Three-tier stratification for CNS COVID-19 to help decide which patients should undergo lumbar puncture with CSF analysis: a case report and literature review

Ramakrishna, Jahanavi M.; Libertin, Claudia R.; Siegel, Jason; Binnicker, Matthew J.; Harris, Dana M.; Matcha, Gautam; Caulfield, Thomas R.; Freeman, William D.

doi:10.2478/rjim-2020-0031

Cited by 4 publications

(4 citation statements)

References 14 publications

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“…As is evident by the fact that 303/430 (70%) patients we identified had CSF SARS-CoV-2 PCR testing performed, it is feasible to perform PCR testing for SARS-CoV-2 in CSF [5-10,15,17,22,24,26-38,43-59, 68-71,73,74,76-78,81,84,88,89,95,97,98,101,103,105,108,109,111, 113,116 156,157,161,164,165,169,171,177,178,[180][181][182][184][185][186][187]190,191,193,[195][196][197][198][199][200][201][203][204][205][206][207]209,[212][213][214][215][216][218][219][220][221][224][225][226][227]230,[233]…”

Section: Discussionmentioning

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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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%

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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“…The viral genome was found in the CSF in a small percentage of these patients. It is possible that systemic inflammation is a determining factor in these cases; however, this cannot be definitively stated since systemic inflammation was not evaluated in the present study with regard to encephalitis 5,8,[10][11][12][14][15][16][17][18][19][20][21][22][23][24][25][27][28][29] . Other factors, such as hypoxia, metabolic alterations and drugs with effect on the CNS, may also have contributed but were not separately analyzed in the studies included in this review.…”

Section: Discussionmentioning

confidence: 99%

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

Domingues¹,

Brunale²,

Senne³

2022

Arq. Neuro-Psiquiatr.

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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.

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“…To give prompt and effective care to patients with COVID-19 CNS-related infection, guidelines for early imaging and CSF analysis should be developed. Lumbar puncture must be done when the risk of CNS-related COVID-19 is high as indicated by severe signs and symptoms of CNS infections and the presence of CNS hyperintense lesions or leptomeningeal enhancement in imaging [ 67 , 68 ]. Moreover, there is a clear need for SARS-CoV-2 CSF testing to be broadly accessible in hospital settings [ 69 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

Elmakaty

Ferih

Karen

et al. 2022

Cells

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This systematic review focused on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients that had detected SARS-CoV-2 virus in cerebrospinal fluid (CSF). A systematic literature search was carried out in PubMed, Embase, Scopus, Web of Science, Medrxiv, and Biorxiv databases from inception to 19 December 2021. Case reports or case series involving patients with proved SARS-CoV-2 presence in CSF by polymerize chain reaction were included. Our search strategy produced 23 articles documenting a total of 23 patients with positive SARS-CoV-2 in the CSF. Fever (55%) was the most common symptom, followed by headaches (41%), cough (32%), and vomiting/nausea (32%). The majority of the cases included was encephalitis (57%), 8 of which were confirmed by magnetic resonance imaging. The second most prevalent presentation was meningitis. The cerebral spinal fluid analysis found disparities in protein levels and normal glucose levels in most cases. This study demonstrates that SARS-CoV-2 can enter the nervous system via various routes and cause CNS infection symptoms. SARS-CoV-2 has been shown to infect the CNS even when no respiratory symptoms are present and nasopharyngeal swabs are negative. As a result, SARS-CoV-2 should be considered as a possible cause of CNS infection and tested for in the CSF.

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Three-tier stratification for CNS COVID-19 to help decide which patients should undergo lumbar puncture with CSF analysis: a case report and literature review

Cited by 4 publications

References 14 publications

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

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

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

Clinical Implications of COVID-19 Presence in CSF: Systematic Review of Case Reports

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