References

rmt

Общая реаниматология

General Reanimatology

1813-97792411-7110

FSBI "SRIGR" RAMS

10.15360/1813-9779-2021-3-65-77

rmt-2083

Research Article

ОБЗОРЫ И КРАТКИЕ СООБЩЕНИЯ

REVIEWS & SHORT COMMUNICATIONS

Особенности симптоматики и патогенеза повреждения центральной нервной системы при COVID-19 по данным клинических исследований (обзор)

Signs and Symptoms of Central Nervous System Involvement and Their Pathogenesis in COVID-19 According to The Clinical Data (Review)

Цыган

Н. В.

Tsygan

N. V.

Николай Васильевич Цыган

188300, Ленинградская обл., Гатчина, мкр. Орлова роща, д. 1; 123182, Москва, пл. Академика Курчатова, д. 1; 194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Nikolay V. Tsygan

mkr. Orlova roshcha, Gatchina, Leningrad region, 188300; 1 Akademika Kurchatova Sq., 123182 Moscow; 6 Akademika Lebedeva Str., 194044 Saint Petersburg

77tn77@gmail.com

Трашков

А. П.

Trashkov

A. P.

188300, Ленинградская обл., Гатчина, мкр. Орлова роща, д. 1; 123182, Москва, пл. Академика Курчатова, д. 1

Alexandr P. Trashkov

1 mkr. Orlova roshcha, Gatchina, Leningrad region, 188300; 1 Akademika Kurchatova Sq., 123182 Moscow

Рябцев

А. В.

Ryabtsev

A. V.

Alexandr V. Ryabtsev

1 mkr. Orlova roshcha, Gatchina, Leningrad region, 188300; 1 Akademika Kurchatova Sq., 123182 Moscow; 6 Akademika Lebedeva Str., 194044 Saint Petersburg

Яковлева

В. А.

Yakovleva

V. A.

Victoria A. Yakovleva

1 mkr. Orlova roshcha, Gatchina, Leningrad region, 188300; 1 Akademika Kurchatova Sq., 123182 Moscow; 6 Akademika Lebedeva Str., 194044 Saint Petersburg

Коневега

А. Л.

Konevega

A. L.

188300, Ленинградская обл., Гатчина, мкр. Орлова роща, д. 1; 123182, Москва, пл. Академика Курчатова, д. 1

Andrey L. Konevega

1 mkr. Orlova roshcha, Gatchina, Leningrad region, 188300; 1 Akademika Kurchatova Sq., 123182 Moscow

Васильев

А. Г.

Vasiliev

A. G.

194100, Санкт-Петербург, ул. Литовская, д. 2

Andrey G. Vasiliev

2 Litovskaya Str., 194100 St. Petersburg

Цыган

В. Н.

Tsygan

V. N.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Vasily N. Tsygan

6 Akademika Lebedeva Str., 194044 Saint Petersburg

Одинак

М. М.

Odinak

M. M.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Miroslav M. Odinak

6 Akademika Lebedeva Str., 194044 Saint Petersburg

Литвиненко

И. В.

Litvinenko

I. V.

194044, Санкт-Петербург, ул. Академика Лебедева, д. 6

Igor V Litvinenko

6 Akademika Lebedeva Str., 194044 Saint Petersburg

Петербургский институт ядерной физики им. Б. П. Константинова, Национальный исследовательский центр Курчатовский институт; Национальный исследовательский центр Курчатовский институт; Военно-медицинская академия им. С. М. Кирова Министерства обороны РоссииРоссияKonstantinov St. Petersburg Institute for Nuclear Physics, National Research Center Kurchatov Institute; National Research Center Kurchatov Institute; Kirov Military Medical AcademyRussian Federation

Петербургский институт ядерной физики им. Б. П. Константинова, Национальный исследовательский центр Курчатовский институт; Национальный исследовательский центр Курчатовский институтРоссияKonstantinov St. Petersburg Institute for Nuclear Physics, National Research Center Kurchatov Institute; National Research Center Kurchatov InstituteRussian Federation

Санкт-Петербургский государственный педиатрический медицинский университет Минздрава РоссииРоссияSaint Petersburg State Pediatric Medical UniversityRussian Federation

Военно-медицинская академия им. С. М. Кирова Министерства обороны РоссииРоссияKirov Military Medical AcademyRussian Federation

2021

02072021

1736577

2021

Цыган Н.В., Трашков А.П., Рябцев А.В., Яковлева В.А., Коневега А.Л., Васильев А.Г., Цыган В.Н., Одинак М.М., Литвиненко И.В.

Tsygan N.V., Trashkov A.P., Ryabtsev A.V., Yakovleva V.A., Konevega A.L., Vasiliev A.G., Tsygan V.N., Odinak M.M., Litvinenko I.V.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://www.reanimatology.com/rmt/article/view/2083

Актуальность пристальной клинической оценки поражения центральной нервной системы вирусом SARS-CoV-2 определяется низкой специфичностью ряда неврологических симптомов, сложностью объективизации жалоб пациента, неоднородной осведомленностью и настороженностью по поводу имеющегося спектра неврологических симптомов COVID-19, низкой частотой патологических изменений по данным нейровизуализации.

Цель обзора. Выявление особенностей симптоматики и патогенеза поражения центральной нервной системы при COVID-19 на основе анализа данных клинической практики.

Из более 200 первично отобранных источников литературы различных баз данных (Scopus, Web of science, РИНЦ и др.) для анализа выбрали 80 источников, из них — 72 источника, опубликованных в течение последних лет (2016-2020 гг.). Критерием исключения источников служили малая информативность и устаревшие данные.

Клиническая картина поражения центральной нервной системы при COVID-19 включает в себя: нарушение обоняния (5-98% случаев), нарушение вкусовой чувствительности (6-89%), дисфонию (28%), дисфагию (19%), количественные и качественные нарушения сознания (3-53%), головную боль (0-70%), головокружение (0-20%), менее 3% случаев — нарушение зрения, слуха, атаксию, судорожный приступ, инсульт. Анализ данных литературы позволил выделить следующие значимые механизмы воздействия высококонтагиозных коронавирусов (в том числе вируса SARS-CoV-2) на центральную нервную систему: нейродегенерация (в том числе цитокининдуцированная); церебральный тромбоз и церебральная тромбоэмболия; повреждение нейрососудистой единицы; иммуноопосредованное поражение нервной ткани, приводящее к развитию инфекционно-аллергического демие-линизирующего процесса.

Рассмотрели симптомы поражения нервной системы при COVID-19, такие как головная боль, головокружение, нарушение обоняния и вкусовых ощущений, изменение уровня сознания, бульбарные нарушения (дисфагия, дисфония). Соответственно, проанализировали данные о возможных путях проникновения SARS-CoV-2 в центральную нервную систему и механизмы поражения нервной ткани.

По результатам проведенного анализа отечественной и зарубежной литературы показали высокую частоту и полиморфность симптомов поражения центральной нервной системы, а также важную роль сосудистого поражения головного мозга и нейродегенерации в патогенезе COVID-19.

Detailed clinical assessment of the central nervous system involvement in SARS-CoV-2 infection is relevant due to the low specificity of neurological manifestations, the complexity of evaluation of patient complaints, reduced awareness of the existing spectrum of neurological manifestations of COVID-19, as well as low yield of the neurological imaging.

The aim. To reveal the patterns of central nervous system involvement in COVID-19 and its pathogenesis based on clinical data.

Among more than 200 primary literature sources from various databases (Scopus, Web of Science, RSCI, etc.), 80 sources were selected for evaluation, of them 72 were published in the recent years (2016-2020). The criteria for exclusion of sources were low relevance and outdated information.

The clinical manifestations of central nervous system involvement in COVID-19 include smell (5-98% of cases) and taste disorders (6-89%), dysphonia (28%), dysphagia (19%), consciousness disorders (3-53%), headache (0-70%), dizziness (0-20%), and, in less than 3% of cases, visual impairment, hearing impairment, ataxia, seizures, stroke. Analysis of the literature data revealed the following significant mechanisms of the effects of highly contagious coronaviruses (including SARS-CoV-2) on the central nervous system: neurodegeneration (including cytokine- induced); cerebral thrombosis and thromboembolism; damage to the neurovascular unit; immune-mediated damage of nervous tissue, resulting in infection and allergy-induced demyelination.

The neurological signs and symptoms seen in COVID-19 such as headache, dizziness, impaired smell and taste, altered level of consciousness, bulbar disorders (dysphagia, dysphonia) have been examined. Accordingly, we discussed the possible routes of SARS-CoV-2 entry into the central nervous system and the mechanisms of nervous tissue damage.

Based on the literature analysis, a high frequency and variability of central nervous system manifestations of COVID-19 were revealed, and an important role of vascular brain damage and neurodegeneration in the pathogenesis of COVID-19 was highlighted.

COVID-19SARS-CoV-2центральная нервная системацентральная гипертермиягипоксиянейродегенерация

COVID-19SARS-CoV-2central nervous systemhypoxianeurodegeneration

Работа выполнена при поддержке НИЦ «Курчатовский институт» (приказ №1363 от 25.06.2019 г.)

The work was supported by the NRC «Kurchatov Institute» (order №1363)

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The authors declare that there are no conflicts of interest present.