A Comprehensive Systematic Review of CSF analysis that defines Neurological Manifestations of COVID-19

Tandon, Medha; Kataria, Saurabh; Patel, Jenil; Mehta, Tejas R.; Daimee, Maha; Patel, Viral; Prasad, Apoorv; Chowdhary, Anisa Anila; Jaiswal, Shruti; Sriwastava, Shitiz

BACKGROUND: Limited literature exists on CSF findings in COVID-19 patients with neurological symptoms. In this review, we conducted a descriptive analysis of CSF findings in patients with COVID-19 to understand prognosis and explore therapeutic options. METHODS: We searched PubMed, Google Scholar and Scopus databases using the keywords “SARS-CoV-2 in cerebrospinal fluid”, “SARS-CoV-2 and CNS Complications”" for reports of CSF findings in COVID-19 related neurological manifestations. Descriptive analysis were conducted to observe the CSF protein and cell counts based on age, gender, severity and fatality of COVID-19, and whether central (CNS) or peripheral nervous system (PNS). RESULTS: A total of 113 patients were identified from 67 studies. Of these, 7 patients (6.2 %) were fatal COVID-19 cases and 35 patients (31%) were considered severe COVID-19 cases. CSF protein was elevated in 100% (7/7) of the fatal cases with an average of 61.28 mg/dl, and in 65.0 % (52/80) in non-fatal cases with an average 56.73 mg/dl. CSF protein levels were elevated in 74.5% (38/51) patients with non-severe COVID-19 and 68.6% (24/35) in those with a severe COVID-19 infection. CSF cell count was increased in 43% of fatal cases, 25.7% severe cases and 29.4% of non-severe cases. CONCLUSION: Our analysis showed that the most common CSF picture in COVID-19 infection is elevated protein with very occasionally mild lymphocyte predominant pleiocytosis. Further studies to elucidate pathophysiology of neurological complications in COVID-19 are recommended.