COVİD-19 ve Tedavi İlişkili Acil Nörolojik Durumlar
Özet
COVID-19, solunum semptomlarının yanı sıra sitokin fırtınası, immün hiperaktivasyon ve sinir sistemine doğrudan invazyon gibi mekanizmalarla ciddi nörolojik komplikasyonlara yol açmaktadır. Sık görülen akut tablolar arasında frontal lob tutulumlu EEG anormallikleriyle seyreden ensefalopati, kriptojenik yeni başlangıçlı refrakter status epileptikus (NORSE) formundaki nöbetler ve tedavi yönetiminde çoklu organ yetmezliği riskine göre antiepileptik doz ayarı gerektiren durumlar yer alır. Akut serebrovasküler hastalıklar çoğunlukla iskemik inme şeklinde gelişirken, intraserebral hemoraji, sinüs ven trombozu, PRES ve RCVS de bildirilmiştir. Patogenezde endotel hasarı, ACE2 reseptörlerinin down-regülasyonu ve hiperkoagülopati ön plandadır; tedavide antikoagülanlar kullanılırken IV tPA ve mekanik trombektomi kar-zarar oranına göre tercih edilir. Ayrıca, immün aracılı postenfeksiyöz bir süreç olan Guillain-Barré sendromu, akut dissemine ensefalomiyelit (ADEM), longitudinal ekstensif transvers miyelit, viral miyozit ve fasiyal paralizi gibi nöromusküler hastalıklar gelişebilmektedir. COVID-19 tedavisinde kullanılan lopinavir/ritonavir, hidroksiklorokin ve azitromisin gibi ajanlar da hareket bozuklukları, miyopati ve nöbet eşiğinin düşmesi gibi nörolojik yan etkilere yol açabilmektedir. Sonuç olarak, virüsün akut ve uzun vadeli bu nörolojik etkilerinin mekanizmalarını anlamak, tedavi protokollerinin optimize edilmesi açısından kritik önem taşımaktadır.
COVID-19 causes severe neurological complications through mechanisms such as cytokine storm, immune hyperactivation, and direct neuroinvasion, in addition to respiratory symptoms. Common acute presentations include encephalopathy characterized by EEG abnormalities with frontal lobe involvement, seizures in the form of cryptogenic new-onset refractory status epilepticus (NORSE), and conditions requiring antiepileptic dose adjustments due to multi-organ failure risks in treatment management. Acute cerebrovascular diseases predominantly manifest as ischemic strokes, though intracerebral hemorrhage, cerebral venous sinus thrombosis, PRES, and RCVS have also been reported. Endothelial damage, down-regulation of ACE2 receptors, and hypercoagulopathy are prominent in pathogenesis; while anticoagulants are used in treatment, IV tPA and mechanical thrombectomy are preferred based on the risk-benefit ratio. Furthermore, neuromuscular disorders such as Guillain-Barré syndrome, which is an immune-mediated post-infectious process, acute disseminated encephalomyelitis (ADEM), longitudinally extensive transverse myelitis, viral myositis, and facial palsy can develop. Agents used in COVID-19 treatment, including lopinavir/ritonavir, hydroxychloroquine, and azithromycin, can also cause neurological side effects such as movement disorders, myopathy, and lowering of the seizure threshold. Consequently, understanding the mechanisms of these acute and long-term neurological effects of the virus is critical for optimizing treatment protocols.
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