Abstract
Background: Neurological manifestations are common in patients with coronavirus disease 2019 (COVID-19), but little is known about pathophysiological mechanisms. In this single-center study, we examined neurological manifestations in 58 patients, including cerebrospinal fluid (CSF) analysis and neuroimaging findings.
Methods: The study included 58 patients with COVID-19 and neurological manifestations in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction screening and on CSF analysis were performed. Clinical, laboratory, and brain magnetic resonance (MR) imaging data were retrospectively collected and analyzed.
Results: 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%). CSF protein and albumin levels 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 immunoglobulin G oligoclonal band was found in 5 patients (11%), suggesting an intrathecal synthesis of immunoglobulin G, and 26 patients (55%) presented identical oligoclonal bands in serum and CSF. Four patients (7%) had a positive CSF SARS-CoV-2 reverse-transcription polymerase chain reaction. Leptomeningeal enhancement was present on brain MR images in 20 patients (38%).
Conclusions: Brain MR imaging 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.
Keywords: COVID-19; cerebrospinal fluid; leptomeningeal enhancement.
【저자키워드】 COVID-19, cerebrospinal fluid, leptomeningeal enhancement., 【초록키워드】 coronavirus disease, SARS-CoV-2, Coronavirus disease 2019, coronavirus, inflammatory markers, severe acute respiratory syndrome Coronavirus, headache, Brain, Laboratory, Severe acute respiratory syndrome, Protein, polymerase chain reaction, SARS-CoV-2 detection, serum, Immunoglobulin G, Immunoglobulin, clinical, Patient, albumin, blood-brain barrier, neurological manifestations, Encephalopathy, Inflammatory marker, cerebrospinal fluid, respiratory, Oligoclonal bands, patients, CSF, Analysis, Seizure, manifestation, Seizures, followed by, Chain Reaction, oligoclonal band, dysfunction, Headaches, acute respiratory syndrome, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, median age, single-center study, positive, albumin levels, pathophysiological mechanisms, neurological manifestation, men, imaging abnormalities, Quotient, CSF analysis, scanty, polymerase chain, analyzed, performed, collected, examined, remained, elevated, albumin level, cerebrospinal, leptomeningeal, patients with COVID-19, 【제목키워드】 Coronavirus disease 2019, imaging, finding, resonance,