European Journal of Neurology | December 28, 2020

Virhammar J, Nääs A, Fällmar D, Cunningham JL, Klang A, Ashton NJ, Jackmann S, Westman G, Frithiof R, Blennow K, Zetterberg H, Kumlien E and Rostami E

European journal of neurology. 2021

DOI: https://doi.org/10.1111/ene.14703

ABSTRACT:

Coronavirus disease 2019 (COVID‐19), is a pandemic caused by the novel severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2). A significant number of case reports and case series have described different types of neurological complications in COVID‐19 [1–3]. The neurological manifestations are broad and may be caused by a direct effect of the virus on the nervous system or by a parainfectious or postinfectious immune‐mediated inflammation [4]. However, neurological complications may also be secondary to critical illness and a long stay in an intensive care unit (ICU).

Recently, neurochemical evidence of acute central nervous system (CNS) injury in patients with COVID‐19 was shown in the form of increased plasma levels of neurofilament light chain (NfL) protein, a marker of axonal injury, and of glial fibrillary acidic protein (GFAp), a marker of astrocytic injury [5, 6]. In this regard, few studies have investigated the cerebrospinal fluid (CSF) in patients with COVID‐19 [7, 8], which is less sensitive than plasma to confounding release of neuromarkers (e.g., from peripheral nerves).

Lumbar puncture (LP) is an important tool to evaluate critically ill patients with neurological symptoms, as it can reveal both the underlying pathology and the severity of injury to the nervous system. There are few reports on results from CSF analysis in patients with COVID‐19, and prospective studies with comprehensive CSF and neurological investigations are rare. The aim of this study was to describe clinical characteristics in relation to findings in CSF analyses among patients with COVID‐19 and neurological symptoms.