Subject(s)
Autoimmune Diseases of the Nervous System/physiopathology , COVID-19/physiopathology , Encephalitis/physiopathology , Seizures/physiopathology , Adolescent , Anticonvulsants/therapeutic use , Autoimmune Diseases of the Nervous System/diagnosis , Autoimmune Diseases of the Nervous System/drug therapy , Autoimmune Diseases of the Nervous System/etiology , Brain/diagnostic imaging , COVID-19/complications , COVID-19/etiology , Claustrum/diagnostic imaging , Electroencephalography , Encephalitis/diagnosis , Encephalitis/drug therapy , Encephalitis/etiology , Female , Fibrin Fibrinogen Degradation Products/metabolism , Glucocorticoids/therapeutic use , Humans , Leukocytosis/cerebrospinal fluid , Magnetic Resonance Imaging , Methylprednisolone/therapeutic use , Pruritus/etiology , Pruritus/physiopathology , Reflex, Abnormal , SARS-CoV-2 , Seizures/drug therapy , Seizures/etiology , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Limited literature exists on Cerebrospinal fluid (CSF) findings in COVID-19 patients with neurological symptoms. In this review, we conducted a descriptive analysis of CSF findings in patients with COVID-19 to understand prognosis and explore therapeutic options. METHODS: We searched PubMed, Google Scholar, and Scopus databases using the keywords "SARS-CoV-2 in cerebrospinal fluid" and "SARS-CoV-2 and CNS Complications"" for reports of CSF findings in COVID-19 related neurological manifestations. Descriptive analyses were conducted to observe the CSF protein and cell counts based on age, gender, severity, fatality of COVID-19, and whether central (CNS) or peripheral nervous system (PNS) was associated. RESULTS: A total of 113 patients were identified from 67 studies. Of these, 7 patients (6.2%) were fatal COVID-19 cases and 35 patients (31%) were considered severe COVID-19 cases. CSF protein was elevated in 100% (7/7) of the fatal cases with an average of 61.28 mg/dl and in 65.0% (52/80) in non-fatal cases with an average 56.73 mg/dl. CSF protein levels were elevated in 74.5% (38/51) patients with non-severe COVID-19 and 68.6% (24/35) in those with a severe COVID-19 infection. CSF cell count was increased in 43% of fatal cases, 25.7% severe cases, and 29.4% of non-severe cases. CONCLUSION: Our analysis showed that the most common CSF findings situation in COVID-19 infection is elevated protein with, very occasionally, mild lymphocyte predominant pleocytosis. Further studies to elucidate the pathophysiology of neurological complications in COVID-19 are recommended.
Subject(s)
COVID-19/cerebrospinal fluid , Leukocytosis/cerebrospinal fluid , Nervous System Diseases/cerebrospinal fluid , SARS-CoV-2/physiology , COVID-19/complications , COVID-19/virology , Humans , Leukocytosis/etiology , Nervous System Diseases/etiologyABSTRACT
In December 2019, a new coronavirus infection was identified in China. Although the clinical presentation of COVID-19 is predominantly respiratory, more than 35%% of patients have neurological symptoms. We report an elderly female with asthenia, dry cough, anosmia, ageusia, fever, nausea, and a severe and persistent headache. She had confirmed COVID-19 using the nasal swab RT-PCR technique. Her cranial tomography was normal. The CSF analysis demonstrated a cell count of 21 cells/mm3 (80% lymphocytes and 20% monocytes), 34 mg/dl protein, and 79 mg/dl glucose. She improved after 4 days. Our report draws attention to the meningeal involvement of SARS-Cov-2.
Subject(s)
Coronavirus Infections/cerebrospinal fluid , Coronavirus Infections/complications , Headache/etiology , Leukocytosis/cerebrospinal fluid , Pneumonia, Viral/cerebrospinal fluid , Pneumonia, Viral/complications , Aged , Betacoronavirus , COVID-19 , Female , Humans , Meningitis, Viral/virology , Pandemics , SARS-CoV-2ABSTRACT
BACKGROUND: Evidence of immune-mediated neurological syndromes associated with the severe acute respiratory syndrome coronavirus (SARS-CoV-2) infection is limited. We therefore investigated clinical, serological and CSF features of coronavirus disease 2019 (COVID-19) patients with neurological manifestations. METHODS: Consecutive COVID-19 patients with neurological manifestations other than isolated anosmia and/or non-severe headache, and with no previous neurological or psychiatric disorders were prospectively included. Neurological examination was performed in all patients and lumbar puncture with CSF examination was performed when not contraindicated. Serum anti-gangliosides antibodies were tested when clinically indicated. RESULTS: Of the 349 COVID-19 admitted to our center between March 23rd and April 24th 2020, 15 patients (4.3%) had neurological manifestations and fulfilled the study inclusion/exclusion criteria. CSF examination was available in 13 patients and showed lymphocytic pleocytosis in 2 patients: 1 with anti-contactin-associated protein 2 (anti-Caspr2) antibody encephalitis and 1 with meningo-polyradiculitis. Increased serum titer of anti-GD1b antibodies was found in three patients and was associated with variable clinical presentations, including cranial neuropathy with meningo-polyradiculitis, brainstem encephalitis and delirium. CSF PCR for SARS-CoV-2 was negative in all patients. CONCLUSIONS: In SARS-Cov-2 infected patients with neurological manifestations, CSF pleocytosis is associated with para- or post-infectious encephalitis and polyradiculitis. Anti-GD1b and anti-Caspr2 autoantibodies can be identified in certain cases, raising the question of SARS-CoV-2-induced secondary autoimmunity.