SARA TERRIM

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Instituto Central, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina

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Autor e Coautores FMUSP-HC Normalizados: BRUNO DIOGENES IEPSEN ×

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  • article 41 Citação(ões) na Scopus
    Neurological consultations and diagnoses in a large, dedicated COVID-19 university hospital
    (2020) STUDART-NETO, Adalberto; GUEDES, Bruno Fukelmann; TUMA, Raphael de Luca e; CAMELO FILHO, Antonio Edvan; KUBOTA, Gabriel Taricani; IEPSEN, Bruno Diogenes; MOREIRA, Gabriela Pantaleao; RODRIGUES, Julia Chartouni; FERRARI, Maira Medeiros Honorato; CARRA, Rafael Bernhart; SPERA, Raphael Ribeiro; OKU, Mariana Hiromi Manoel; TERRIM, Sara; LOPES, Cesar Castello Branco; PASSOS NETO, Carlos Eduardo Borges; FIORENTINO, Matheus Dalben; SOUZA, Julia Carvalhinho Carlos De; BAIMA, Jose Pedro Soares; SILVA, Tomas Fraga Ferreira Da; MORENO, Cristiane Araujo Martins; SILVA, Andre Macedo Serafim; HEISE, Carlos Otto; MENDONCA, Rodrigo Holanda; FORTINI, Ida; SMID, Jerusa; ADONI, Tarso; GONCALVES, Marcia Rubia Rodrigues; PEREIRA, Samira Luisa Apostolos; PINTO, Lecio Figueira; GOMES, Helio Rodrigues; ZANOTELI, Edmar; BRUCKI, Sonia Maria Dozzi; CONFORTO, Adriana Bastos; CASTRO, Luiz Henrique Martins; NITRINI, Ricardo
    Background: More than one-third of COVID-19 patients present neurological symptoms ranging from anosmia to stroke and encephalopathy. Furthermore, pre-existing neurological conditions may require special treatment and may be associated with worse outcomes. Notwithstanding, the role of neurologists in COVID-19 is probably underrecognized. Objective: The aim of this study was to report the reasons for requesting neurological consultations by internists and intensivists in a COVID-19-dedicated hospital. Methods: This retrospective study was carried out at Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Brazil, a 900-bed COVID-19 dedicated center (including 300 intensive care unit beds). COVID-19 diagnosis was confirmed by SARS-CoV-2-RT-PCR in nasal swabs. All inpatient neurology consultations between March 23rd and May 23rd, 2020 were analyzed. Neurologists performed the neurological exam, assessed all available data to diagnose the neurological condition, and requested additional tests deemed necessary. Difficult diagnoses were established in consensus meetings. After diagnosis, neurologists were involved in the treatment. Results: Neurological consultations were requested for 89 out of 1,208 (7.4%) inpatient COVID admissions during that period. Main neurological diagnoses included: encephalopathy (44.4%), stroke (16.7%), previous neurological diseases (9.0%), seizures (9.0%), neuromuscular disorders (5.6%), other acute brain lesions (3.4%), and other mild nonspecific symptoms (11.2%). Conclusions: Most neurological consultations in a COVID-19-dedicated hospital were requested for severe conditions that could have an impact on the outcome. First-line doctors should be able to recognize neurological symptoms; neurologists are important members of the medical team in COVID-19 hospital care.
  • article 14 Citação(ões) na Scopus
    Clinical, cerebrospinal fluid, and neuroimaging findings in COVID-19 encephalopathy: a case series
    (2021) TUMA, Raphael L.; GUEDES, Bruno F.; CARRA, Rafael; IEPSEN, Bruno; RODRIGUES, Julia; CAMELO-FILHO, Antonio Edvan; KUBOTA, Gabriel; FERRARI, Maira; STUDART-NETO, Adalberto; OKU, Mariana Hiromi; TERRIM, Sara; LOPES, Cesar C. B.; PASSOS NETO, Carlos E. B.; FIORENTINO, Matheus D.; SOUZA, Julia C. C.; BAIMA, Jose Pedro S.; SILVA, Tomas; PERISSINOTTI, Iago; MARTIN, Maria da Graca M.; GONCALVES, Marcia; FORTINI, Ida; SMID, Jerusa; ADONI, Tarso; LUCATO, Leandro; NITRINI, Ricardo; GOMES, Helio; CASTRO, Luiz H.
    Objective To describe the clinical, neurological, neuroimaging, and cerebrospinal fluid (CSF) findings associated with encephalopathy in patients admitted to a COVID-19 tertiary reference center. Methods We retrospectively reviewed records of consecutive patients with COVID-19 evaluated by a consulting neurology team from March 30, 2020 through May 15, 2020. Results Fifty-five patients with confirmed SARS-CoV-2 were included, 43 of whom showed encephalopathy, and were further divided into mild, moderate, and severe encephalopathy groups. Nineteen patients (44%) had undergone mechanical ventilation and received intravenous sedatives. Eleven (26%) patients were on dialysis. Laboratory markers of COVID-19 severity were very common in encephalopathy patients, but did not correlate with the severity of encephalopathy. Thirty-nine patients underwent neuroimaging studies, which showed mostly non-specific changes. One patient showed lesions possibly related to CNS demyelination. Four had suffered an acute stroke. SARS-CoV-2 was detected by RT-PCR in only one of 21 CSF samples. Two CSF samples showed elevated white blood cell count and all were negative for oligoclonal bands. In our case series, the severity of encephalopathy correlated with higher probability of death during hospitalization (OR = 5.5 for each increment in the degree of encephalopathy, from absent (0) to mild (1), moderate (2), or severe (3), p < 0.001). Conclusion In our consecutive series with 43 encephalopathy cases, neuroimaging and CSF analysis did not support the role of direct viral CNS invasion or CNS inflammation as the cause of encephalopathy.