Cerebrospinal fluid findings in patients with neurological manifestations in post-COVID-19 syndrome

Fabian Boesl; Yasemin Goereci; Ameli Gerhard; Benno Bremer; Vanessa Raeder; Finja Schweitzer; Uta Hoppmann; Janina Behrens; Judith Bellmann-Strobl; Friedemann Paul; Brigitte Wildemann; Sven Jarius; Harald Prüss; Heinrich J Audebert; Clemens Warnke; Christiana Franke

doi:10.1007/s00415-023-12092-4

Cerebrospinal fluid findings in patients with neurological manifestations in post-COVID-19 syndrome

J Neurol. 2024 Jan;271(1):59-70. doi: 10.1007/s00415-023-12092-4. Epub 2023 Nov 24.

Authors

Fabian Boesl¹, Yasemin Goereci², Ameli Gerhard³, Benno Bremer³, Vanessa Raeder³, Finja Schweitzer², Uta Hoppmann^{4

5

6}, Janina Behrens^{4

5

6}, Judith Bellmann-Strobl^{4

5

6}, Friedemann Paul^{4

5

6}, Brigitte Wildemann⁷, Sven Jarius⁷, Harald Prüss^{3

8}, Heinrich J Audebert³, Clemens Warnke², Christiana Franke³

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany. fabian.boesl@charite.de.
² Department of Neurology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
³ Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Department of Neurology and Experimental Neurology, Berlin, Germany.
⁴ Experimental and Clinical Research Center, A Cooperation Between the Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.
⁵ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Experimental and Clinical Research Center, Berlin, Germany.
⁶ Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
⁷ Molecular Neuroimmunology Group, Department of Neurology, University of Heidelberg, Heidelberg, Germany.
⁸ German Center for Neurodegenerative Diseases (DZNE), Berlin, Germany.

Abstract

Background: Information on cerebrospinal fluid (CSF) findings in patients with neurological manifestations in post-COVID-19 syndrome is scarce.

Methods: Retrospective evaluation of 84 CSF samples in patients fulfilling post-COVID-19 criteria in two neurological post-COVID-19 outpatient clinics.

Results: 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.

Conclusions: 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.

Keywords: Blood–CSF barrier dysfunction; Cerebrospinal fluid; Long-COVID; Neurology; Post-COVID; Post-acute sequelae of SARS-CoV-2 infection.

MeSH terms

Autoantibodies
Blood-Brain Barrier
COVID-19* / complications
Cerebrospinal Fluid
Humans
Post-Acute COVID-19 Syndrome*
Retrospective Studies

Substances

Autoantibodies

Abstract

MeSH terms

Substances

Grants and funding