SARS-COV-2感染中脑病/播散性脑脊髓炎3例分析

Q4 Medicine
D. Metodiev, Y. Toshev, K. Anachkov, N. Sarbyanova, S. Nachev
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引用次数: 0

摘要

摘要А与许多其他病毒性流行病一样,目前的严重急性呼吸系统综合征冠状病毒2型也以神经系统受累为特征,主要发生在患有合并症的老年患者中。最近的科学报告表明,神经系统的受累表现为与脑损伤的严重程度和程度相关的各种临床症状。脑病、脑炎和多神经炎是严重急性呼吸系统综合征冠状病毒2型患者的并发症。这些并发症已在形态学上得到证实。作为一种免疫特权结构,神经组织特别容易受到自身免疫攻击。因此,在严重急性呼吸系统综合征冠状病毒2型感染患者中也有各种神经系统疾病的报道,如多发性硬化症、格林-巴利综合征,以及自身免疫性脑炎和精神病。在此,我们报告了三例感染严重急性呼吸系统综合征冠状病毒2型后死亡的患者。我们强调在对大脑和颈椎的详细研究中发现的病理形态学变化。炎症表现的分析主要表现为静脉周淋巴细胞浸润、血清渗出和血管周围的红细胞贮库,显示存在最初的脱髓鞘(其中两例)。大多数大小不同的静脉血管的血液供应和明显的“污泥”现象是最令人印象深刻的发现,因为在某些部位,血栓形成证明了这些变化。在靠近脑干核团的脑干中也观察到炎症表现。严重急性呼吸系统综合征冠状病毒2型病毒诱导多种免疫系统反应。一些患者的反应可以忽略不计或没有反应,而另一些患者则出现了“细胞因子风暴”,对包括大脑在内的多个器官造成系统损伤。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Three Cases of Encephalopathy / Disseminated Encephalomyelitis in SARS-COV-2 Infection
Abstract Аs many other viral pandemics, the current SARS-CoV-2 is also characterized by nervous system involvement, mainly in elderly patients with comorbidities. Recent scientific reports indicate that involvement of the nervous system is manifested by a variety of clinical symptoms related to the severity and extent of brain damage. Encephalopathy, encephalitis and polyneuritis are among the complications reported in patients with SARSCoV- 2. These complications have been morphologically proven. As an immune-privileged structure, neural tissue is particularly vulnerable to autoimmune attacks. Therefore, various neurological diseases such as MS, Guillain-Barre syndrome, as well as autoimmune encephalitis and psychosis have also been reported in patients with SARS-CoV-2 infection. Herein, we present three cases of patients who died after infection with the SARS-CoV-2 virus. We emphasize on the pathomorphological changes found in a detailed study of the brain and cervical spine. The analysis of the inflammatory findings, mainly manifested by perivenous lymphocytic infiltrates, serodiapedesis and erythrocyte depots around the vessels, showed a presence of initial demyelination (in two of the cases). The blood supply of most venous vessels with different size and a pronounced “sludge” phenomenon were the most impressive findings, as in some sections these changes were demonstrated by a presence of thrombosis. Inflammatory manifestations were also observed in the brainstem near to the stem nuclei. The SARS-CoV-2 virus induces a variety of immune system responses. In some patients there is a negligible or no reaction, while in others there is a “cytokine storm” with a system damage of multiple organs – often including the brain.
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来源期刊
Acta Medica Bulgarica
Acta Medica Bulgarica Medicine-Medicine (all)
CiteScore
0.30
自引率
0.00%
发文量
33
审稿时长
25 weeks
期刊介绍: About 30 years ago - in 1973, on the initiative of the Publishing House „Medicine and Physical Culture", namely its former director Mr. Traian Ivanov, the Ministry of Health set up and accepted to subsidize a new medical magazine that was to be published only in the English language and had to reflect the status and the achievements of the Bulgarian medical science. Thus the language barrier was overcome and stable relations were established with the international medical society, large libraries, and university centers. The famous internationally known scientist professor Assen A. Hadjiolov was elected edition-in-chief by the first editorial staff and the magazine was named Acta Medica Bulgarica.
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