Cerebrospinal Fluid Features in Patients With Coronavirus Disease 2019 and Neurological Manifestations: Correlation with Brain Magnetic Resonance Imaging Findings in 58 Patients
Cerebrospinal Fluid Features in Patients With Coronavirus Disease 2019 and Neurological Manifestations: Correlation with Brain Magnetic Resonance Imaging Findings in 58 Patients
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DOI：
10.1093/infdis/jiaa745
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发表时间：
2021-01-08
影响因子：
6.4
通讯作者：
Kremer, Stephane
中科院分区：
文献类型：
--
作者：
Lersy, Francois;Benotmane, Ilies;Kremer, Stephane
背景：2019冠状病毒病（COVID-19）患者常见神经系统表现，但对其病理生理机制知之甚少。在这项单中心研究中，我们检查了58例患者的神经学表现，包括脑脊液（CSF）分析和神经影像学结果。方法：对58例伴有神经系统症状的新冠肺炎患者进行严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）逆转录聚合酶链反应筛查和脑脊液分析。回顾性收集和分析临床、实验室和脑磁共振（MR）成像资料。结果：患者以男性居多（66%），中位年龄62岁。脑病发生率最高（81%），其次是锥体功能障碍（16%）、癫痫发作（10%）和头痛（5%）。脑脊液蛋白和白蛋白水平分别升高38%和23%。总共40%的患者显示白蛋白商升高，提示血脑屏障完整性受损。5例（11%）患者发现CSF特异性免疫球蛋白G寡克隆带，提示鞘内免疫球蛋白G合成，26例（55%）患者血清和脑脊液中出现相同的寡克隆带。4例（7%）患者CSF SARS-CoV-2逆转录聚合酶链反应阳性。20例患者（38%）在脑磁共振图像上出现轻脑膜增强。结论：与COVID-19相关的神经系统症状患者的脑MR成像异常，尤其是脑膜轻脑膜增强和脑脊液炎症标志物升高是常见的，而脑脊液中SARS-CoV-2的检测仍然很少。
Background: Neurological manifestations are common in patients with coronavirus disease 2019 (COVID-19), but little is known about pathophysiological mechanisms. In this single-center study, we examined neurological manifestations in 58 patients, including cerebrospinal fluid (CSF) analysis and neuroimaging findings.Methods: The study included 58 patients with COVID-19 and neurological manifestations in whom severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse-transcription polymerase chain reaction screening and on CSF analysis were performed. Clinical, laboratory, and brain magnetic resonance (MR) imaging data were retrospectively collected and analyzed.Results: Patients were mostly men (66%), with a median age of 62 years. Encephalopathy was frequent (81%), followed by pyramidal dysfunction (16%), seizures (10%), and headaches (5%). CSF protein and albumin levels were increased in 38% and 23%, respectively. A total of 40% of patients displayed an elevated albumin quotient, suggesting impaired blood-brain barrier integrity. CSF-specific immunoglobulin G oligoclonal band was found in 5 patients (11%), suggesting an intrathecal synthesis of immunoglobulin G, and 26 patients (55%) presented identical oligoclonal bands in serum and CSF. Four patients (7%) had a positive CSF SARS-CoV-2 reverse-transcription polymerase chain reaction. Leptomeningeal enhancement was present on brain MR images in 20 patients (38%).Conclusions: Brain MR imaging abnormalities, especially leptomeningeal enhancement, and increased inflammatory markers in CSF are frequent in patients with neurological manifestations related to COVID-19, whereas SARS-CoV-2 detection in CSF remained scanty.