Hospital Practices and Research

Cerebrospinal Fluid Analysis in Patients with COVID-Induced Encephalopathy

Document Type : Original Article

Authors

Hossein Pakdel 1
Masoud Etemadifar 2
Maryam Gholami 3
Amirreza Hasanzadeh 3

1 Department of Neurology, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Neurosurgery, Isfahan University of Medical Sciences, Isfahan, Iran

3 Isfahan University of Medical Sciences, Isfahan, Iran

https://doi.org/10.30491/hpr.2025.495955.1463
Abstract
Background: The novel coronavirus has been found to have neurological manifestations, and cerebrospinal fluid (CSF) analysis could be helpful in the differential diagnosis of critically ill patients with neurological symptoms and act as a prognostic factor in these patients.
Objectives: In this study, we assessed the CSF of patients with COVID-19 who presented with encephalopathy to elucidate any common characteristics.
Methods: This cross-sectional study included 36 patients with positive COVID-19 PCR who presented with encephalopathy and were hospitalized. We evaluated RT-PCR, total cell counts, LDH, protein, and glucose levels of CSF samples. Clinical manifestations, neurological complaints, and outcomes (death or survival) were extracted from patients' files.
Results: A total of 36 patients underwent lumbar puncture and CSF analysis. RT-PCR for SARS-CoV-2 RNA was negative in all thirty-six cases. Fever was present in 29 (80.6%) patients, shortness of breath in 23 (63.9%), and cough in 14 (38.9%) as primary clinical manifestations. Seizures were reported in 12 (33.3%) patients as a neurological presentation. The mortality rate was 7 (19.4%) in our cases. Abnormalities in WBC count were found in 6 (16.6%) of CSF samples. The remaining patients had normal CSF results, indicating no specific pattern of CSF markers.
Conclusion: Our study did not reveal any usual patterns in CSF analysis. Moreover, we were unable to detect SARS-CoV-2 RNA in CSF samples definitively. These findings suggest that the indirect mechanisms of SARS-CoV-2 may play a significant role in the neurological manifestations associated with COVID-19.

Keywords

COVID-19
Encephalopathy
Cerebrospinal Fluid
Encephalitis
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