Status of SARS-CoV-2 in cerebrospinal fluid of patients with COVID-19 and stroke.

Al Saiegh, Fadi; Ghosh, Ritam; Leibold, Adam; Avery, Michael B; Schmidt, Richard F; Theofanis, Thana; Mouchtouris, Nikolaos; Philipp, Lucas; Peiper, Stephen C; Wang, Zi-Xuan; Rincon, Fred; Tjoumakaris, Stavropoula I; Jabbour, Pascal; Rosenwasser, Robert H; Gooch, M Reid

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.