Cerebrospinal fluid analysis in patients with COVID-19-associated central nervous system manifestations: a systematic review.

BACKGROUND: Central nervous system (CNS) symptoms may occur in patients with acute COVID-19. The role of CSF examination in these patients remains to be established. OBJECTIVE: A systematic review of CSF findings relating to COVID-19 was carried out. METHODS: CSF parameters, including cytological and biochemical analyses, SARS-CoV-2 RT-PCR and other CSF markers, were recorded and analyzed among patients with acute COVID-19 and one of the following CNS syndromes: stroke, encephalopathy, encephalitis, inflammatory syndromes, seizure, headache and meningitis. RESULTS: Increased white blood cells and/or increased protein concentration were found in 52.7% of the patients with encephalitis, 29.4% of the patients with encephalopathy and 46.7% of the patients with inflammatory syndromes (P < 0.05). CSF RT-PCR for SARS-CoV-2 was positive in 17.35% of the patients with encephalitis and less than 3.5% of the patients with encephalopathy or inflammatory syndromes (P < 0.05). Intrathecal production of immunoglobulins was found in only 8% of the cases. More than 85% of the patients had increased CSF cytokines and chemokines. Increased CSF neurofilament light chain (NfL) and CSF Tau were found in 71% and 36% of the cases, respectively. CONCLUSION: Non-specific inflammatory CSF abnormalities were frequently found in patients with COVID-19 CNS syndromes. The increase in neurodegeneration biomarkers suggests that neuronal damage occurs, with long-term consequences that are still unknown.

Telemedicine use among neurologists before and during COVID-19 pandemic.

BACKGROUND: After the public health emergency due to COVID-19 was declared in Brazil, the federal government temporarily regulated and authorized the use of telemedicine services for patient consultation, monitoring, and diagnosis. For more than a decade, neurologists have recognized the benefits of telemedicine in the acute management of stroke patients. However, as the use of telemedicine was restricted until the COVID-19 pandemic, the view of Brazilian neurologists about telemedicine is unknown. METHODS: All neurologists registered at the Brazilian Academy of Neurology were invited by e-mail to participate in a survey about personal perceptions on telemedicine use. RESULTS: One hundred sixty-two neurologists from all regions of Brazil answered the online questionnaire. The survey showed that 18.5% of participants worked with telemedicine before the pandemic, while 63.6% reported working with telemedicine during the pandemic. The main telemedicine modalities used during the pandemic were teleorientation and teleconsultation. DISCUSSION: According to our data, the COVID-19 pandemic deeply influenced the behavior of Brazilian neurologists, who developed a more favorable view about telemedicine and actively searched for information about telemedicine. As there is a need for more training in this area in Brazil, universities and medical societies must strive to improve telemedicine education. Expanding the use of high-quality teleneurology can contribute to a better care for patients with neurological diseases in Brazil.

Telemedicine in neurology: current evidence.

BACKGROUND: Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. OBJECTIVE: This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. METHODS: A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. RESULTS: Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. CONCLUSION: Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases.

Telemedicine in neurology: current evidence

ABSTRACT Background: Telemedicine was first introduced in Neurology as a tool to facilitate access to acute stroke treatment. More recently, evidence has emerged of the use of telemedicine in several other areas of Neurology. With the advent of the COVID-19 pandemic and the need for social isolation, Brazilian authorities have expanded the regulation of the use of telemedicine, thus allowing the treatment of many patients with neurological diseases to be conducted with less risk of SARS-CoV-2 contamination. Objective: This study aimed to critically review the current evidence of the use, efficacy, safety, and usefulness of telemedicine in Neurology. Methods: A review of PubMed indexed articles was carried out by searching for the terms "telemedicine AND": "headache", "multiple sclerosis", "vestibular disorders", "cerebrovascular diseases", "epilepsy", "neuromuscular diseases", "dementia", and "movement disorders". The more relevant studies in each of these areas were critically analyzed. Results: Several articles were found and analyzed in each of these areas of Neurology. The main described contributions of telemedicine in the diagnosis and treatment of such neurological conditions were presented, indicating a great potential of use of this type of assistance in all these fields. Conclusion: Current evidence supports that teleneurology can be a tool to increase care for patients suffering from neurological diseases. RESUMO Introdução: A telemedicina surge pela primeira vez na neurologia como uma ferramenta para facilitar o acesso ao tratamento do acidente vascular cerebral (AVC) Agudo. Mais recentemente, inúmeras evidências têm surgido acerca da eficácia e da segurança do uso da telemedicina em várias outras áreas da neurologia. Com o advento da pandemia de COVID-19 e a necessidade de isolamento social, as autoridades brasileiras flexibilizaram a regulamentação da telemedicina, permitindo assim que inúmeros pacientes com doenças neurológicas possam ter acesso ao tratamento, com menor risco de exposição à contaminação pelo SARS-CoV-2. Objetivo: O objetivo deste artigo foi avaliar criticamente as evidências correntes acerca da segurança e eficácia do uso da telemedicina em diversas áreas da neurologia. Métodos: Este artigo foi uma revisão de artigos indexados no PubMed, buscando os termos telemedicina, cefaleias, esclerose múltipla, doenças vestibulares, doenças cerebrovasculares, epilepsia, doenças neuromusculares, demência e desordens do movimento. Os artigos mais relevantes em cada uma das áreas foram criticamente analisados. Resultados: Diversos artigos foram identificados e analisados em todas as áreas anteriormente citadas. Os principais achados quanto às contribuições da telemedicina, para o diagnóstico e tratamento das condições, foram apresentados, indicando potenciais benefícios da telemedicina em todas as áreas buscadas. Conclusão: As evidências atuais indicam que a teleneurologia é uma potencial ferramenta para ampliar o acesso ao cuidado em inúmeras áreas da neurologia.

First case of SARS-COV-2 sequencing in cerebrospinal fluid of a patient with suspected demyelinating disease.

The association between coronaviruses and central nervous system (CNS) demyelinating lesions has been previously shown. However, no case has been described of an association between the novel coronavirus (SARS-COV-2) and CNS demyelinating disease so far. SARS-COV-2 was previously detected in cerebrospinal fluid (CSF) sample of a patient with encephalitis. However, the virus identity was not confirmed by deep sequencing of SARS-COV-2 detected in the CSF. Here, we report a case of a patient with mild respiratory symptoms and neurological manifestations compatible with clinically isolated syndrome. The viral genome of SARS-COV-2 was detected and sequenced in CSF with 99.74-100% similarity between the patient virus and worldwide sequences. This report suggests a possible association of SARS-COV-2 infection with neurological symptoms of demyelinating disease, even in the absence of relevant upper respiratory tract infection signs.