| Abstract | Uvod: Od početka pandemije virusa SARS-CoV-2 bilo je jasno da je virus izrazito
neurotropan. Neurološke manifestacije mogu se kretati od nespecifičnih simptoma kao što su
vrtoglavica, glavobolja i smetnje mirisa do teških oblika neurološke disfunkcije. Neke
neurološke komplikacije mogu se javiti čak i nakon blagih oblika respiratornih bolesti. Cilj ove
studije bio je procijeniti cerebrovaskularnu reaktivnost u bolesnika s nespecifičnim
neurološkim simptomima nakon SARS-CoV-2 infekcije.
Metode: Za 25 bolesnika (mušarci N=16, žene N=9), u dobi od 33 do 62 godine, koji
su imali nespecifične neurološke simptome 36 dana nakon preboljele blage infekcije SARSCoV-2 virusom i 180 dana nakon početka SARS-COV-2 infekcije, kao i 25 zdravih ispitanika
u kontrolnoj skupini, ispitivali smo vazoreaktivnost moždanih krvnih žila pomoću
transkranijskog doplera kodiranog bojom i testom zadržavanja daha. Mjerili smo vršnu
sistoličku brzinu (PSV, eng. Peak Systolic Velocity), krajnju dijastoličku brzinu (EDV, eng.
End-Diastolic Velocity ) i srednju brzinu (MV, eng.Mean flow Velocity), indeks otpora (RI,
eng.Resistance Index) i indeks pulsatilnosti (PI, eng.Pulsatility Index) srednje moždane arterije
(MCA, eng. Middle Cerebral Artery).
Rezultati: 36 dana nakon početka SARS-CoV-2 infekcije pronađene su statistički
značajno niže brzine protoka kroz srednju moždanu arteriju u mirovanju [razlika aritmetičkih
sredina iznosi za PSV 12,5 (T=4,5, p<0.001), za EDV 4,6 (T=3,2, p=0.002), za MV 9,2 (T=4,4,
p<0,001), za RI 0,03 (T=3,1, p=0,003)], niže maksimalne brzine na kraju razdoblja zadržavanja
daha (2,4 puta za PSV, za EDV 1,4 puta niže i 1,2 puta niže za MV) i niži indeks zadržavanja
daha (BHI) (0,554 vs. p<0,001)) u odnosu na kontrolnu skupinu zdravih ispitanika. Nakon 180
dana od početka SARS-CoV-2 infekcije nema značajnih promjena ispitivanih parametara za
PSV (t=1,1, p=0,065), EDV (t=0,21; p=0,837), MV(t=1,6; p=0,118), PI(t=1,1; p=0,286) nakon
testa zadržavanja daha ni u fazi mirovanja za PSV (t=1,5; p=0,156), RI (t =1,9; p=0,07), i MV
(t=1,4, p=0,066) dok su vrijednosti EDV (t=4,9; p<0,001) i PI (t=2,4; p=0,028) bile više.
Zaključci: Smanjenje brzina protoka kroz srednju moždanu arteriju ukazuju na
oslabljenu moždanu vazoreaktivnost u skupini ispitanika nakon infekcije SARS-CoV-2
virusom s obzirom na kontrolnu skupinu i sugeriraju oštećenje vaskularnog endotela virusom
SARS-CoV-2. Nakon 180 dana od početka infekcije nije došlo do oporavka moždane
vazoreaktivnosti kod ispitanika nakon SARS-CoV-2 infekcije. |
| Abstract (english) | Background: From the beginning of the SARS-CoV-2 virus pandemic, it was clear that
the virus was highly neurotropic. Neurological manifestations can range from non-specific
symptoms such as dizziness, headache and odor disturbances to severe forms of neurological
dysfunction. Some neurological complications can occur even after mild forms of respiratory
diseases. The aim of this study was to assess cerebrovascular reactivity in patients with
nonspecific neurological symptoms after SARS-CoV-2 infection.
Methods: For 25 patients (men N=16, women N=9), aged 33 to 62 years, who had
nonspecific neurological symptoms 36 days after mild SARS-CoV-2 virus infection and 180
days after the onset of SARS-COV-2 infections, as well as 25 healthy subjects in the control
group, we examined cerebrovascular vasoreactivity using color-coded transcranial Doppler and
breath retention test. We measured peak systolic velocity (PSV), end-diastolic velocity (EDV)
and mean velocity (MV), resistance index (RI). ) and the Pulsatility Index (PI) of the Middle
Cerebral Artery (MCA).
Results: 36 days after the onset of SARS-CoV-2 infection, statistically significantly
lower resting cerebral artery flow rates were found [the difference in arithmetic means is for
PSV 12.5 (T=4,5, p<0,001), for EDV 4,6 (T=3.2, p=0.002), for MV 9,2 (T=4.4, p <0,001), for
RI 0,03 (T=3,1, p=0.003)], lower maximum velocities at the end of the breath holding period
(2,4 times) for PSV, for EDV 1,4 times lower and 1,2 times lower for MV) and lower breath
retention index (BHI) (0,554 vs. p <0,001)) compared to the control group of healthy subjects
180 days after the onset of SARS -CoV-2 infection there are no significant changes in the
examined parameters for PSV (t=1.1, p=0,065), EDV (t=0.21; p=0,837), MV (t=1,6; p=0,118),
PI (t=1,1; p=0,286) after the breath hold test and in rest period for PSV (t=1,5; p=0,156), RI
(t=1,9; p=0,07), and MV (t=1,4, p=0,066) while the values of EDV (t=4,9; p<0,001) and PI (t
=2,4; p=0,028) during rest period were higher.
Conclusions: Decreased flow rates through the middle cerebral artery indicate poor
cerebral vasoreactivity in the group of subjects after SARS-CoV-2 virus infection relative to
the control group and suggest vascular endothelial damage by the SARS-CoV-2 virus. After
180 days from the onset of infection, there was no recovery of cerebral vasoreactivity in subjects
after SARS-CoV-2 infection. |
