BMC Neurology (Jun 2020)

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

  • 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,
  • Sean MacKay,
  • Nathan D. Grubaugh,
  • Serena Spudich,
  • Lydia Aoun Barakat

DOI
https://doi.org/10.1186/s12883-020-01812-2
Journal volume & issue
Vol. 20, no. 1
pp. 1 – 5

Abstract

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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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