Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke
Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke
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DOI：
10.1136/jnnp-2020-323522
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发表时间：
2020-08-01
影响因子：
11
通讯作者：
Gooch, M. Reid
中科院分区：
文献类型：
--
作者：
Al Saiegh, Fadi;Ghosh, Ritam;Gooch, M. Reid
2019年12月新型冠状病毒（严重急性呼吸系统综合征(SARS)-CoV-2）的出现导致了COVID-19大流行。COVID-19对中枢神经系统的影响程度尚不清楚，脑脊液中是否存在SARS-CoV-2颗粒是一个有争议的话题。病例描述我们报告了两例COVID-19患者并伴有神经系统症状。我们的第一位患者是一名31岁的男性，他因COVID-19出现流感样症状，后来出现急性发作的严重头痛和意识丧失，并被诊断为亨特和赫斯三级蛛网膜下腔出血，原因是动脉瘤破裂。我们的第二位患者是一名62岁的女性，她患有缺血性中风并大出血转换，需要进行降压性半脑切除术。尽管同时患有神经系统疾病，但两例患者的脑脊液在实时PCR分析中反复阴性。我们的报告显示，即使患者在鼻拭子上检测出COVID-19呈阳性，其脑脊液也可能没有病毒颗粒。SARS-CoV-2是否存在于脑脊液中可能取决于全系统疾病的严重程度和病毒向神经组织的趋向性程度，应在未来的研究中进一步研究。
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.