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BACKGROUND: SARS-CoV-2 virus infection may affect other organs including the nervous system with variable neurological manifestations, even some research has reported that SARS-CoV-2 can be found in the brain parenchyma and / or in the cerebrospinal fluid (CSF). Although these reports of neurological involvement secondary to COVID-19 has increased, the clinical manifestations and the forms of neurological invasion is not fully understood. OBJECTIVES: In this paper, we report a case series of patients with SARS-CoV-2 infection with involvement of the nervous system and its neurological complications. In addition, a bibliographic review was developed in different databases with the aim of expanding information on neurological complications and the pathophysiological mechanisms of invasion to the nervous system. CASE REPORT: Case 1, a 79 year old male developed an infarct of the head of the caudate nucleus and thrombosis of the superior longitudinal sinus. Case 2, a 62 year old female developed an intraparenchymal hemorrhage in the left parietal lobe while hospitalized and COVID19 encephalitis was diagnosed. Case 3, a 59 year old healthy male developed a Fisher IV subarachnoid hemorrhage by aneurysmal origin of the right middle cerebral artery and right temporal intraparenchymal hematoma, due to rapid and severe neurological impairment new brain images was performed showing a right cerebellar ischemic stroke leading to compression of the cistern and brainstem. CONCLUSIONS: In these cases, the surgery goal was relieved symptoms, neurologic functional recovery, and life survival. We considered its diffusion and knowledge as imperative for all practitioners involved in the care of this patient.

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Acute aortic syndrome includes a group of diseases that have clinical similarity in their natural history, the most important characteristic being their association with a high vital risk. The diagnosis and management of aortic dissection depends on the degree of aortic involvement according to the location of the lesion, as defined by the Stanford classification. In this syndrome, chest pain is considered the cardinal symptom; however, there are situations where clinical feedback is difficult. We present the case of a patient who debuted with a Stanford A aortic dissection, with an indication for surgical resolution in the acute phase, but who unexpectedly presented unspecific clinical manifestations. An opportune diagnosis was not obtained. After repeated consultations for changes in his symptoms, the definitive diagnosis was determined through imaging study, evolving favorably with ambulatory therapy.

El síndrome aórtico agudo incluye un grupo de enfermedades que poseen similitud clínica en su historia natural, siendo la característica más importante su asociación a un alto riesgo vital. Entre estas patologías, el diagnóstico y manejo de la disección aórtica depende del grado de compromiso aórtico según la ubicación de la lesión definida bajo la clasificación de Stanford. Dentro de las manifestaciones clave se considera al dolor torácico como el síntoma cardinal. Sin embargo, existen situaciones que por ambigüedad clínica retrasan el diagnóstico. Se presenta el caso de un paciente que debutó con una disección aórtica Stanford A, con indicación de resolución quirúrgica en fase aguda pero que dado lo inespecífico de su cuadro clínico, no se logró un diagnóstico oportuno. Posterior a reiteradas consultas por cambios en su sintomatología, se determinó el cuadro definitivo a través de estudio imagenológico, evolucionando de forma favorable con terapia ambulatoria.

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RESUMO

Introducción: Desde su primer uso en 1926 en el manejo de la eclampsia el sulfato de magnesio ha sido un medicamento utilizado y estudiado ampliamente por obstetras. Durante mucho tiempo se mantuvo escepticismo sobre sus potenciales beneficios, pero la aparición de estudios bien estructurados aportó evidencia a favor o en contra de algunos de estos. Objetivo: Realizar una revisión de la literatura acerca dela farmacología, fisiología, farmacocinética, mecanismos de acción, principales usos y regímenes de administración del sulfato de magnesio en obstetricia. Metodología: Búsqueda bibliográfica en Medline, a través de PubMed, utilizando los términos Magnesium Sulfate, Pharmacology, Obstetrics, Pre-eclampsia, Eclampsia, Neuroprotective Agents. Se adicionaron otros artículos con el fin de ampliar información en ciertos temas. Conclusiones: Las propiedades farmacológicas que expresa el sulfato de magnesio se relacionan directamente con su efecto antagónico con el calcio. Muestra efectos a nivel muscular, neuronal, cardiovascular, entre otros. Sus usos en obstetricia abarcan principalmente el manejo de la preeclampsia, prevención de la eclampsia, y prevención de la parálisis cerebral del recién nacido prematuro. El uso como agente tocolítico en el trabajo de parto prematuro aun es discutido ya que la evidencia es inconclusa.

Introduction: Since its first use in 1926 in eclampsia´s management magnesium sulphate has been a drug used and studied extensively by obstetricians. For a long time, practitioners remained sceptical about its potential benefits but the emergence of well-structured studies provided evidence in favor and against. Objective: A review of the literature on the pharmacology, physiology, pharmacokinetics, mechanisms of action, main applications and schemes of administration of the sulfate of magnesium in obstetrics. Methodology: Search in the database MEDLINE via PubMed, using the terms: Magnesium Sulfate, pharmacology, Obstetrics, Preeclampsia, Eclampsia, Neuroprotective Agents. Other papers were added in order to expand information on some topics. Conclusions: The pharmacological properties that express the magnesium sulfate is linked directly with its effect antagonistic with the calcium. Shows effects to level muscle, neuronal, cardiovascular, among others. Its uses in obstetrics include mainly the management of preeclampsia, prevention of eclampsia, and prevention of cerebral palsy in the premature neonate. The magnesium sulphate tocolytic effects even is discussed because the evidence is inconclusive.

Introdução: Desde que o sulfato de magnésio foi utilizado em 1926, no tratamento de eclampsia, tem sido usado e amplamente estudado por obstetras. Longo o ceticismo sobre seus potenciais benefícios permaneceu, mas tarde o aparecimento de estudos bem estruturados forneceram evidências a favor ou contra algum destes. Objetivo: Revisar a literatura sobre a farmacologia, fisiologia, fármaco cinética, mecanismos de ação, principais usos e administração de sulfato de magnésio em obstetrícia. Metodologia: Pesquisa bibliográfica Medline via PubMed utilizando os termos sulfato de magnésio, farmacologia, obstetrícia, pré-eclâmpsia, eclâmpsia, agentes neuroprotectores. Foram adicionados outros itens, a fim de obter maior informação sobre determinados temas. Conclusões: As propriedades farmacológicas que expressa o sulfato de magnésio estão diretamente relacionadas com o efeito antagônico do cálcio. Mostra os efeitos a nível muscular, neuronal, cardiovascular, entre outros. Em obstetrícia o uso abrange principalmente o tratamento da pré-eclampsia, a prevenção da eclampsia, e prevenção de paralisia cerebral no recém-nascido prematuro. Usa-lo como agente toco lítico no trabalho de parto prematuro é incerto porque a evidência é inconclusa.

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