A CLINICAL CASE OF A LESION OF THE CENTRAL NERVOUS SYSTEM ASSOCIATED WITH A NEW CORONAVIRUS INFECTION COVID-19: PROBLEMS OF DIAGNOSIS AND EXAMINATION OF THE CONNECTION WITH THE PROFESSION OF A MEDICAL WORKER

DOI: https://doi.org/10.29296/25877305-2022-11-09
Issue: 
11
Year: 
2022

Professor S. Babanov, MD; Associate Professor T. Azovskova, Candidate
of Medical Sciences; Associate Professor N. Lavrentyeva, Candidate of Medical Sciences
Samara State Medical University, Ministry of Health of Russia

A novel coronavirus infection in medical workers can be considered as an occupational disease if the infection occurred while they were performing their official duties. One of the most important complications of the novel coronavirus infection (COVID-19) is damage to the nervous system. From the point of view of pathogenesis, neurological disorders in COVID-19 can be caused by a "cytokine storm", hypoxemia, homeostasis disorders (encephalopathy of critical conditions), neurotropy and neurovirulence of SARS-CoV-2 (isolated cranial nerve damage, focal and diffuse CNS lesions), as well as mixed effects of these factors. COVID-19 also affects the course of chronic neurological diseases. The spectrum of neurological disorders in COVID-19 is wide: from cranial mononeuropathies, clinically manifested by anosmia, ageusia/dysgeusia to acute inflammatory polyneuropathy of Guillain–Barre and severe lesions of the brain and spinal cord in the form of acute hemorrhagic necrotizing encephalopathy and myelopathy. The presented clinical case describes one of the possible serious complications of COVID-19 – encephalopathy. The article presents the principles and results of a medical examination conducted in order to establish a causal relationship of the disease with professional activity. The need for a multidisciplinary approach to the diagnosis of manifestations, treatment of COVID 19 and its complications with the mandatory participation of a neurologist is emphasized. It is obvious that the COVID-19 pandemic will have significant consequences in the context of immediate and long-term neurological complications.

Keywords: 
infectious diseases
novel coronavirus infection COVID-19
viral brain damage
encephalopathy
occupational diseases
medical workers



References: 
  1. Vremennye metodicheskie rekomendatsii «Profilaktika, diagnostika i lechenie novoi koronavirusnoi infektsii (COVID-19)». Versiya 13 (14.10.2021). Minzdrav Rossii, 2021 (in Russ.).
  2. Garipova R.V., Strizhakov L.A., Babanov S.A. Novaya koronavirusnaya infektsiya kak professional'noe zabolevanie: slozhnye ekspertnye sluchai. Mat-ly 16-go Vseross. kongr. «Professiya i zdorov'e». Vladivostok, 2021 (in Russ.).
  3. Kosarev. V.V., Babanov S.A. Professional'nye zabolevaniya meditsinskikh rabotnikov. Samara: OOO «Ofort», 2014; 201 р. (in Russ.).
  4. Novaya koronavirusnaya infektsiya COVID-19: professional'nye aspekty sokhraneniya zdorov'ya i bezopasnosti meditsinskikh rabotnikov: metodicheskie rekomendatsii. Pod red. I.V. Bukhtiyarova, Yu.Yu. Gorblyanskogo. M.: AMT, FGBNU «NII MT», 2021; 132 р. (in Russ.).
  5. Spravochnik po formulirovaniyu klinicheskogo diagnoza boleznei nervnoi sistemy. Pod red. V.N. Shtoka, O.S. Levina. M.: MIA, 2010; 519 р. (in Russ.).
  6. Ternovyh I.K., Topuzova M.P., Chaykovskaya A.D. et al. Neurological manifestations and complications in patients with COVID-19. Translational Medicine. 2020; 7 (3): 21–9 (in Russ.). DOI: 10.18705/2311-4495-2020-7-3-21-29
  7. Postanovlenie Pravitel'stva RF ot 16.05.2020 g. №695 «Ob utverzhdenii Vremennogo polozheniya o rassledovanii strakhovykh sluchaev prichineniya vreda zdorov'yu meditsinskogo rabotnika v svyazi s razvitiem u nego poluchennykh pri ispolnenii trudovykh obyazannostei zabolevaniya (sindroma) ili oslozhneniya, vyzvannykh podtverzhdennoi laboratornymi metodami issledovaniya novoi koronavirusnoi infektsiei i povlekshikh za soboi vremennuyu netrudosposobnost', no ne privedshikh k invalidnosti» (in Russ.).
  8. Postanovlenie Pravitel'stva RF ot 15.12.2000 g. №967 «Ob utverzhdenii Polozheniya o rassledovanii i uchete professional'nykh zabolevanii» (s izmeneniyami i dopolneniyami) (in Russ.).
  9. Ukaz Prezidenta RF ot 06.05.2020 g. №313 (s dopolneniyami ot 30.07.2020 g. №487) «O predostavlenii dopolnitel'nykh strakhovykh garantii otdel'nym kategoriyam meditsinskikh rabotnikov» (in Russ.).
  10. Baig A.M., Khaleeq A., Ali U. et al. Evidence of the COVID-19 virus targeting the CNS: tissue distribution, host virus interaction, and proposed neurotropic mechanisms. ACS Chem Neurosci. 2020; 11 (7): 995–8. DOI: 10.1021/acschemneuro.0c00122
  11. Li K., Wohlford-Lenane C., Perlman S. et al. Middle East respiratory syndrome coronavirus causes multiple organ damage and lethal disease in mice transgenic for human dipeptidyl peptidase 4. J Infect Dis. 2016; 213 (5): 712–22. DOI: 10.1093/infdis/jiv499
  12. Desforges M., Miletti T.C., Gagnon M. et al. Activation of human monocytes after infection by human coronavirus 229E. Virus Res. 2007; 130 (1–2): 228–40. DOI: 10.1016/j.virusres.2007.06.016
  13. Li J., Gao J., Xu Y.P. et al. Expression of severe acute respiratory syndrome coronavirus receptors, ACE2 and CD209L in different organ derived microvascular endothelial cells. Zhonghua Yi Xue Za Zhi. 2007; 87 (12): 833–7.
  14. Li Y.C., Bai W.Z., Hirano N. et al. Neurotropic virus tracing suggests a membranous-coating-mediated mechanism for transsynaptic communication. J Comp Neurol. 2013; 521 (1): 203–12. DOI: 10.1002/cne.23171
  15. Benussi A., Pilotto A., Premi E. et al. Clinical characteristics and outcomes of inpatients with neurologic disease and COVID-19 in Brescia, Lombardy, Italy. Neurology. 2020; 95 (7): e910-e920. DOI: 10.1212/WNL.0000000000009848
  16. Mao L., Jin H., Wang M. et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol. 2020; 77 (6): 683–90. DOI: 10.1001/jamaneurol.2020.1127
  17. Poyiadji N., Shahin G., Noujaim D. et al. COVID-19- associated acute emorrhagic necrotizing encephalopathy: CT and MRI features. Radiology. 2020; 296 (2): E119-E120. DOI: 10.1148/radiol.2020201187
  18. Paniz-Mondolfi A., Brice C., Grames Z. et al. Central nervous system involvement by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). J Med Virol. 2020; 92 (7): 699–702. DOI: 10.1002/jmv.25915
  19. Patersen R.W., Brown R.L., Benjamin L. et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain. 2020; 143 (10): 3104–20. DOI: 10.1093/brain/awaa240
  20. Zhou L., Zhang M., Wang J. et al. Sars-CoV-2: Underestimated damage to nervous system. Travel Med Infect Dis. 2020; 36: 101642. DOI: 10.1016/j.tmaid.2020.101642
  21. Ye M., Ren Y., Lv T. Encephalitis as a clinical manifestation of COVID-19. Brain Behav Immun. 2020; 88: 945–6. DOI: 10.1016/j.bbi.2020.04.017