Encephalopathy as the Presenting Symptom of COVID-19

Hayat, Umar; Ahmed, Salmaan; Hussain, Mohammed Ali; Hameed, Nasir

doi:10.17161/kjm.vol13.14766

Cited by 2 publications

(13 citation statements)

References 14 publications

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“…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%

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

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

153

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: Resultsmentioning

confidence: 99%

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

Lewis

Frontera

Placantonakis

et al. 2021

Journal of the Neurological Sciences

153

152

View full text Add to dashboard Cite

show abstract

“…After review of the 117 publications, we identified 193 patients who met inclusion criteria 1,2,10–124 . There were 105/189 (56%) male patients 1,2,10–12,14,16,17,19,22,26,27,31,33,35,37–40,46,47,50,51,54,57–60,62,64–71, 75,76,79,81,82,84,85,87,89,91,93,95–97,99,101–105,107–109,113–120,124 . The median age was 56 (range 2–96) years old …”

Section: Resultsmentioning

confidence: 99%

“…There were 105/189 (56%) male patients 1,2,10–12,14,16,17,19,22,26,27,31,33,35,37–40,46,47,50,51,54,57–60,62,64–71, 75,76,79,81,82,84,85,87,89,91,93,95–97,99,101–105,107–109,113–120,124 . The median age was 56 (range 2–96) years old 1,2,10–122,124 . There were 79/167 (47%) patients with severe COVID‐19 …”

Section: Resultsmentioning

confidence: 99%

“…The primary neurological symptoms that precipitated MRI and CSF acquisition are shown in Figure 3; for the majority of patients (144, 75%), this workup was performed due to coma/encephalopathy with or without seizure/abnormal movement/headache 1,2,11,12, 14–16,22,23,26,33,36,39–42,44–48,50,51,53–57,61,63–73,75–84,87,88,90–92,94–105,108, 109,111–119,121–123 …”

Section: Resultsmentioning

confidence: 99%

“…CSF WBC +/– red blood cell (RBC) count was reported for 186 (96%) patients; 61 (33%) had a CSF WBC count >5 cells/μl, a CSF WBC:RBC ratio >1:1000 or a CSF WBC count that was described as “increased.” 1,2,10–28, 30–35,37–82,84,86,87,89–124 CSF protein was reported for 184 (95%) patients; 68 (37%) had a CSF protein >60 mg/dl or a CSF protein that was described as “increased.”…”

Section: Resultsmentioning

confidence: 99%

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COVID‐19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta‐analysis of the relationship to CSF SARS‐CoV‐2

Lewis

Jain

Frontera

et al. 2021

Journal of Neuroimaging

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Background and Purpose We reviewed the literature to evaluate cerebrospinal fluid (CSF) results from patients with coronavirus disease 2019 (COVID‐19) who had neurological symptoms and had an MRI that showed (1) central nervous system (CNS) hyperintense lesions not attributed to ischemia and/or (2) leptomeningeal enhancement. We sought to determine if these findings were associated with a positive CSF severe acute respiratory syndrome associated coronavirus 2 (SARS‐CoV‐2) polymerase chain reaction (PCR). Methods We performed a systematic review of Medline and Embase from December 1, 2019 to November 18, 2020. CSF results were evaluated based on the presence/absence of (1) ≥ 1 CNS hyperintense lesion and (2) leptomeningeal enhancement. Results In 117 publications, we identified 193 patients with COVID‐19 who had an MRI of the CNS and CSF testing. There were 125 (65%) patients with CNS hyperintense lesions. Patients with CNS hyperintense lesions were significantly more likely to have a positive CSF SARS‐CoV‐2 PCR (10% [9/87] vs. 0% [0/43], p = 0.029). Of 75 patients who had a contrast MRI, there were 20 (27%) patients who had leptomeningeal enhancement. Patients with leptomeningeal enhancement were significantly more likely to have a positive CSF SARS‐CoV‐2 PCR (25% [4/16] vs. 5% [2/42], p = 0.024). Conclusion The presence of CNS hyperintense lesions or leptomeningeal enhancement on neuroimaging from patients with COVID‐19 is associated with increased likelihood of a positive CSF SARS‐CoV‐2 PCR. However, a positive CSF SARS‐CoV‐2 PCR is uncommon in patients with these neuroimaging findings, suggesting they are often related to other etiologies, such as inflammation, hypoxia, or ischemia.

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Encephalopathy as the Presenting Symptom of COVID-19

Cited by 2 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

COVID‐19 associated brain/spinal cord lesions and leptomeningeal enhancement: A meta‐analysis of the relationship to CSF SARS‐CoV‐2

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