From the Department of Neuroscience (J.V., E.K., S.J.), Neurology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (D.F., J.W., A.G.), Radiology, Uppsala University, Uppsala, Sweden; Department of Surgical Sciences (R.F., H.D.P.D.O.-R.), Anaesthesia and Intensive Care, Uppsala University, Uppsala, Sweden; Department of Neuroscience (M.K.S., H.D.P.D.O.-R., E.R.), Neurosurgery, Uppsala University, Uppsala, Sweden; Department of Internal Medicine (M.K., J.L.), Nyköping Hospital, Nyköping, Sweden; Department of Radiology (J.F.), Nyköping Hospital, Nyköping, Sweden; Department of Neuroscience (J.L.C.), Psychiatry, Uppsala University, Uppsala, Sweden; Department of Medical Sciences (K.B.), Uppsala University, Uppsala, Sweden; Department of Chemistry-BMC (J.B.), Analytical Chemistry and Neurochemistry, Uppsala University, Uppsala, Sweden; Department of Psychiatry and Neurochemistry (H.Z.), Institute of Neuroscience & Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal; and Clinical Neurochemistry Laboratory (H.Z.), Sahlgrenska University Hospital, Mölndal, Sweden.
Neurology. 2020 Sep 8;95(10):445-449. doi: 10.1212/WNL.0000000000010250. Epub 2020 Jun 25.
Here, we report a case of COVID-19-related acute necrotizing encephalopathy where SARS-CoV-2 RNA was found in CSF 19 days after symptom onset after testing negative twice. Although monocytes and protein levels in CSF were only marginally increased, and our patient never experienced a hyperinflammatory state, her neurologic function deteriorated into coma. MRI of the brain showed pathologic signal symmetrically in central thalami, subinsular regions, medial temporal lobes, and brain stem. Extremely high concentrations of the neuronal injury markers neurofilament light and tau, as well as an astrocytic activation marker, glial fibrillary acidic protein, were measured in CSF. Neuronal rescue proteins and other pathways were elevated in the in-depth proteomics analysis. The patient received IV immunoglobulins and plasma exchange. Her neurologic status improved, and she was extubated 4 weeks after symptom onset. This case report highlights the neurotropism of SARS-CoV-2 in selected patients and emphasizes the importance of repeated lumbar punctures and CSF analyses in patients with suspected COVID-19 and neurologic symptoms.
在这里，我们报告了一例 COVID-19 相关的急性坏死性脑病病例，该患者在症状出现后 19 天，经过两次检测均为阴性后，在 CSF 中发现了 SARS-CoV-2 RNA。尽管 CSF 中的单核细胞和蛋白水平仅略有增加，且我们的患者从未经历过过度炎症状态，但她的神经功能仍恶化至昏迷。脑部 MRI 显示双侧丘脑、岛叶、内侧颞叶和脑干存在对称性病理信号。CSF 中神经元损伤标志物神经丝轻链和 tau 以及星形胶质细胞激活标志物胶质纤维酸性蛋白的浓度极高。在深入的蛋白质组学分析中，神经元挽救蛋白和其他通路被上调。该患者接受了 IV 免疫球蛋白和血浆置换治疗。她的神经状态得到改善，并在症状出现后 4 周拔管。本病例报告强调了 SARS-CoV-2 在某些患者中的神经嗜性，并强调了在疑似 COVID-19 和神经系统症状患者中重复进行腰椎穿刺和 CSF 分析的重要性。
