4) baş ağrısı, 33’ünde (%18,4) dizziness, 20’sinde (%11,2) bilinç değişikliği, 106’sında (%59,9) miyalji, 62’sinde (%34,6) koku kaybı tespit edilirken, 52 ‘sinde tat alma bozukluğu(%29 ) gözlenmiştir. Akut iskemik serebrovasküler hastalık 5 hastada (% 2,8), hemorajik serebrovasküler hastalık ise 1 hastada(% 0,6)gözlenmiştir. Hastaların laboratuar parametrelerini değerlendirdiğimizde lenfopeni % 51’inde, trombosit değerinde değişiklik ise %31’inde tespit edildi. Akut faz reaktanlarından C-reaktif protein (CRP) artışı % 89’unda, ferritin düzeyinde artış ise %27’sinde gözlendi. Hastaların %17 ‘sinde kreatin kinaz (CK) düzeyinde, %20 sinde ise laktat dehiderogenaz (LDH) düzeyinde %34’ünde de D-dimer artışı izlendi. Miyalji olan hastalarda CK seviyelerinde istatiksel anlamlı artış gözlendi.(p = 0.001). Sonuç: COVID-19 enfeksiyonuna bağlı klinik tablonun tek bir nörolojik belirti veya bulgu ile de prezente olabileceği akılda tutulmalıdır. Multidisipliner yaklaşımla yapılacak yeni çalışmalarla gelişebilecek komplikasyon çeşitliliğinin, nörolojik hastalıklarla ilişkisinin ve hastalık yönetiminin daha anlaşılır hale geleceği düşünülmektedir.

Evaluation of Neurologic Symptoms in Patients with Polymerase Chain Reactionpositive COVID-19 and Viral Pneumonia

Objective: The most frequent symptoms affecting the respiratory system in COVID-19 are fever, dry cough, sore throat, and dyspnea. It has been shown that infections due to COVID-19 disease are not always limited to the respiratory tract, there may also be neurologic involvement, which may occur as a result of the spread of the virus to the central nervous system through various mechanisms. Neurologic involvements include headache, dizziness, seizures, encephalitis, stroke, neuromuscular disorders, and peripheral nervous system involvement. Method: In this study, neurologic findings,laboratory parameters and other characteristics of 179 patients with COVID-19 pneumonia were evaluated retrospectively. Results: Headache, dizziness, altered consciousness, myalgia, loss of smell, and taste disturbance were observed in 101/179 (56.4%), 33/179 (18.4%), 20/179 (11.2%), 80/179 (44.6%), 62/179 (34.6%), and 52/179 (29%) patients, respectively. Acute ischemic cerebrovascular disease was observed in 5/179 patients (2.8%) and hemorrhagic cerebrovascular disease was observed in one patient (0.6%). Lymphopenia was observed in 51% and thrombocytopenia was detected in 25.4%. Increased C-reactive protein, ferritin level, creatine kinase, lactate dehydrogenase, and D-dimer levels were observed in 89%, 27%, 17%, 20%, and 34% of the patients, respectively.We found a significant relationship between myalgia and increased CK levels (p = 0.001). Conclusion: Neurologic symptoms can be the first and only symptom of COVID-19. It is thought that the variety of complications that may develop, the relationship of COVID-19 with neurologic diseases, and disease management will become more understandable with future studies conducted with a multidisciplinary approach.

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