Reply to: Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens - Critical Care Science (CCS)
Crit Care Sci. 2023;35(3):340-341
We thank Dr. Finsterer and Dr. Scorza for their interest in and praise for our study entitled “Critical COVID-19 and neurological dysfunction – a direct comparative analysis between SARS-CoV-2 and other infectious pathogens”.()
It is pointed out that our study’s clinical neurological examination was incomplete. It is true that, for the strict sake of the study, the researchers did not perform a detailed neurological examination of the included patients, but instead focused on the assessment of signs of corticospinal tract dysfunction (CSTD), in accordance with the rationale of the study. Our research primary goal was not to fully characterize the neurological status of acute respiratory distress syndrome (ARDS) patients but to identify whether SARS-CoV-2 is more frequently associated with signs of CSTD (and other neurological signs, symptoms, and syndromes) than other pathogens causing severe respiratory failure. As reported by Parsons et al.() and referenced in our paper, corticospinal tract lesions are the most common lesions of the white matter depicted in COVID-19 patients; these lesions were the focus of our study. Accordingly, our sample size was calculated based on the use of deep tendon reflex responses as the main outcome variable. Nonetheless, all patients were submitted to daily full neurological examinations during their stay in the intensive care unit (ICU); these examinations were performed by the attending intensive care physicians in accordance with the standard of clinical practice of the Intensive Care Medicine Department. All relevant data (clinical, laboratory, and complementary diagnostic tests) regarding the presence of neurological signs, symptoms, and syndromes during the ICU stay were included in the electronic clinical records and retrieved by the researchers.
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We thank Dr. Finsterer and Dr. Scorza for their interest in and praise for our study entitled “Critical COVID-19 and neurological dysfunction - a direct comparative analysis between SARS-CoV-2 and other infectious pathogens”.()
It is pointed out that our study’s clinical neurological examination was incomplete. It is true that, for the strict sake of the study, the researchers did not perform a detailed neurological examination of the included patients, but instead focused on the assessment of signs of corticospinal tract dysfunction (CSTD), in accordance with the rationale of the study. Our research primary goal was not to fully characterize the neurological status of acute respiratory distress syndrome (ARDS) patients but to identify whether SARS-CoV-2 is more frequently associated with signs of CSTD (and other neurological signs, symptoms, and syndromes) than other pathogens causing severe respiratory failure. As reported by Parsons et al.() and referenced in our paper, corticospinal tract lesions are the most common lesions of the white matter depicted in COVID-19 patients; these lesions were the focus of our study. Accordingly, our sample size was calculated based on the use of deep tendon reflex responses as the main outcome variable. Nonetheless, all patients were submitted to daily full neurological examinations during their stay in the intensive care unit (ICU); these examinations were performed by the attending intensive care physicians in accordance with the standard of clinical practice of the Intensive Care Medicine Department. All relevant data (clinical, laboratory, and complementary diagnostic tests) regarding the presence of neurological signs, symptoms, and syndromes during the ICU stay were included in the electronic clinical records and retrieved by the researchers.
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