Yoğun Bakımda COVID-19 ve Nörolojik Hastalıklar
Özet
Aralık 2019'da Wuhan'da ortaya çıkan COVID-19, SARS-CoV-2 virüsünün neden olduğu ve solunum sisteminin yanı sıra santral sinir sistemini de ciddi şekilde etkileyen bir hastalıktır. Virüs, hücre yüzeyindeki ACE-2 reseptörleri aracılığıyla konakçıya bağlanarak yaygın semptomlara ve nörolojik komplikasyonlara yol açar. Bu kapsamda hastalarda baş ağrısı, deliryum, bilinç değişiklikleri, epileptik nöbetler, nöromusküler ve nöroimmünolojik bozukluklar ile inme gibi tablolar gözlenmektedir. Özellikle yoğun bakım hastalarında gelişen deliryumun önlenmesi, hastaların takibi ve uygun ilaç tedavilerinin (haloperidol, ketiapin vb.) doz kontrolü kritik önem taşır. Epilepsi hastalarında ilaç etkileşimleri ve EEG çekimleri titizlikle yönetilmelidir. Nöromusküler ve MS gibi nöroimmünolojik hastalıklarda mevcut immünsupresif tedavilerin kesilmemesi, rebound etkilerin önlenmesi adına önerilmektedir. Ayrıca, hiperkoagülabilite ve endotel hasarı nedeniyle gelişen iskemik veya hemorajik inmeler, COVID-19 vakalarında morbidite ve mortaliteyi önemli ölçüde artırmaktadır. COVID-19'un sadece solunum sistemini değil, sinir sistemini de etkilediğinin bilinmesi tedavi sürecinde klinisyenlere rehberlik etmektedir.
COVID-19, which emerged in Wuhan in December 2019, is a disease caused by the SARS-CoV-2 virus that seriously affects the central nervous system in addition to the respiratory system. The virus leads to widespread symptoms and neurological complications by binding to the host via ACE-2 receptors on the cell surface. Within this scope, conditions such as headache, delirium, altered consciousness, epileptic seizures, neuromuscular and neuroimmunological disorders, and stroke are observed in patients. Preventing delirium, monitoring patients, and controlling the dosage of appropriate drug treatments (haloperidol, quetiapine, etc.) are of critical importance, especially in intensive care patients. Drug interactions and EEG recordings in epilepsy patients must be managed meticulously. In neuromuscular and neuroimmunological diseases such as MS, continuing existing immunosuppressive treatments is recommended to prevent rebound effects. Furthermore, ischemic or hemorrhagic strokes developing due to hypercoagulability and endothelial damage significantly increase morbidity and mortality in COVID-19 cases. Knowing that COVID-19 affects not only the respiratory system but also the nervous system guides clinicians in the treatment process.
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