Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke. Issue 8 (30th April 2020)

• Record Type: Journal Article
• Authors: Al Saiegh, Fadi; Ghosh, Ritam; Leibold, Adam; Avery, Michael B; Schmidt, Richard F; Theofanis, Thana; Mouchtouris, Nikolaos; Philipp, Lucas; Peiper, Stephen C; Wang, Zi-Xuan; Rincon, Fred; Tjoumakaris, Stavropoula I; Jabbour, Pascal; Rosenwasser, Robert H; Gooch, M. Reid
• Is Part Of: Journal of neurology, neurosurgery and psychiatry. Volume 91:Issue 8(2020)
• Page Start: 846
• Page End: 848
• Publication Date: 2020-04-30
• Subjects: stroke -- subarachnoid haemorrhage -- infectious diseases -- cerebrovascular disease -- CSF; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Psychiatry -- Periodicals; 616.8
• DOI: 10.1136/jnnp-2020-323522
• Languages: English
• ISSNs: 0022-3050

Abstract

Abstract : Background: Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the COVID-19 pandemic. The extent of COVID-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate. Case description: We present two patients with COVID-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients' CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease. Conclusion: Our report shows that patients' CSF may be devoid of viral particles even when they test positive for COVID-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus' nervous tissue tropism and should be examined in future studies.