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 Cruz; Craig Wilen; Albert I. Ko; Albert I. Ko; Sean MacKay; Nathan D. Grubaugh; Serena Spudich; Lydia Aoun Barakat

doi:10.1186/s12883-020-01812-2

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

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93 Scopus citations

Abstract

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 language	English (US)
Article number	248
Journal	BMC Neurology
Volume	20
Issue number	1
DOIs	https://doi.org/10.1186/s12883-020-01812-2
State	Published - Jun 18 2020
Externally published	Yes

Keywords

COVID-19
Neuroinflammation
SARS-CoV-2

ASJC Scopus subject areas

Clinical Neurology

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10.1186/s12883-020-01812-2

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Farhadian, S., Farhadian, S., Glick, L. R., Vogels, C. B. F., Thomas, J., Chiarella, J., Casanovas-Massana, A., Zhou, J., Odio, C., Vijayakumar, P., Geng, B., Fournier, J., Bermejo, S., Fauver, J. R., Alpert, T., Wyllie, A. L., Turcotte, C., Steinle, M., Paczkowski, P., ... Barakat, L. A. (2020). Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19. BMC Neurology, 20(1), Article 248. https://doi.org/10.1186/s12883-020-01812-2

Farhadian, S, Farhadian, S, Glick, LR, Vogels, CBF, Thomas, J, Chiarella, J, Casanovas-Massana, A, Zhou, J, Odio, C, Vijayakumar, P, Geng, B, Fournier, J, Bermejo, S, Fauver, JR, Alpert, T, Wyllie, AL, Turcotte, C, Steinle, M, Paczkowski, P, Dela Cruz, C, Wilen, C, Ko, AI, Ko, AI, MacKay, S, Grubaugh, ND, Spudich, S & Barakat, LA 2020, 'Acute encephalopathy with elevated CSF inflammatory markers as the initial presentation of COVID-19', BMC Neurology, vol. 20, no. 1, 248. https://doi.org/10.1186/s12883-020-01812-2

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abstract = "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.",

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AU - Glick, Laura R.

AU - Vogels, Chantal B.F.

AU - Thomas, Jared

AU - Chiarella, Jennifer

AU - Casanovas-Massana, Arnau

AU - Zhou, Jing

AU - Odio, Camila

AU - Vijayakumar, Pavithra

AU - Geng, Bertie

AU - Fournier, John

AU - Bermejo, Santos

AU - Fauver, Joseph R.

AU - Alpert, Tara

AU - Wyllie, Anne L.

AU - Turcotte, Cynthia

AU - Steinle, Matthew

AU - Paczkowski, Patrick

AU - Dela Cruz, Charles

AU - Wilen, Craig

AU - Ko, Albert I.

AU - MacKay, Sean

AU - Grubaugh, Nathan D.

AU - Spudich, Serena

AU - Barakat, Lydia Aoun

PY - 2020/6/18

Y1 - 2020/6/18

N2 - 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.

AB - 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.

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

Abstract

Keywords

ASJC Scopus subject areas

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