2020
DOI: 10.1111/ene.14536
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COVID‐19 meningitis without pulmonary involvement with positive cerebrospinal fluid PCR

Abstract: We discuss the case of a 49‐year‐old woman with a past history of hypertension who we diagnosed with COVID‐19 meningitis following two positive CSF RT‐PCR results. In contrast to what was originally believed, the SARS‐CoV‐2 can cause meningitis in isolation, perhaps by crossing the blood‐brain barrier. Hence, it seems essential that physicians maintain a high index of suspicion for neurological involvement among COVID‐19 patients, with early CSF analysis and brain imaging sometimes being indicated.

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Cited by 36 publications
(52 citation statements)
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“…The CSF SARS-CoV-2 PCR resulted positive for 16/303 (5%) patients, all of whom had symptoms that localized to the CNS (16/238 (7%) patients with symptoms that localized to the CNS): 8/16 (50%) who had encephalopathy/coma +/- seizures, 4/16 (25%) who had headache +/- encephalopathy, 1/16 (6%) who had cerebellar symptoms, 1/16 (6%) who had paresthesias, 1/16 (6%) who had seizures without encephalopathy and 1/16 (6%) who had vision loss ( Table 2 ) [ [26] , [27] , [28] , [29] , 150 , 164 , 180 , 195 , 199 , 224 , 225 , 227 , 236 , 238 , 241 ]. The cycle threshold (Ct; the number of amplification cycles required for the target gene to exceed the threshold, which is inversely related to viral load) was only provided for 2/16 (13%) patients with a positive CSF SARS-CoV-2 PCR (37.12, 37.52 and 36.44 for the N1 gene, but negative for N2 for the patient reported by Moriguchi et al and 34.29 for the patient reported by Virhammar et al), though Fadakar et al noted that a Ct of 35 was the cutoff for a positive SARS-CoV-2 PCR [ [26] , [27] , [28] , [29] , 150 , 164 , 180 , 184 , 195 , 199 , 224 , 225 , 227 , 236 , 238 , 241 ]. There were 6/16 (38%) patients who did not have a positive nasopharyngeal/oropharyngeal SARS-CoV-2 PCR, 1 of whom had positive SARS-CoV-2 serum antibodies [ 26 , 27 , 153 , 184 , 241 , 250 ].…”
Section: Resultsmentioning
confidence: 99%
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“…The CSF SARS-CoV-2 PCR resulted positive for 16/303 (5%) patients, all of whom had symptoms that localized to the CNS (16/238 (7%) patients with symptoms that localized to the CNS): 8/16 (50%) who had encephalopathy/coma +/- seizures, 4/16 (25%) who had headache +/- encephalopathy, 1/16 (6%) who had cerebellar symptoms, 1/16 (6%) who had paresthesias, 1/16 (6%) who had seizures without encephalopathy and 1/16 (6%) who had vision loss ( Table 2 ) [ [26] , [27] , [28] , [29] , 150 , 164 , 180 , 195 , 199 , 224 , 225 , 227 , 236 , 238 , 241 ]. The cycle threshold (Ct; the number of amplification cycles required for the target gene to exceed the threshold, which is inversely related to viral load) was only provided for 2/16 (13%) patients with a positive CSF SARS-CoV-2 PCR (37.12, 37.52 and 36.44 for the N1 gene, but negative for N2 for the patient reported by Moriguchi et al and 34.29 for the patient reported by Virhammar et al), though Fadakar et al noted that a Ct of 35 was the cutoff for a positive SARS-CoV-2 PCR [ [26] , [27] , [28] , [29] , 150 , 164 , 180 , 184 , 195 , 199 , 224 , 225 , 227 , 236 , 238 , 241 ]. There were 6/16 (38%) patients who did not have a positive nasopharyngeal/oropharyngeal SARS-CoV-2 PCR, 1 of whom had positive SARS-CoV-2 serum antibodies [ 26 , 27 , 153 , 184 , 241 , 250 ].…”
Section: Resultsmentioning
confidence: 99%
“…Although the CSF RBC count was only reported for 61/430 (14%) patients [ 22 , 28 , 29 , 31 , 35 , 39 , 40 , 44 , 73 , 74 , 77 , 78 , 81 , 89 , 92 , 102 , 110 , 118 , [120] , [121] , [122] , [123] , 128 , 133 , 134 , [138] , [139] , [140] , 156 , 165 , 166 , [172] , [173] , [174] , [175] , [176] , 180 , 184 , 188 , 191 , 192 , 198 , 202 , 204 , 208 , 215 , 220 , 225 , 227 , 233 , 241 , 242 , 246 ], the CSF white blood cell (WBC) count was provided for 409/430 (95%) patients, 270 (66%) of whom had >0 cells/μL, >1 WBC:1,000 RBC or were noted to have “pleocytosis” ( Fig. 3 ) [ [5] , [6] , [7] , [8] , 10 , 13 , [15] , [16] , [17] , [18] ...…”
Section: Resultsmentioning
confidence: 99%
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