ORIGINAL
Introdução: apesar dos avanços no conhecimento da COVID-19, o papel da hipertensão intracraniana (HIC) na fisiopatogênese de sintomas neurológicos ainda merece investigação. Objetivo: analisar pressão-intracraniana, pela medida do diâmetro-da-bainha-do-nervo-óptico (DBNO), em tomografias computadorizadas de crânio (TCC) de pacientes com e sem COVID-19. Métodos: foram utilizadas TCCs admissionais (primeiras 24h) de pacientes com SARS-CoV-2-RT-PCR-positivo e comparados com pacientes do período pré-pandemia. As tomografias pertencem ao Banco-de-Imagens-Clínicas-Institucional, que armazena automaticamente exames desde out/2014. Resultados: os grupos foram semelhantes: a) idade; b) sexo (p=0,688 e p=0,784); e c) comorbidades (hipertensão (p=0,299), diabetes-2 (p=0,094). No grupo-COVID-19, aumento do DBNO ocorreu em 24% dos casos. Outros marcadores de HIC foram vistos em 1-28% desses casos. Óbitos foram mais frequentes no grupo COVID-19 (32,8% vs 9,3%, p<0,001), bem como desfechos desfavoráveis (64,7% vs 36%, p<0,001). Resultado pobre esteve relacionado a aumento do DBNO (15,8%), desvio das estruturas da linha-média (83,3%) e cisternas apagadas (100%). Conclusão: HIC, inferida pelo DBNO nas TCCs admissionais, parece ter papel na sintomatologia neurológica e desfecho de pacientes com COVID-19. Outros marcadores de HIC (desvio da linha média e cisternas apagadas) se mostraram fortemente relacionados a desfechos desfavoráveis, provavelmente por sinalizarem esgotamento da complacência e herniação cerebral iminente, o que favorece a busca do DBNO como marcador precoce de HIC.
Introduction: despite advances in knowledge of COVID-19, there are still gaps in its understanding, particularly the role of intracranial-hypertension (ICH) in COVID-19 patients with neurological symptomatology. Objective: to analyze intracranial pressure (ICP) through optic nerve sheath diameter (ONSD) in patients with and without COVID-19. Methods: cranial computed tomography (CCT) scans at admission (first 24h) of patients with positive SARS-CoV-2-RT-PCR were compared with similar patients from a pre-pandemic period. All CCT are part of the Institutional-Clinical-Image-Databank (BIC-HPS), which automatically stores exams since Oct/2014. Results: the groups were similar: a) age (p=0.688); b) gender (p=0.784); and c) comorbidities: hypertension (p=0.299), diabetes-2 (p=0.094). In the COVID-19-group, increased ONSD occurred in 24% of cases. Other HIC markers were present in 1-28% of these patients. Deaths were more frequent in COVID-19-group (32.8% vs 9.3%, p<0,001), as well as unfavorable functional outcomes (64.7% vs 36%, p<0,001). Conclusion: ICH, inferred using ONSD at initial CCT, seemed to have a role in neurological symptoms and outcomes, in a fraction of COVID-19 patients. Other ICH markers, as midline-shift and cisternal-effacement have shown strong relationships with functional-outcomes, possibly for being markers of exhausted C omplacency and imminent herniation, which may signal active evaluation of ONSD as early marker of ICH amenable to treatment.
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1 MD, MSc, Neurosurgeon, Metropolitan Hospital Oeste Pelópidas Silveira IMIP/SES/SUS, Post-graduation Program in Neuropsychiatry and Behavior Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
2 RN, Nurse, Metropolitan Hospital Oeste Pelópidas Silveira IMIP/SES/SUS, Recife, Pernambuco, Brazil.
3 MD, Intensive Care Medicine, Metropolitan Hospital Oeste Pelópidas Silveira IMIP/SES/SUS, Recife, Pernambuco, Brazil.
4 MSc, Statistics and Biostatistics, Instituto de Medicina Integral Professor Fernando Figueira – IMIP, Recife, Pernambuco, Brazil.
5 MD, PhD, Neurosurgeon, Post-graduation Program in Neuropsychiatry and Behavior Sciences, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
Received Dec 12, 2022
Accepted Dec 26, 2022
