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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}jefferson.edu

Abstract

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

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Footnotes

  • 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.

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