REVIEW
Introdução: Órgão alvo de constante estudo, o cérebro ainda hoje guarda mistérios envolvendo sua fisiologia e mecanismos de adaptação frente às agressões extrínsecas. Alteração rara, porém significativa, decorrente de lesão na área frontal, é o transtorno de personalidade. De etiologia variada, o transtorno ganha destaque nesta revisão por se mostrar como uma consequência tardia da infecção pelo severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objetivo: verificar se o Sars-Cov-2 é capaz de causar transtorno de personalidade como complicação neurológica da COVID-19, assim como analisar as prováveis vias fisiopatológicas envolvidas no processo. Métodos: A revisão foi realizada em livros científicos de anatomia, neurologia e psiquiatria, além das bases de dados da Biblioteca Virtual de Saúde (BVS), Medical Literature Analysis and Retrieval System Online (MEDLINE, mediante PUBMED), UpToDate, LILACS, The Lancet Neurology e The Lancet Psychiatry, no período entre 21 de abril de 2021 a 26 de outubro de 2022, sendo incluídos estudos originais, artigos no prelo, comunicações preliminares e revisões de literatura em línguas inglesa, espanhola e portuguesa. Foram excluídas bibliografias sem relevância temática. Os resultados foram agrupados em resumos críticos com temática semelhante para fins de síntese e discussão. Resultados: Foram encontrados 772 registros compatíveis, sendo selecionados cinco estudos clínicos elegíveis à análise de texto completo, contendo pacientes com quadro clínico e/ou alterações em exames de imagem relevantes. Estudo realizado por meio de três bases de dados abertas em abril de 2020 no Reino Unido contabilizou 125 pacientes atendidos por COVID-19, registrando 23 casos de alteração do estado mental, destes, dois foram diagnosticados com o transtorno de personalidade. Discussão: Dentre as possíveis vias diretas e indiretas de comprometimento do sistema nervoso central (SNC) pelo vírus, a via hematogênica, na qual ocorre a tempestade de citocinas, se destaca como possível rota utilizada pelo SARS-CoV-2. Dois casos de transtorno de personalidade pós-COVID-19 foram registrados até a data desta produção. Conclusão: Falta de protocolo para acompanhamento dos pacientes pós-COVID-19 e desconhecimento acerca das possíveis manifestações neuropsiquiátricas com relação direta ou indireta à presença do SARS-CoV-2 no SNC representam as limitações e evidenciam a crucialidade desta pesquisa.
Introduction: Target of constant study, the brain still holds mysteries involving its physiology and adaptation mechanisms in the face of extrinsic aggressions. A rare change, however meaningful, resulting from damage to the frontal area is the personality disorder. Of varied etiology, the disorder is highlighted in this review for being a late consequence of infection by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: to verify whether Sars-Cov-2 is capable of causing personality disorder as a neurological complication of COVID-19, as well as to analyze the likely pathophysiological pathways involved in the process. Methods: The review was accomplished in scientific books on anatomy, neurology and psychiatry, in addition to the databases Virtual Health Library (VHL), Medical Literature Analysis and Retrieval System Online (MEDLINE, through PUBMED), UpToDate, LILACS, The Lancet Neurology and The Lancet Psychiatry, from April 21, 2021 to October 26, 2022, including original studies, articles in press, preliminary communications and literature reviews in English, Spanish and Portuguese. Bibliographies without thematic relevance were excluded. The results were grouped into critical summaries with a similar theme for the purpose of synthesis and discussion. Results: A total of 772 compatible records were found, and five clinical studies eligible for full-text analysis were selected, containing patients with a clinical picture and/or alterations in relevant imaging tests. A study accomplished using three databases opened in April 2020 in the United Kingdom counted 125 patients cared for COVID-19, recording 23 cases of altered mental status, of which two were diagnosed with the personality disorder. Discussion: Among the possible direct and indirect pathways of central nervous system (CNS) involvement by the virus, the hematogenous route, in which the cytokine storm occurs, stands out as a possible route used by SARS-CoV-2. Two cases of post-COVID-19 personality disorder have been recorded until the date of this production. Conclusion: Lack of a protocol for monitoring post-COVID-19 patients and lack of knowledge about the various neuropsychiatric manifestations directly or indirectly related to the presence of SARS-CoV-2 in the CNS show the cruciality of this research. This review has no funding or conflict of interest.
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1MS, Medical Student, Centro Universitário do Planalto Central Apparecido dos Santos – Uniceplac, Brasília, DF, Brazil.
2MSc, PhD, Neurosurgeon, Lago Sul Hospital; Professor at Centro Universitário do Planalto Central Apparecido dos Santos – Uniceplac, Brasília, DF, Brazil.
Received Aug 13, 2022
Corrected Jul 1, 2023
Accepted Jul 21, 2023
