by Dr. Juliette Dufour
For March 2022, we have selected: S. Jarius et al, Covid-19 Paper of the month: Cerebrospinal fluid findings in COVID-19: a multicenter study of 150 lumbar punctures in 127 patients. Journal of Neuroinfammation, 2022, https://doi.org/10.1186/s12974-021-02339-0.
A broad spectrum of neurological manifestations, ranging from mild hyposmia and dysgeusia to life-threatening conditions such as acute encephalopathy and stroke, have been described in association with COVID-19.
Cerebrospinal fluid (CSF) analysis is a diagnostic mainstay in neurology. However, limited information on CSF findings in patients with COVID-19 is currently available. Comprehensive data on the CSF profile in patients with COVID-19 and neurological involvement from large-scale multicentre studies are missing so far. The objective of this study was therefore to systematically analyse the CSF profile in COVID-19, on behalf of the German Society for CSF Diagnostics and Clinical Neurochemistry (DGLN).
Our authors of the month conducted a systematic retrospective analysis of 150 lumbar punctures in 127 patients with PCR-proven COVID-19 and neurological symptoms seen at 17 European university centres. Patients were stratified according to the type and severity of the neurological symptoms, acuity, co-/preexisting neurological conditions, and treatment status.
The results of the CSF analysis were the following:
- Routine CSF findings were normal in 35%.
- The most frequent pathological finding was blood-CSF barrier (BCB) dysfunction (measured by QAlb), which was present in 58/116 (50%) samples from patients without pre-/coexisting CNS diseases (group I).
- CSF total protein was elevated in 54/118 (45.8%) samples (median 65.35 mg/dl [45.3–240.4]) and strongly correlated with QAlb.
- The CSF white cell count (WCC) was increased in 14/128 (11%) samples (mostly lympho-monocytic; median 10 cells/µl).
- An albuminocytological dissociation (ACD) was found in 43/115 (37.4%) samples.
- CSF lactate was increased in 26/109 (24%)
- CSF-IgG was elevated in 50/100 (50%), but was of peripheral origin
- In 58/103 samples (56%) pattern four oligoclonal bands (OCB) compatible with systemic inflammation were present, while CSF-restricted OCB were found in only 2/103 (1.9%).
- SARS-CoV-2-CSF-PCR was negative in 76/76 samples.
- Cytokine levels (IL-6) were frequently elevated in the CSF and serum.
In samples from patients with pre-/coexisting CNS disorders (group II [N=19]; including multiple sclerosis, JC-virus-associated immune reconstitution inflammatory syndrome, HSV/VZV encephalitis/meningitis, CNS lymphoma, anti-Yo syndrome, subarachnoid haemorrhage), CSF findings were mostly representative of the respective disease.
Our authors of the month conclude that the CSF profile in COVID-19 with neurological symptoms is mainly characterised by BCB disruption in the absence of intrathecal inflammation, compatible with cerebrospinal endotheliopathy. Direct infection of the CNS with SARS-CoV-2, if occurring at all, seems to be very rare (100% negative PCR in CSF).