Abstract:Highlights
SARS-CoV-2 meningoencephalitis should be considered in patients presenting with neurologic symptoms during this pandemic.
Patients with high suspicion for SARS-CoV-2 neurologic involvement should receive brain imaging and lumbar puncture.
A verified assay for detecting SARS-CoV-2 virus RNA in cerebrospinal fluid needs development for acute care center use.
“…CSF pleocytosis may be indicative of infection, inflammation or other CNS injury [ 247 ]. There were 29/409 patients (7%) who had a CSF WBC count of 21–100 cells/μL, all of whom had symptoms that localized to the CNS; 10 (34%) of these patients had CSF RBC counts provided, all of whom had a CSF RBC count of <300 cells/μL; Naz et al described a patient with headache and indicated that CSF was consistent with viral meningitis, but the CSF WBC count was unclear, as it was noted that he had 90 lymphocytes and 10 neutrophils (no units provided so we were unsure if these were percentages or numbers of cells), so we classified these findings as “increased WBC.” [ 10 , [27] , [28] , [29] , 44 , 75 , 79 , [127] , [128] , [129] , 140 , 145 , 154 , 160 , 161 , 170 , 173 , 183 , 184 , 187 , 198 , 205 , 208 , 216 ] Fig. 3 Cerebrospinal fluid white blood cell count results.…”
Section: Resultsmentioning
confidence: 99%
“…Similarly, Demirci Otluoglu et al noted CSF protein was 0.4 mg/L (0.04 mg/dL) and Dharsandiya et al indicated the CSF protein was 39 g/dL (3,900 mg/dL), but both authors described the protein as normal, and Matos et al reported a CSF protein of 0.78 mg/dL, but noted it was mildly elevated; we presumed these were meant to be 0.4g/L (40 mg/dL), 39 mg/dL, and 78 mg/dL, respectively [ 150 , 151 , 200 ]. There were 27/397 (7%) patients who had CSF protein >200 mg/dL (19/27 (70%) with symptoms that localized to the CNS and 8/27 (30%) with symptoms that localized to the PNS) [ 16 , 21 , 31 , 32 , 34 , 44 , 53 , 58 , 78 , 81 , 89 , 104 , 113 , 127 , 128 , 160 , 170 , 173 , 176 , 184 , 199 , [220] , [221] , [222] , 245 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…There were 29/409 patients (7%) who had a CSF WBC count of 21-100 cells/μL, all of whom had symptoms that localized to the CNS; 10 (34%) of these patients had CSF RBC counts provided, all of whom had a CSF RBC count of <300 cells/μL; Naz et al described a patient with headache and indicated that CSF was consistent with viral meningitis, but the CSF WBC count was unclear, as it was noted that he had 90 lymphocytes and 10 neutrophils (no units provided so we were unsure if these were percentages or numbers of cells), so we classified these findings as "increased WBC." [10,[27][28][29]44,75,79,[127][128][129]140,145,154,160,161,170,173,183,184,187,198,205,208,216] The CSF WBC count was >100 cells/μL for 8/409 patients (2%). Although Abdel-Mannan et al noted that two patients with encephalopathy had a CSF WBC count of 8,000 cells/μL and 2,000 cells/μL in a table, they indicated in the text that CSF was acellular; we attempted to reach the authors for clarification, but were unsuccessful, so we classified these two patients as having "normal WBC") [31,75,127,130,171,199,222,241,245].…”
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.
“…CSF pleocytosis may be indicative of infection, inflammation or other CNS injury [ 247 ]. There were 29/409 patients (7%) who had a CSF WBC count of 21–100 cells/μL, all of whom had symptoms that localized to the CNS; 10 (34%) of these patients had CSF RBC counts provided, all of whom had a CSF RBC count of <300 cells/μL; Naz et al described a patient with headache and indicated that CSF was consistent with viral meningitis, but the CSF WBC count was unclear, as it was noted that he had 90 lymphocytes and 10 neutrophils (no units provided so we were unsure if these were percentages or numbers of cells), so we classified these findings as “increased WBC.” [ 10 , [27] , [28] , [29] , 44 , 75 , 79 , [127] , [128] , [129] , 140 , 145 , 154 , 160 , 161 , 170 , 173 , 183 , 184 , 187 , 198 , 205 , 208 , 216 ] Fig. 3 Cerebrospinal fluid white blood cell count results.…”
Section: Resultsmentioning
confidence: 99%
“…Similarly, Demirci Otluoglu et al noted CSF protein was 0.4 mg/L (0.04 mg/dL) and Dharsandiya et al indicated the CSF protein was 39 g/dL (3,900 mg/dL), but both authors described the protein as normal, and Matos et al reported a CSF protein of 0.78 mg/dL, but noted it was mildly elevated; we presumed these were meant to be 0.4g/L (40 mg/dL), 39 mg/dL, and 78 mg/dL, respectively [ 150 , 151 , 200 ]. There were 27/397 (7%) patients who had CSF protein >200 mg/dL (19/27 (70%) with symptoms that localized to the CNS and 8/27 (30%) with symptoms that localized to the PNS) [ 16 , 21 , 31 , 32 , 34 , 44 , 53 , 58 , 78 , 81 , 89 , 104 , 113 , 127 , 128 , 160 , 170 , 173 , 176 , 184 , 199 , [220] , [221] , [222] , 245 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…There were 29/409 patients (7%) who had a CSF WBC count of 21-100 cells/μL, all of whom had symptoms that localized to the CNS; 10 (34%) of these patients had CSF RBC counts provided, all of whom had a CSF RBC count of <300 cells/μL; Naz et al described a patient with headache and indicated that CSF was consistent with viral meningitis, but the CSF WBC count was unclear, as it was noted that he had 90 lymphocytes and 10 neutrophils (no units provided so we were unsure if these were percentages or numbers of cells), so we classified these findings as "increased WBC." [10,[27][28][29]44,75,79,[127][128][129]140,145,154,160,161,170,173,183,184,187,198,205,208,216] The CSF WBC count was >100 cells/μL for 8/409 patients (2%). Although Abdel-Mannan et al noted that two patients with encephalopathy had a CSF WBC count of 8,000 cells/μL and 2,000 cells/μL in a table, they indicated in the text that CSF was acellular; we attempted to reach the authors for clarification, but were unsuccessful, so we classified these two patients as having "normal WBC") [31,75,127,130,171,199,222,241,245].…”
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.
“…The CSF protein was reported for 64/69 (93%) patients [1][2][3][4][5][6][8][9][10][11][12][13][14][15][16][17][18][27][28][29][30][31][32][33][34][35][37][38][39][40][41][42][44][45][46][47][48][49][50][51][52][53][54][55][57][58][59][61][62][63][64][65] and ranged from 15-541 mg/dL. There were 27 patients (39%) with CSF protein >60 mg/dL…”
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