Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms

doi:10.1016/j.jns.2020.117090

Observational Study

. 2020 Nov 15:418:117090.

doi: 10.1016/j.jns.2020.117090. Epub 2020 Aug 11.

Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms

Affiliations

¹ Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany. Electronic address: bernhard.neumann@medbo.de.
² Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany. Electronic address: moritz.schmidbauer@med.uni-muenchen.de.
³ Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany. Electronic address: konstantin.dimitriadis@med.uni-muenchen.de.
⁴ Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany. Electronic address: Soeren.otto@med.uni-muenchen.de.
⁵ Department of Neurology, Klinikum rechts der Isar, Technical University of Munich Germany, Germany. Electronic address: benjamin.knier@tum.de.
⁶ Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: wolf-dirk.niesen@uniklinik-freiburg.de.
⁷ Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: jonas.hosp@uniklinik-freiburg.de.
⁸ Hans-Berger-Department of Neurology, Jena University Hospital, Jena, Germany. Electronic address: Albecht.guenther@med.uni-jena.de.
⁹ Department of Neurology, SRH Wald-Klinikum Gera GmbH, Gera, Germany. Electronic address: Sarah.Lindemann@srh.de.
¹⁰ Department of Neurology, Klinikum Kassel, Kassel, Germany. Electronic address: gabor.nagy@klinikum-kassel.de.
¹¹ Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany. Electronic address: tim.steinberg@medbo.de.
¹² Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany. Electronic address: ralf.linker@medbo.de.
¹³ Department of Neurology, Klinikum rechts der Isar, Technical University of Munich Germany, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany. Electronic address: hemmer@tum.de.
¹⁴ Department of Neurology, Klinikum Kassel, Kassel, Germany. Electronic address: Julian.Boesel@klinikum-kassel.de.

PMID: 32805440
PMCID: PMC7417278
DOI: 10.1016/j.jns.2020.117090

Observational Study

Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms

Bernhard Neumann et al. J Neurol Sci. 2020.

. 2020 Nov 15:418:117090.

doi: 10.1016/j.jns.2020.117090. Epub 2020 Aug 11.

Authors

Affiliations

¹ Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany. Electronic address: bernhard.neumann@medbo.de.
² Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany. Electronic address: moritz.schmidbauer@med.uni-muenchen.de.
³ Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany; Institute for Stroke and Dementia Research (ISD), Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany. Electronic address: konstantin.dimitriadis@med.uni-muenchen.de.
⁴ Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität (LMU), Munich, Germany. Electronic address: Soeren.otto@med.uni-muenchen.de.
⁵ Department of Neurology, Klinikum rechts der Isar, Technical University of Munich Germany, Germany. Electronic address: benjamin.knier@tum.de.
⁶ Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: wolf-dirk.niesen@uniklinik-freiburg.de.
⁷ Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany. Electronic address: jonas.hosp@uniklinik-freiburg.de.
⁸ Hans-Berger-Department of Neurology, Jena University Hospital, Jena, Germany. Electronic address: Albecht.guenther@med.uni-jena.de.
⁹ Department of Neurology, SRH Wald-Klinikum Gera GmbH, Gera, Germany. Electronic address: Sarah.Lindemann@srh.de.
¹⁰ Department of Neurology, Klinikum Kassel, Kassel, Germany. Electronic address: gabor.nagy@klinikum-kassel.de.
¹¹ Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany. Electronic address: tim.steinberg@medbo.de.
¹² Department of Neurology, University of Regensburg, Bezirksklinikum, Regensburg, Germany. Electronic address: ralf.linker@medbo.de.
¹³ Department of Neurology, Klinikum rechts der Isar, Technical University of Munich Germany, Germany; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany. Electronic address: hemmer@tum.de.
¹⁴ Department of Neurology, Klinikum Kassel, Kassel, Germany. Electronic address: Julian.Boesel@klinikum-kassel.de.

PMID: 32805440
PMCID: PMC7417278
DOI: 10.1016/j.jns.2020.117090

Abstract

•
Largest cohort of patients with COVID-19 and neurological symptoms who underwent LP.
•
In all 30 cases, RT-PCR for SARS-CoV-2 from CSF was negative.
•
CSF analysis findings, including WBC, were normal in most patients with COVID-19.
•
Neurological symptoms in COVID-19 seem to be caused mainly by indirect mechanism.

Keywords: COVID-19; Cerebrospinal fluid; Neurological symptoms; SARS-CoV-2.

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Conflict of interest statement

None.

Figures

**Fig. 1**
Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms. CSF cell count (n = 30) (A), CSF protein levels (n = 23) (B), CSF lactate levels (n = 16) (C) and albumin ratio (n = 25) of patients with COVID-19 infection. Empty dots (circle) are pathological results (A-C). In D grey dots symbolize intermediate blood brain barrier disruption and empty dots (circle) severe blood brain barrier disruption. CSF = cerebrospinal fluid, HSVE = herpes simplex virus encephalitis, ICH = intracranial hemorrhage.

See this image and copyright information in PMC

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References

1. Helms J., Kremer S., Merdji H. Neurologic features in severe SARS-CoV-2 Infection. N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2008597. NEJMc2008597. - DOI - PMC - PubMed
1. Moriguchi T., Harii N., Goto J. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int. J. Infect. Dis. 2020;94:55–58. doi: 10.1016/j.ijid.2020.03.062. - DOI - PMC - PubMed
1. Puelles V.G., Lütgehetmann M., Lindenmeyer M.T. Multiorgan and renal tropism of SARS-CoV-2 [published online ahead of print, 2020 May 13] N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2011400. NEJMc2011400. - DOI - PMC - PubMed
1. Tatu L., Nono S., Grácio S., Koçer S. Guillain-Barré syndrome in the COVID-19 era: another occasional cluster? [published online ahead of print, 2020 Jun 23] J. Neurol. 2020:1–3. doi: 10.1007/s00415-020-10005. - DOI - PMC - PubMed
1. Oxley T.J., Mocco J., Majidi S. Large-vessel stroke as a presenting feature of Covid-19 in the young. N. Engl. J. Med. 2020;382(20):e60. doi: 10.1056/NEJMc2009787. - DOI - PMC - PubMed

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[1] Helms J., Kremer S., Merdji H. Neurologic features in severe SARS-CoV-2 Infection. N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2008597. NEJMc2008597. - DOI - PMC - PubMed

[2] Helms J., Kremer S., Merdji H. Neurologic features in severe SARS-CoV-2 Infection. N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2008597. NEJMc2008597. - DOI - PMC - PubMed

[3] Moriguchi T., Harii N., Goto J. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int. J. Infect. Dis. 2020;94:55–58. doi: 10.1016/j.ijid.2020.03.062. - DOI - PMC - PubMed

[4] Moriguchi T., Harii N., Goto J. A first case of meningitis/encephalitis associated with SARS-Coronavirus-2. Int. J. Infect. Dis. 2020;94:55–58. doi: 10.1016/j.ijid.2020.03.062. - DOI - PMC - PubMed

[5] Puelles V.G., Lütgehetmann M., Lindenmeyer M.T. Multiorgan and renal tropism of SARS-CoV-2 [published online ahead of print, 2020 May 13] N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2011400. NEJMc2011400. - DOI - PMC - PubMed

[6] Puelles V.G., Lütgehetmann M., Lindenmeyer M.T. Multiorgan and renal tropism of SARS-CoV-2 [published online ahead of print, 2020 May 13] N. Engl. J. Med. 2020 doi: 10.1056/NEJMc2011400. NEJMc2011400. - DOI - PMC - PubMed

[7] Tatu L., Nono S., Grácio S., Koçer S. Guillain-Barré syndrome in the COVID-19 era: another occasional cluster? [published online ahead of print, 2020 Jun 23] J. Neurol. 2020:1–3. doi: 10.1007/s00415-020-10005. - DOI - PMC - PubMed

[8] Tatu L., Nono S., Grácio S., Koçer S. Guillain-Barré syndrome in the COVID-19 era: another occasional cluster? [published online ahead of print, 2020 Jun 23] J. Neurol. 2020:1–3. doi: 10.1007/s00415-020-10005. - DOI - PMC - PubMed

[9] Oxley T.J., Mocco J., Majidi S. Large-vessel stroke as a presenting feature of Covid-19 in the young. N. Engl. J. Med. 2020;382(20):e60. doi: 10.1056/NEJMc2009787. - DOI - PMC - PubMed

[10] Oxley T.J., Mocco J., Majidi S. Large-vessel stroke as a presenting feature of Covid-19 in the young. N. Engl. J. Med. 2020;382(20):e60. doi: 10.1056/NEJMc2009787. - DOI - PMC - PubMed

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Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms

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Cerebrospinal fluid findings in COVID-19 patients with neurological symptoms

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