Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany.
Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
J Neurol. 2024 Jan;271(1):59-70. doi: 10.1007/s00415-023-12092-4. Epub 2023 Nov 24.
Information on cerebrospinal fluid (CSF) findings in patients with neurological manifestations in post-COVID-19 syndrome is scarce.
Retrospective evaluation of 84 CSF samples in patients fulfilling post-COVID-19 criteria in two neurological post-COVID-19 outpatient clinics.
In 68% of samples, all CSF parameters were normal. The most frequent pathological CSF finding was elevation of total protein (median total protein 33.3 mg/dl [total range 18.5-116.2]) in 20 of 83 (24%) samples. The second most prevalent pathological finding was a blood-CSF barrier dysfunction as measured by elevation of QAlb (median QAlb 4.65 [2.4-13.2]) in 11/84 (13%). Pleocytosis was found in only 5/84 (6%) samples and was mild in all of them. CSF-restricted oligoclonal bands were found in 5/83 (6%) samples. Anti-neuronal autoantibodies in CSF were negative in most cases, whilst 12/68 (18%) samples were positive for anti-myelin autoantibodies in serum. PCR for herpesviridae (HSV-1/-2, VZV, EBV, CMV, HHV6) showed, if at all, only weakly positive results in CSF or EDTA whole blood/plasma.
The majority of samples did not show any pathologies. The most frequent findings were elevation of total protein and blood-CSF barrier dysfunction with no signs of intrathecal inflammation. CSF analysis still keeps its value for exclusion of differential diagnoses.
关于新冠后综合征患者出现神经表现时的脑脊液（CSF）结果信息较为匮乏。
对两家新冠后神经门诊符合新冠后标准的 84 例 CSF 样本进行回顾性评估。
68%的样本所有 CSF 参数均正常。最常见的异常 CSF 发现是总蛋白升高（20/83 例[24%]样本的中位数总蛋白为 33.3mg/dl[总范围 18.5-116.2]）。其次常见的异常发现是血脑屏障功能障碍，白蛋白升高（11/84 例[13%]样本的中位数 QAlb 为 4.65[2.4-13.2]）。仅 5/84（6%）样本发现细胞增多，且均为轻度。83 例样本中有 5 例（6%）发现 CSF 寡克隆带受限。CSF 中抗神经元自身抗体在大多数情况下为阴性，而 12/68（18%）例血清中抗髓鞘自身抗体阳性。疱疹病毒（HSV-1/-2、VZV、EBV、CMV、HHV6）的 PCR 检测结果在 CSF 或 EDTA 全血/血浆中仅呈弱阳性，若有阳性结果。
大多数样本未显示任何病理学异常。最常见的发现是总蛋白升高和血脑屏障功能障碍，无鞘内炎症迹象。CSF 分析仍然具有排除鉴别诊断的价值。
