Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19

Shelli Farhadian, Shelli Farhadian, Laura R. Glick, Chantal B.F. Vogels, Jared Thomas, Jennifer Chiarella, Arnau Casanovas-Massana, Jing Zhou, Camila Odio, Pavithra Vijayakumar, Bertie Geng, John Fournier, Santos Bermejo, Joseph R. Fauver, Tara Alpert, Anne L. Wyllie, Cynthia Turcotte, Matthew Steinle, Patrick Paczkowski, Charles Dela CruzCraig Wilen, Albert I. Ko, Albert I. Ko, Sean MacKay, Nathan D. Grubaugh, Serena Spudich, Lydia Aoun Barakat

Research output: Contribution to journalArticlepeer-review

84 Scopus citations


Background: COVID-19 is caused by the severe acute respiratory syndrome virus SARS-CoV-2. It is widely recognized as a respiratory pathogen, but neurologic complications can be the presenting manifestation in a subset of infected patients. Case presentation: We describe a 78-year old immunocompromised woman who presented with altered mental status after witnessed seizure-like activity at home. She was found to have SARS-CoV-2 infection and associated neuroinflammation. In this case, we undertake the first detailed analysis of cerebrospinal fluid (CSF) cytokines during COVID-19 infection and find a unique pattern of inflammation in CSF, but no evidence of viral neuroinvasion. Conclusion: Our findings suggest that neurologic symptoms such as encephalopathy and seizures may be the initial presentation of COVID-19. Central nervous system inflammation may associate with neurologic manifestations of disease.

Original languageEnglish (US)
Article number248
JournalBMC Neurology
Issue number1
StatePublished - Jun 18 2020
Externally publishedYes


  • COVID-19
  • Neuroinflammation
  • SARS-CoV-2

ASJC Scopus subject areas

  • Clinical Neurology


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