Cerebrospinal fluid findings in neurological diseases associated with COVID-19 and insights into mechanisms of disease development.
Cerebrospinal fluid findings in neurological diseases associated with COVID-19 and insights into mechanisms of disease development.
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神经系统疾病中与COVID-19的神经系统疾病的脑脊液发现以及对疾病发育机制的见解。
DOI：
10.1016/j.ijid.2020.10.044
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发表时间：
2021-01
期刊：
影响因子：
--
通讯作者：
Silva MTT
中科院分区：
文献类型：
--
作者：
Espíndola OM;Brandão CO;Gomes YCP;Siqueira M;Soares CN;Lima MASD;Leite ACCB;Torezani G;Araujo AQC;Silva MTT
[目的]分析SARS-CoV-2感染患者脑脊液及神经系统表现，为了解中枢神经系统参与新冠肺炎发病机制提供依据。58例患者按主要神经表现分为：头痛14例，脑病24例，炎性神经系统疾病，包括脑膜脑炎4例，急性脊髓炎3例，脑膜炎2例，急性播散性脑脊髓炎2例，脑炎2例，视神经脊髓炎1例，格林-巴利综合征6例。结合脑脊液细胞计数、总蛋白和血糖水平、总牛磺酸和神经细丝轻链(NFL)蛋白浓度、寡克隆条带模式和SARS-CoV-2RNA检测来评估有关年龄、性别、脑血管疾病和颅内压的数据。炎症性神经系统疾病患者的脑脊液以细胞增多、总蛋白和神经营养因子水平升高为特征。脑病患者多为老年男性，平均年龄(61.0±17.6)岁。58例患者中有2例脑脊液中检出SARS-CoV-2RNA：1例为顽固性头痛，另1例在出现新冠肺炎症状4天后出现急性呼吸窘迫综合征。3名患者出现鞘内免疫球蛋白合成，4名患者在脑脊液和血清中有相同的寡克隆条带，表明全身炎症。有神经系统表现的新冠肺炎患者，即使在相同的临床条件下，也有不同的脑脊液图谱。我们的发现表明，病毒复制可能在触发免疫细胞对中枢神经系统的渗透以及随后的促进神经元损伤的炎症中起作用。
To analyze the cerebrospinal fluid (CSF) of patients with SARS-CoV-2 infection and neurological manifestations to provide evidence for the understanding of mechanisms associated with central nervous system (CNS) involvement in COVID-19. Patients (n = 58) were grouped according to their main neurological presentation: headache (n = 14); encephalopathy (n = 24); inflammatory neurological diseases, including meningoencephalitis (n = 4), acute myelitis (n = 3), meningitis (n = 2), acute disseminated encephalomyelitis (ADEM) (n = 2), encephalitis (n = 2), and neuromyelitis optica (n = 1); and Guillain-Barré syndrome (n = 6). Data regarding age, sex, cerebrovascular disease, and intracranial pressure were evaluated in combination with CSF profiles defined by cell counts, total protein and glucose levels, concentration of total Tau and neurofilament light chain (NfL) proteins, oligoclonal band patterns, and detection of SARS-CoV-2 RNA. CSF of patients with inflammatory neurological diseases was characterized by pleocytosis and elevated total protein and NfL levels. Patients with encephalopathy were mostly older men (mean age of 61.0 ± 17.6 years) with evidence of cerebrovascular disease. SARS-CoV-2 RNA in CSF was detected in 2 of 58 cases: a patient with refractory headache, and another patient who developed ADEM four days after onset of COVID-19 symptoms. Three patients presented intrathecal IgG synthesis, and four had identical oligoclonal bands in CSF and serum, indicating systemic inflammation. Patients with neurological manifestations associated with COVID-19 had diverse CSF profiles, even within the same clinical condition. Our findings indicate a possible contribution of viral replication on triggering CNS infiltration by immune cells and the subsequent inflammation promoting neuronal injury.
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影响因子：
4.8
作者：
Bookstaver PB;Mohorn PL;Shah A;Tesh LD;Quidley AM;Kothari R;Bland CM;Weissman S
通讯作者：
Weissman S
影响因子：
5
作者：
Desforges M;Le Coupanec A;Stodola JK;Meessen-Pinard M;Talbot PJ
通讯作者：
Talbot PJ
影响因子：
2.7
作者：
Jacob, Anu;Weinshenker, Brian G.
通讯作者：
Weinshenker, Brian G.
影响因子：
5.4
作者：
Arbour, N;Day, R;Talbot, PJ
通讯作者：
Talbot, PJ
影响因子：
15.1
作者：
Dogan, Lerzan;Kaya, Dilaver;Afsar, Nazire
通讯作者：
Afsar, Nazire