Review
A Comprehensive Systematic Review of CSF analysis that defines Neurological Manifestations of COVID-19

https://doi.org/10.1016/j.ijid.2021.01.002Get rights and content
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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.

Abbreviations

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

Keywords

COVID-19
SARS-CoV-2
Oligoclonal bands
CSF Protein
CSF cell count

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