A Comprehensive Systematic Review of CSF analysis that defines Neurological Manifestations of COVID-19. (March 2021)

• Record Type: Journal Article
• Authors: Tandon, Medha; Kataria, Saurabh; Patel, Jenil; Mehta, Tejas R; Daimee, Maha; Patel, Viral; Prasad, Apoorv; Chowdhary, Anisa Anila; Jaiswal, Shruti; Sriwastava, Shitiz
• Is Part Of: International journal of infectious diseases. Volume 104(2021)
• Page Start: 390
• Page End: 397
• Publication Date: 2021-03
• Subjects: nCov NovelCoronavirus -- COVID-19 Coronavirus infectious disease-2019 -- MERS MiddleEast Respiratory Syndrome -- SARS-CoV-2 Severe Acute Respiratory Distress Syndrome coronavirus 2 -- CSF Cerebrospinal fluid -- CNS Central Nervous System -- PNS Peripheral Nervous System -- NFL Neurofilament Light Chain -- RT-PCR Reverse Transcription Polymerase Chain Reaction -- GBS Guillain-Barre Syndrome -- IDSA/ATS Infectious Diseases Society of America/American Thoracic Society; COVID-19 -- SARS-CoV-2 -- Oligoclonal bands -- CSF Protein -- CSF cell count; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.01.002
• Languages: English
• ISSNs: 1201-9712

Abstract

Abstract: Background: Limited literature exists on Cerebrospinal fluid (CSF) findings in COVID-19 patients with neurological symptoms. In this review, we conducted a descriptive analysis of CSF findings in patients with COVID-19 to understand prognosis and explore therapeutic options. Methods: We searched PubMed, Google Scholar, and Scopus databases using the keywords "SARS-CoV-2 in cerebrospinal fluid" and "SARS-CoV-2 and CNS Complications"" for reports of CSF findings in COVID-19 related neurological manifestations. Descriptive analyses were conducted to observe the CSF protein and cell counts based on age, gender, severity, fatality of COVID-19, and whether central (CNS) or peripheral nervous system (PNS) was associated. Results: A total of 113 patients were identified from 67 studies. Of these, 7 patients (6.2%) were fatal COVID-19 cases and 35 patients (31%) were considered severe COVID-19 cases. CSF protein was elevated in 100% (7/7) of the fatal cases with an average of 61.28 mg/dl and in 65.0% (52/80) in non-fatal cases with an average 56.73 mg/dl. CSF protein levels were elevated in 74.5% (38/51) patients with non-severe COVID-19 and 68.6% (24/35) in those with a severe COVID-19 infection. CSF cell count was increased in 43% of fatal cases, 25.7% severe cases, and 29.4% of non-severe cases. Conclusion: Our analysis showed that the most common CSF findings situation in COVID-19 infection is elevated protein with, very occasionally, mild lymphocyte predominant pleocytosis. Further studies to elucidate the pathophysiology of neurological complications in COVID-19 are recommended.