Neurologische Komplikationen bei COVID-19-Infektion

Seit ersten Berichten einer neuen Atemwegsinfektion aus der Hauptstadt Wuhan der zentralchinesischen Provinz Hubei Ende 2019 breitet sich das Coronavirus SARS-CoV-2 weltweit aus. Mittlerweile ist bekannt, dass eine COVID-19-Infektion häufig begleitet wird von neurologischen Symptomen und Komplikationen. Dieser Artikel beleuchtet die klinische Relevanz der COVID-19-Pandemie für die Neurologie im Allgemeinen und insbesondere im Hinblick auf an Parkinson vorerkrankte Patienten.

Fallbeispiel 1

Die Geburtstagsfeier

Herr M. ist ein 80-jähriger berenteter Busfahrer, welcher mit seiner Ehefrau in der eigenen Wohnung lebt. An Vorerkrankungen hat er einen insulinpflichtigen Diabetes mellitus, arterielle Hypertonie, einen Body Mass Index (BMI) von 35 kg/m² und ein mit Marcumar behandeltes Vorhofflimmern. Außerdem ist seit vielen Jahren ein akinetisch-rigides Parkinson-Syndrom bekannt. Anlässlich seines runden Geburtstags überraschen ihn seine Kinder mit einer großen Familienfeier. Alle Teilnehmer sind scheinbar gesund. 3 Tage später fühlt sich Herr M. abgeschlagen, der Allgemeinzustand des Patienten verschlechtert sich stetig und seine Frau wundert sich, warum ihr Ehemann so durcheinander ist. Neben Herrn M. werden 5 weitere Partygäste positiv auf das SARS-CoV-2-Virus getestet.

Kernaussagen

• Das SARS-CoV-2-Virus tritt via ACE2-Rezeptor in seine Wirtszellen ein. Neben einer direkten viralen Infektion des Gehirns ist außerdem eine hämatogene sowie eine retrograde Infektion über das enterische Nervensystem aufsteigend über den N. vagus denkbar.

• Neurologische Symptome und Komplikationen einer COVID-19-Infektion können in jedem Stadium der Erkrankung auftreten.

• Vier von 5 stationär behandelte COVID-19-Patienten entwickeln neurologische Beschwerden.

• Enzephalopathien sind eine häufige neurologische Manifestation und mit erhöhter Letalität und schlechterem funktionalen Outcome assoziiert.

• Ischämische Schlaganfälle im Rahmen einer COVID-19-Infektion sind häufig zurückzuführen auf einen intrakraniellen Gefäßverschluss. Die Letalität ist besonders hoch.

• Neurologische Vorerkrankungen erhöhen das Risiko eines schweren COVID-19-Verlaufs.

• Ein Post-COVID-19-Syndrom wird diskutiert, welches sich insbesondere durch persistierende Fatigue auszeichnet.

• Ob eine COVID-19-Infektion Neurodegeneration fördert, ist zum gegenwärtigen Zeitpunkt unklar.

Publication History

Article published online:
01 June 2021

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