Article Text

Download PDFPDF

Short report
Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke
  1. Fadi Al Saiegh1,
  2. Ritam Ghosh1,
  3. Adam Leibold1,
  4. Michael B Avery1,
  5. Richard F Schmidt1,
  6. Thana Theofanis1,
  7. Nikolaos Mouchtouris1,
  8. Lucas Philipp1,
  9. Stephen C Peiper2,
  10. Zi-Xuan Wang3,
  11. Fred Rincon1,
  12. Stavropoula I Tjoumakaris1,
  13. Pascal Jabbour1,
  14. Robert H Rosenwasser1,
  15. M. Reid Gooch1
  1. 1 Department of Neurological Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
  2. 2 Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  3. 3 Surgery & Pathology, Molecular & Genomic Pathology Laboratory, Thomas Jefferson University, Philadelphia, Pennsylvania, United States
  1. Correspondence to Dr M. Reid Gooch, Department of Neurological Surgery, Thomas Jefferson University, Philadelphia PA 19107, Pennsylvania, USA; reid.gooch{at}


Background Emergence of the novel corona virus (severe acute respiratory syndrome (SARS)-CoV-2) in December 2019 has led to the COVID-19 pandemic. The extent of COVID-19 involvement in the central nervous system is not well established, and the presence or the absence of SARS-CoV-2 particles in the cerebrospinal fluid (CSF) is a topic of debate.

Case description We present two patients with COVID-19 and concurrent neurological symptoms. Our first patient is a 31-year-old man who had flu-like symptoms due to COVID-19 and later developed an acute-onset severe headache and loss of consciousness and was diagnosed with a Hunt and Hess grade 3 subarachnoid haemorrhage from a ruptured aneurysm. Our second patient is a 62-year-old woman who had an ischaemic stroke with massive haemorrhagic conversion requiring a decompressive hemicraniectomy. Both patients’ CSF was repeatedly negative on real-time PCR analysis despite concurrent neurological disease.

Conclusion Our report shows that patients’ CSF may be devoid of viral particles even when they test positive for COVID-19 on a nasal swab. Whether SARS-CoV-2 is present in CSF may depend on the systemic disease severity and the degree of the virus’ nervous tissue tropism and should be examined in future studies.

  • stroke
  • subarachnoid haemorrhage
  • infectious diseases
  • cerebrovascular disease
  • CSF

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.
View Full Text

Statistics from


  • Contributors FAS and RG: conceptualisation and methodology; SP, ZW, NM, RG, AL, MBA, RFS, TT, NM, LP, FR, SIT, PJ and RHR: data curation and formal analysis; RG: study supervision; FAS and LP: visualisation; FAS: original draft preparation;All authors: writing, review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.