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Cerebrospinal fluid findings and hypernatremia in COVID-19 patients with altered mental status

Authors
  • Toklu, Hale1
  • Ganti, Latha1
  • Crimi, Ettore1
  • Cintron, Cristobal1
  • Hagan, Joshua1
  • Serrano, Enrique1
  • 1 North Florida Regional Medical Center, GME Bldg., Suite 122E, 1147 NW 64th Terrace, Gainesville, FL, 32605, USA , Gainesville (United States)
Type
Published Article
Journal
International Journal of Emergency Medicine
Publisher
Springer Berlin Heidelberg
Publication Date
Dec 09, 2020
Volume
13
Issue
1
Identifiers
DOI: 10.1186/s12245-020-00327-4
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundThe objective of the study was to assess the cerebrospinal fluid (CSF) findings in COVID-19 patients.AimsThis was an observational retrospective cohort from electronic medical records of hospitalized patients (n = 2655) with confirmed COVID-19 between February 15, 2020, and April 15, 2020, in 182 hospitals from a large health system in the USA. The review of data yielded to a total of 79 patients in 20 hospitals who had CSF analysis.MethodsOutcomes during hospitalization, including hospital length of stay, disease severity, ventilator time, and in-hospital death were recorded. Independent variables collected included patient demographics, diagnoses, laboratory values, and procedures.ResultsA total of 79 patients underwent CSF analysis. Of these, antigen testing was performed in 73 patients. Ten patients had CSF analysis for general markers such as total protein, cell count, glucose, clarity, and color. Seven of the 10 cases (70%) had normal total cell count and normal white blood cell count in CSF. Sixty-three percent (5/8) had elevated total protein. Two patients had normal levels of lactate dehydrogenase (LDH) and 1 patient had significantly elevated (fourfold) neuron-specific enolase (NSE) level in CSF.ConclusionUnlike bacterial infections, viral infections are less likely to cause remarkable changes in CSF glucose, cell count, or protein. Our observations showed no pleocytosis, but mild increase in protein in the CSF of the COVID-19 patients. The fourfold elevation of NSE may have diagnostic/prognostic value as a biomarker in CSF for COVID-19 patients who have altered mental status.Graphical abstract

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