COVID-19 Presenting With Confusion: An Unusual but Suggestive Electroencephalography Pattern of Encephalitis

Affes, Zied; Bouvard, E.; Lévy, P.; Dussaule, Claire; Grateau, Gilles; Haymann, Jean‐Philippe

doi:10.1097/wnp.0000000000000795

Cited by 5 publications

(17 citation statements)

References 16 publications

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“…Although CSF testing of biomarkers is not universally available, we identified 57 patients who had CSF biomarkers measured, 45 (79%) of whom had elevation of at least one CSF biomarker suggesting the presence of inflammation, axonal injury, gliosis and Alzheimer-type pathologic changes [10,24,25,30,31,98,111,119,128,135,136,149,157,165,182,191,205,215,217,227,231,236]. Interestingly, some of these patients had elevation of biomarkers in the CSF, but not the serum, which is similar to ICANS, the neurotoxicity that occurs after treatment with chimeric antigen receptor T-cell therapy [10,217,231].…”

Section: Discussionmentioning

confidence: 99%

“…To evaluate for axonal injury, the CSF was tested for 1) 14-3-3 in 9 patients with encephalopathy, 2) neurofilament light chain in 8 patients with encephalopathy and 3) phosphorylated neurofilament heavy chain in 1 patient with ophthalmoplegia [10,24,25,119,157,217]. There were 4/9 (44%) patients who were positive for 14-3-3 in the CSF, 1 of whom was negative on an initial lumbar puncture then positive when a second CSF sample was obtained [24,25]. All of the patients with 14-3-3 detected in the CSF also had SARS-CoV-2 antibodies in the CSF at a 1:10 dilution and 3/4 had SARS-CoV-2 antibodies detected in the CSF at 1:100 dilution, though they all had a CSF:serum SARS-CoV-2 IgG index <1, and 2/4 had an elevated albumin index [25].…”

Section: Other Csf Biomarkersmentioning

confidence: 99%

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Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

150

152

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We sought to review the literature on cerebrospinal fluid (CSF) testing in patients with COVID-19 for evidence of viral neuroinvasion by SARS-CoV-2. Methods: We performed a systematic review of Medline and Embase between December 1, 2019 and November 18, 2020 to identify case reports or series of patients who had COVID-19 diagnosed based on positive SARS-CoV-2 polymerase chain reaction (PCR) or serologic testing and had CSF testing due to a neurologic symptom. Results: We identified 242 relevant documents which included 430 patients with COVID-19 who had acute neurological symptoms prompting CSF testing. Of those, 321 (75%) patients had symptoms that localized to the central nervous system (CNS). Of 304 patients whose CSF was tested for SARS-CoV-2 PCR, there were 17 (6%) whose test was positive, all of whom had symptoms that localized to the central nervous system (CNS). The majority (13/17, 76%) of these patients were admitted to the hospital because of neurological symptoms. Of 58 patients whose CSF was tested for SARS-CoV-2 antibody, 7 (12%) had positive antibodies with evidence of intrathecal synthesis, all of whom had symptoms that localized to the CNS. Of 132 patients who had oligoclonal bands evaluated, 3 (2%) had evidence of intrathecal antibody synthesis. Of 77 patients tested for autoimmune antibodies in the CSF, 4 (5%) had positive findings. Conclusion: Detection of SARS-CoV-2 in CSF via PCR or evaluation for intrathecal antibody synthesis appears to be rare. Most neurological complications associated with SARS-CoV-2 are unlikely to be related to direct viral neuroinvasion.

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Section: Discussionmentioning

confidence: 99%

Section: Other Csf Biomarkersmentioning

confidence: 99%

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

150

152

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“…After review of the 117 publications, we identified 193 patients who met inclusion criteria 1,2,10–124 . There were 105/189 (56%) male patients 1,2,10–12,14,16,17,19,22,26,27,31,33,35,37–40,46,47,50,51,54,57–60,62,64–71, 75,76,79,81,82,84,85,87,89,91,93,95–97,99,101–105,107–109,113–120,124 . The median age was 56 (range 2–96) years old …”

Section: Resultsmentioning

confidence: 99%

“…There were 105/189 (56%) male patients 1,2,10–12,14,16,17,19,22,26,27,31,33,35,37–40,46,47,50,51,54,57–60,62,64–71, 75,76,79,81,82,84,85,87,89,91,93,95–97,99,101–105,107–109,113–120,124 . The median age was 56 (range 2–96) years old 1,2,10–122,124 . There were 79/167 (47%) patients with severe COVID‐19 …”

Section: Resultsmentioning

confidence: 99%

COVID‐19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta‐analysis of the relationship to CSF SARS‐CoV‐2

Lewis

Jain

Frontera

et al. 2021

Journal of Neuroimaging

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Background and Purpose We reviewed the literature to evaluate cerebrospinal fluid (CSF) results from patients with coronavirus disease 2019 (COVID‐19) who had neurological symptoms and had an MRI that showed (1) central nervous system (CNS) hyperintense lesions not attributed to ischemia and/or (2) leptomeningeal enhancement. We sought to determine if these findings were associated with a positive CSF severe acute respiratory syndrome associated coronavirus 2 (SARS‐CoV‐2) polymerase chain reaction (PCR). Methods We performed a systematic review of Medline and Embase from December 1, 2019 to November 18, 2020. CSF results were evaluated based on the presence/absence of (1) ≥ 1 CNS hyperintense lesion and (2) leptomeningeal enhancement. Results In 117 publications, we identified 193 patients with COVID‐19 who had an MRI of the CNS and CSF testing. There were 125 (65%) patients with CNS hyperintense lesions. Patients with CNS hyperintense lesions were significantly more likely to have a positive CSF SARS‐CoV‐2 PCR (10% [9/87] vs. 0% [0/43], p = 0.029). Of 75 patients who had a contrast MRI, there were 20 (27%) patients who had leptomeningeal enhancement. Patients with leptomeningeal enhancement were significantly more likely to have a positive CSF SARS‐CoV‐2 PCR (25% [4/16] vs. 5% [2/42], p = 0.024). Conclusion The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID‐19 is associated with increased likelihood of a positive CSF SARS‐CoV‐2 PCR. However, a positive CSF SARS‐CoV‐2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.

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“…An early case report describes a 78 year old male patient whose main complaint at admission was acute confusion, behavioral disorders, and cognitive troubles 31 . The physical exam, blood and cerebral spinal fluid (CSF) tests were unremarkable.…”

Section: Case Reportsmentioning

confidence: 99%

Central nervous system outcomes of COVID-19

Doyle

2022

Translational Research

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The worldwide pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has infected an estimated 200 million people with over 4 million deaths. Although COVID-19, the disease caused by the SARS-CoV-2 virus, is primarily a respiratory disease, an increasing number of neurologic symptoms have been reported. Some of these symptoms, such as loss of smell or taste, are mild and non-life threatening, while others, such as stroke or seizure, are more critical. Many of these symptoms remain long after the acute illness has passed, a phenomenon known as “long COVID” or Post-Acute Sequelae of SARS-CoV-2 infection (PASC). Neurological symptoms can be difficult to study due to the complexity of the central and peripheral nervous system. These neurologic symptoms can be difficult to identify and quantitate. This narrative review will describe approaches for assessing neurologic manifestations of COVID-19, with examples of the data they provide, as well as some directions for future research to aid in understanding the pathophysiology of COVID-19 related neurological implications.

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COVID-19 Presenting With Confusion: An Unusual but Suggestive Electroencephalography Pattern of Encephalitis

Cited by 5 publications

References 16 publications

Cerebrospinal fluid in COVID-19: A systematic review of the literature

Cerebrospinal fluid in COVID-19: A systematic review of the literature

COVID‐19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta‐analysis of the relationship to CSF SARS‐CoV‐2

Central nervous system outcomes of COVID-19

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