Salman Maryam A, Mallah Saad I, Khalid Wasay, Ryan Moran Laura, Abousedu Yousef A I, Jassim Ghufran A
School of Medicine, Royal College of Surgeons in Ireland, Busaiteen, Kingdom of Bahrain.
School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland.
Int J Gen Med. 2021 Dec 29;14:10385-10395. doi: 10.2147/IJGM.S333966. eCollection 2021.
The coronavirus disease 2019 (COVID-19) has been shown to affect several systems, notably the respiratory system. However, there has been considerable evidence implicating the nervous system in COVID-19 infection. This study aims to investigate the clinical characteristics of patients whose cerebrospinal fluid (CSF) tested positive for SARS-CoV-2.
A comprehensive search of PubMed, EMBASE, Scopus, WHO Coronavirus database, bioRxiv, medRxiv, and Web of Science databases was carried out in August 2020. Original studies involving patients who tested positive for SARS-COV-2 in their CSF were included. Key search terms encompassed all variations of "COVID-19" AND "Cerebrospinal Fluid".
A total of 525 studies were identified. Fifty-six full-text articles were assessed, of which 14 were included. In total, 14 patients tested positive for SARS-CoV-2 in their CSF. 21.4% (3/14) of patients had negative nasopharyngeal (NP) swabs despite a positive CSF sample. About 14.2% (2/14) of patients who initially had positive NP swabs developed neurological deterioration after a supposed recovery as indicated by their negative NP swabs, but their CSF still tested positive for SARS-CoV-2. Common symptoms were headache (42.8%; 6/14), fever (35.6%; 5/14), vomiting (28.6%; 4/14), cough (28.6; 4/14), visual disturbances (28.6%; 4/14), diarrhea (21.4%; 3/14), and seizures (21.4%; 3/14). Four patients (28.6%) were admitted to ICU, one (7.14%) was admitted to a rehabilitation facility, and two (14.3%) died.
Physicians should be familiar with the presenting neurological features of COVID-19, and be aware that they can occur despite a negative NP swab. The results of this study are intended to aid in the development of informed guidelines to diagnose and treat COVID-19 patients with neurological manifestations.
2019年冠状病毒病（COVID-19）已被证明会影响多个系统，尤其是呼吸系统。然而，有大量证据表明神经系统也参与了COVID-19感染。本研究旨在调查脑脊液（CSF）中SARS-CoV-2检测呈阳性的患者的临床特征。
2020年8月对PubMed、EMBASE、Scopus、世界卫生组织冠状病毒数据库、bioRxiv、medRxiv和科学引文索引数据库进行了全面检索。纳入了涉及脑脊液中SARS-CoV-2检测呈阳性患者的原始研究。关键检索词包括“COVID-19”和“脑脊液”的所有变体。
共识别出525项研究。评估了56篇全文文章，其中14篇被纳入。共有14例患者的脑脊液中SARS-CoV-2检测呈阳性。尽管脑脊液样本呈阳性，但21.4%（3/14）的患者鼻咽拭子检测为阴性。约14.2%（2/14）最初鼻咽拭子检测呈阳性的患者在看似康复后出现神经功能恶化，其鼻咽拭子检测为阴性，但脑脊液中SARS-CoV-2检测仍呈阳性。常见症状包括头痛（42.8%；6/14）、发热（35.6%；5/14）、呕吐（28.6%；4/14）、咳嗽（28.6%；4/14）、视觉障碍（28.6%；4/14）、腹泻（21.4%；3/14）和癫痫发作（21.4%；3/14）。4例患者（28.6%）入住重症监护病房，1例（7.14%）入住康复机构，2例（14.3%）死亡。
医生应熟悉COVID-19的神经系统表现特征，并意识到即使鼻咽拭子检测为阴性也可能出现这些表现。本研究结果旨在帮助制定明智的指南，以诊断和治疗有神经症状的COVID-19患者。
