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Case Reports
. 2020 Jun 18;20(1):248.
doi: 10.1186/s12883-020-01812-2.

Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19

Shelli Farhadian  1   2 , Laura R Glick  3 , Chantal B F Vogels  4 , Jared Thomas  3 , Jennifer Chiarella  5 , Arnau Casanovas-Massana  4 , Jing Zhou  6 , Camila Odio  3 , Pavithra Vijayakumar  3 , Bertie Geng  3 , John Fournier  7 , Santos Bermejo  8 , Joseph R Fauver  4 , Tara Alpert  4 , Anne L Wyllie  4 , Cynthia Turcotte  6 , Matthew Steinle  6 , Patrick Paczkowski  6 , Charles Dela Cruz  8 , Craig Wilen  9 , Albert I Ko  7   4 , Sean MacKay  6 , Nathan D Grubaugh  4 , Serena Spudich  5 , Lydia Aoun Barakat  7
Affiliations
Case Reports

Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19

Shelli Farhadian et al. BMC Neurol. .

Abstract

Background: COVID-19 is caused by the severe acute respiratory syndrome virus SARS-CoV-2. It is widely recognized as a respiratory pathogen, but neurologic complications can be the presenting manifestation in a subset of infected patients.

Case presentation: We describe a 78-year old immunocompromised woman who presented with altered mental status after witnessed seizure-like activity at home. She was found to have SARS-CoV-2 infection and associated neuroinflammation. In this case, we undertake the first detailed analysis of cerebrospinal fluid (CSF) cytokines during COVID-19 infection and find a unique pattern of inflammation in CSF, but no evidence of viral neuroinvasion.

Conclusion: Our findings suggest that neurologic symptoms such as encephalopathy and seizures may be the initial presentation of COVID-19. Central nervous system inflammation may associate with neurologic manifestations of disease.

Keywords: COVID-19; Neuroinflammation; SARS-CoV-2.

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Conflict of interest statement

The authors report no competing interests.

Figures

Fig. 1
Fig. 1
Chest radiographs. Chest X-ray on admission (left) and on hospital day 13 (right), showing worsening bilateral infiltrates
Fig. 2
Fig. 2
MRI brain. MRI without contrast demonstrates generalized atrophy and patchy periventricular and subcortical white matter hyperintensities
Fig. 3
Fig. 3
Cytokine analysis of CSF and plasma. The COVID-19 patient showed a marked increase of a variety of inflammatory cytokine and chemokines in CSF and plasma compare to three control subjects including IL-17A, IL-6, IL-8, IP-10, with a unique MCP-1 signature identified in COVID-19 CSF. All samples were run in duplicate. Mean +/− SD.s
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Update of

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