Neurological manifestations are common in patients with COVID-19, but little is known about pathophysiological mechanisms. In this single-centre study, the authors described neurological manifestations of 58 patients, regarding cerebrospinal fluid (CSF) analysis and neuroimaging findings.
58 COVID-19 patients with available data on neurological manifestations and SARS-CoV-2 RT-PCR screening on CSF analysis were included. Clinical, laboratory, and brain MRI data were retrospectively collected and analysed. The patients were mostly men (66%) with a median age of 62 years. Encephalopathy was frequent (81%), followed by pyramidal dysfunction (16%), seizures (10%), and headaches (5%). Protein and albumin levels in CSF were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient suggesting impaired blood-brain barrier integrity. CSF-specific IgG oligoclonal bands were found in five (11%) cases, suggesting intrathecal synthesis of IgG, and 26 (55%) patients presented with identical oligoclonal bands in serum and CSF. Four (7%) patients harboured positive SARS-CoV-2 RT-PCR in CSF. Regarding brain MRI, 20 (38%) patients presented with leptomeningeal enhancement. The authors concluded that brain MRI abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV 2 detection in CSF remained scanty.
DOI: https://doi.org/10.1093/infdis/jiaa745